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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
1-2
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
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
CHADD Parent to Parent © 2008
1-1411-2008
“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
2-18
Low self-esteem Social and academic failure Risk for substance abuse Possible increase in anti-social
behavior
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
2-20
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
6-23
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
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.
4-29
Let deficits become strengths!
Deficit (Rethink as) Strength Hyperactivity
Distractibility
Impulsivity
disorganized
Focused energy
Multi - Interested
Learned outspokenness
Creativity outside limits
1-30
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?
1-31
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….
1-32
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.
1-33
Core approaches that work and are appreciated
LovePatienceForgivenessOpen-mindednessAssertivenessLong-sufferingSupportUnderstandingGuidance
EducatedAdvocateAble to believe the unbelievableTrustTangent listeningTeaching on pointLove Patience Forgiveness
1-34
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
7-35
The Impact of AD/HD on the Spouse or Significant Other
Intimacy Communication Finances Anger Management Impulsivity Uninvolvement with family Hyperactive behavior Irritability/frustration
7-36
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%
7-37
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
5-40
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!
5-41
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)
5-42
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)
6-43
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)
6-44
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
6-46