ADHD Pres 41511

Let’s Stay Focused!

What is AD/HD?

A) A vague disorder that is not well documented or reliably diagnosed

B) A problem caused by a permissive society

C) A disorder of the brain with well-documented diagnostic and treatment guidelines

D) A behavioral problem caused by poor parenting

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AD/HD Types

Specified by the DSM-IV-RAmerican Psychiatric Association

Diagnostic and Statistical Manual, 4th Edition

AD/HD Diagnostic Subtypes: Primarily Inattentive Type Primarily Hyperactive/Impulsive Type Combined Type

Characteristics of AD/HD

A chronic disorder Characterized by a pattern of inattention

and/or hyperactivity and/or impulsivity Significantly impaired age-appropriate

functioning in at least two areas of life, such as home, social settings, school or work

Predominately Inattentive Type AD/HD-I

At least six of nine characteristics are required for diagnosis: Often fails to give close attention to details or makes

careless mistakes in schoolwork, the work environment or other activities.

Often has difficulty sustaining attention in tasks or play activities.

Often does not seem to listen when spoken to directly. Often does not follow through on instructions and fails to

finish schoolwork or other tasks. Often has difficulty organizing tasks and activities.

(cont’d.)

Predominately Inattentive Type AD/HD- I

At least six of nine characteristics are required for diagnosis: Often avoids, dislikes or is reluctant to engage in tasks

requiring sustained mental effort (school or homework). Often loses things necessary for tasks or activities (toys,

assignments, tools). Often easily distracted by extraneous stimuli. Often forgetful in daily activities.

Inattentive Type

Some individuals could have problems with: Slow cognitive processing

(speed of comprehension) Trouble “filtering out” distractions

What Does it Take to Pay Attention?

Focus Select Sustain Resist Distraction Shift

Predominately Hyperactive/Impulsive Type

At least six of nine characteristics are required for diagnosis:Hyperactivity Often fidgets with hands or feet or squirms in seat Often leaves seat in classroom or other situations in which

remaining seated is the expectation Often runs about or climbs excessively in situations in which it is

inappropriate (in adolescents and adults, it may be limited to subjective feelings of restlessness)

Often has difficulty playing or engaging in leisure activities quietly Often “on the go” or acts as if “driven by a

motor”

Predominately Hyperactive/Impulsive Type

Impulsivity Often blurts out answers before

questions have been completed Often has difficulty waiting turn Often interrupts or intrudes on

others

Impulsivity!!!

Behavioral Impulsivity Inability to control behavior or delay reacting Includes impulsive actions, risk-taking

behaviors

Impulsivity!!!

Cognitive Impulsivity Impaired ability to inhibit one’s actions Jumps into work before reading directions Inability to stop and problem solve Responds emotionally and makes poor

decisions

Tests…

Drawing by Jeffery T. Houghton

CHADD Parent to Parent © 2008

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“Children with AD/HD Are Managed by The

Moment!” Russell Barkley Ph.D

Girls and Women with AD/HD

Most have inattentive type Commonly diagnosed with

depression and/or anxiety Hyperactivity can be associated with hyper-talk Very good at making themselves appear invisible Hormones from puberty on may have a great impact May have an increased sense of inadequacy

AD/HD Emotional Characteristics

Easily angered or has a short fuse Moody Easily frustrated Gets upset or annoyed quickly Irritable Loses control easily

From “The ADD/ADHD Checklist” by Sandra Rief, M.A.

AD/HD… Further Defined

Individuals with AD/HD may also: Have difficulty with transitions and changes in

routine or activity Become over-stimulated Display aggressive behavior Have immature social skills Be difficult to discipline effectively Be extremely insecure and have low self-

esteem From “The ADD/ADHD Checklist” by Sandra Rief, M.A.

Left Untreated… The Consequences

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Low self-esteem Social and academic failure Risk for substance abuse Possible increase in anti-social

behavior

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The Most Debilitating Effect of AD/HD is the Loss of Self-Esteem

Multimodal Treatment of AD/HD

Parent and child education about diagnosis and treatment

Increased and consistent structure Behavior management techniques Creative Parenting Medication School programming and supports

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The Impact of AD/HD on the Family

& Creating Developmentally andAge-Appropriate

Positive Behavioral Interventions

Solutions for the Child with AD/HD

Consistency from both parents is the key Follow through with consequences, charts, rules,

time outs Create “house rules” Clarify expectations, break tasks into small steps

and even photograph the expected result Use enforceable statements without anger,

lectures, threats or warnings Delay consequences as you think through a plan

without anger

“Executive Functioning”

Children with AD/HD generally suffer from poor “Executive Functioning”

“Executive Functioning” refers to our ability to organize, prioritize and analyze in order to make reasonable decisions and plans

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Revised 7-15-06

Utilizing working memory and accessing recall

Brown’s Model of Executive FunctionsImpaired in AD/HD

Executive Functions

Brown, T.E. Manual for Attention Deficit Disorder Scales for Children and Adolescents; 2001.

Monitoring and self-regulating action

6.Action

5.Memory

Managing frustration and modulating emotion

Regulating alertness, sustaining effort and processing speed

3.Effort

4.Emotion

1.Activation

Organizing, prioritizing, and activating to work

Focusing, sustaining focus and shifting focus to tasks

2.Focus

Executive Functioning

Key areas of the brain act as the control center for an array of “executive functions” which control skills such as:

Remembering important information – WORKING MEMORY

Expressing oneself in written or spoken language Organizing time and space Starting and finishing projects Controlling emotions Using internal self-talk to control one’s actions Analyzing and solving complex problems, and Planning ahead for the future - FORESIGHT

Executive Functioning

Dr. Tom Brown uses a metaphor that compares executive functioning of the brain “to the function of a conductor of an orchestra.”

The conductor organizes, activates, focuses, integrates, and directs the musicians as they play, enabling the orchestra to produce complex music.

Similarly, the brain’s executive functions organize, activate, focus, integrate and direct, allowing the brain to perform both routine and creative work.

Picture courtesy of Marlene Snyder, Ph.D. and the Cape Cod Times

Stimulant Medication Impacts Dopamine Receptors

Synaptic Gap Dendritic Spine

Dopamine

Receptor

Dopamine

Stimulant medication

floods the gap with dopamine

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Creative Parenting

101

Direct verbal / visual cues

Get direct eye contact

Keep messages short

Teach child to comply within specific behavioral limits

Provides the child with a verbal cue that signals to pay attention to something of importance (i.e., “You need to…”)

Helps prevent parental instructions from becoming “background noise” Ask (without sarcasm) what was just stated.

Eliminate distractions if necessary.

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Let deficits become strengths!

Deficit (Rethink as) Strength Hyperactivity

Distractibility

Impulsivity

disorganized

Focused energy

Multi - Interested

Learned outspokenness

Creativity outside limits

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The “box”

Typical AD/HD

“Think outside of the box, Johnny...”

Think outside the what?

What box…

“I live outside the box.”

How many boxes do you want?

Colored?

Designs?

Anything else?

That’s it?

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Class pay attention!

Teacher’s Instructions AD/HD Child begins to think

Complete your projects like this.. A,B,C,D…

Next, you will need…

…does anyone have any questions?

Cool if we go D,C, A,B

…or I’ve got another idea…

Next…?? Boy I’m tired, pretty dress, next Wednesday, I’m bored, Xbox 360 tonight, …you will…huh? ….wonder what they’re having for lunch, man I’m hun..and we’ll be graded huh? What’d she say???

…man, I’m lost again….

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Good news / bad news

Good news Your child is different Invest yourself with your time. You get to grow! See “deficits,” as strengths. No one gets it “completely”

right. A unique dialog awaits you! Your child becomes just like

you…except REALLY different!

Bad news You’re child’s different You’ve just gotten busier! Confusion becomes a friend Only you will know how to get

this completely right. This is not a dialog you’ve heard

before, nor is everyone having it. You’re not going to predict how

they’ll come out.

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Core approaches that work and are appreciated

LovePatienceForgivenessOpen-mindednessAssertivenessLong-sufferingSupportUnderstandingGuidance

EducatedAdvocateAble to believe the unbelievableTrustTangent listeningTeaching on pointLove Patience Forgiveness

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Challenges (cont’d)

Problems with intimate relationships Time management difficulties Difficulty attending to details Inability to locate and maintain important

paperwork Difficulty managing finances Other

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The Impact of AD/HD on the Spouse or Significant Other

Intimacy Communication Finances Anger Management Impulsivity Uninvolvement with family Hyperactive behavior Irritability/frustration

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Possible Substance Abuse Problems in Teens & Adults with AD/HD

The risk for developing substance abuse problems is almost twice as high for adults with AD/HD as those without the disorder

52% vs. 27%

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The Most Debilitating Effect of AD/HD is the Loss of Self-Esteem

Criminal Criminal behaviorbehavior

School exclusionSchool exclusion

Substance abuse Substance abuse

Teenage Teenage pregnancypregnancy

Conduct disorderConduct disorder

Lack of Lack of motivationmotivation

Complex learning Complex learning difficultiesdifficulties

AD/HD OnlyLow self-esteem

Disruptive behaviorPoor social skillsLearning Delay

Challenging behavior

ODD

Age 6 10 14–16

Likely Progression of

Untreated AD/HDKewley, 1999

Collaboration:

Family CenteredCompassionate

Culturally EffectiveComprehensive

FamilyChild/Teen

Schools Clinicians:

Primary Care PhysicianPediatric Sub-Specialist

Allied Health Care Professionals

Community

Community Community

Team Building

SchoolsTeachers

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Updated October 2007

Eligibility for AD/HD at School

Eligibility for school support services is based on school related performance and behaviors only.

A child’s functioning at home or outside of school is not sufficient for consideration of an evaluation.

Remember – decisions to evaluate must be based on a variety of data!

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Eligibility Under Section 504

For purposes of §504, a “disabled person” is one who: Has a physical or mental impairment

which substantially limits one or more major life activities

Has a record of such impairment, or Is regarded as having such an

impairment It is about impairment, not

diagnosis.34 C.F.R. §104.3(j)(1)

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Understanding Classwork and Homework-Related Problems

Getting behind in class and/or poor grades Failing to write down assignments Not understanding what assignments are and

when they are due (cont'd)

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Classwork and Homework- Related Problems

Forgetting assignment book/textbooks or materials needed

Taking hours to do minutes of homework Hassling about when and where to do

homework Failing to bring home notes concerning

homework Lying about having done homework

(cont'd)

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Homework Chart School Age Week of 9/12–9/16

Item Tickets Sun Mon Tues Wed Thurs

Sits down by 4 p.m. to do HW 2 tickets 2 2 0 2 2

Records homework in planner

4 tickets 4 4 4 0 4

Sits in chair for 30 min.and completes at least one assignment

4 tickets 2 4 3 4 2

Completes homework without whining

6 tickets 3 6 4 6 6

totals 11 tickets 16 tickets 11 tickets 12 tickets 14 tickets

Parents can determine if a child should receive a partial payout for a behavior.

Review of Executive Functioning: Practical Implications on Performance at Home and School

Getting started Remembering chores and assignments Memorizing multiplication tables or other facts Writing essays Remembering what was read (reading

comprehension) Controlling emotions Analyzing and problem solving Planning for the future

Information from Chris A. Zeigler Dendy

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