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An ADHD Primer:Treatment for Educators
Jill Zaruba, OTColumbus Community Hospital
Tawnya Meadows, Ph.D.Munroe-Meyer Institute, UNMC
Not recommended!
What we know works:
Drug TherapyBehavior TherapyCombined Behavioral/Drug
Treatments
APA Task Force on Evidence-Based Treatments, JCCAP, Pelham, Wheeler, & Chronis, 1998
American Academic of Pediatrics
AAP Guidelines
1. Establish a management program that recognizes ADHD as a chronic condition (strength of evidence: good; strength of recommendation: strong).
AAP Guidelines
2. Clinician, parents, and child, in collaboration with school should specify appropriate target outcomes to guide management (strength of evidence: good; strength of recommendation: strong).
AAP Guidelines
3. Recommend stimulant medication and/or behavior therapy as appropriate (strength of evidence: strong).
AAP Guidelines
4. When management has not met target, clinicians should evaluate the original diagnosis, treatments, adherence and coexisting conditions (evidence: weak; recommendation: strong).
AAP Guidelines
5. Periodically provide systematic follow-up to monitor targets and adverse effects by gaining information from child, parents, and teachers (evidence: fair; recommendation: strong).
What we know DOESN’T work:
Play therapyIndividual or family counseling (without altering
the environment)Social skills/self-monitoring/organizational
planning Dietary managementMegavitamin therapySensory integration therapy/chiropracticsEEG Biofeedback
• Optometric vision training
• Anti-motion-sickness medication
• Treatment for candida yeast infection
• Applied kinesiology (realigning bones in the skull)
What we know works:
CNS Stimulant Medicationso 250 studies (N > 5000)
Behavior Therapyo 48 classroom studies (N > 900)o 80 parent/home studies (N > 5,000)
Combined Behavioral/Drug Treatments
o 25 studies (N > 800)
Behavior Therapy for ADHD
ComponentsHighly structured
Behavior Therapy for ADHD
ComponentsHighly structuredImmediate feedback
reinforcer or reward for appropriate behavior
consequence for inappropriate behavior
Behavior Therapy for ADHD
ComponentsHighly structuredImmediate feedback
reinforcer or reward for appropriate behavior
consequence for inappropriate behaviorSalient/meaningful feedback
Behavior Therapy for ADHD
ComponentsHighly structuredImmediate feedback
reinforcer or reward for appropriate behavior
consequence for inappropriate behaviorSalient/meaningful feedbackProgramming at home and school
School Behavior Intervention
Examples:1. The Attention Training System
(ATS)2. Home School Note3. Self-monitoring
4. Accommodations
School Behavior Intervention:
The Attention Training System (ATS)
1. Technology Teacher Module Student Module
School Behavior Intervention:
The Attention Training System (ATS)1. Technology
Teacher Module Student Module
2. Immediate feedback
School Behavior Intervention:
The Attention Training System (ATS)
1. Technology Teacher Module Student Module
2. Immediate feedback3. Meaningful consequences
School Behavior Intervention:
The Attention Training System (ATS)
1. Technology Teacher Module Student Module
2. Immediate feedback3. Meaningful consequences4. Structured “time”
School Behavior Intervention
The ATS: Lisa
0102030405060708090100
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Days
%TimeOff
Task
No ATS ATS No ATS ATS
School Behavior Intervention
The ATS: Troy
0102030405060708090100
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
Days
%TimeOff
Task
No ATS No ATS No ATS
ATS ATS Meds Only
School Behavior InterventionHome School Notes
Address Problems WithAcademic effortIn-class behaviorsAssignment completion
School Behavior InterventionHome School Notes
ProceduresIdentify target behaviors
School Behavior InterventionHome School Notes
Academic Behaviors Working on
assignments Completing homework Handing in
assignments All work up to date On time for class
Social Behaviors Out of seat Talking without
permission Disrespectful behavior Bothering peers Following instructions Hands to self
School Behavior InterventionHome School Notes
ProceduresIdentify target behaviorsDesign school note form
School Behavior InterventionHome School Notes
GOAL:8 of 12 YES
Desk neat and organized
Homework written neatly, accurately in book by class bell
Class assignment neat and 80% accurate or better
Math L. Arts History Science
Yes No Yes No Yes No Yes No
Yes No Yes No Yes No Yes No
Yes No Yes No Yes No Yes No
School Behavior InterventionHome School Notes
ProceduresIdentify target behaviorsDesign school note formIdentify reinforcers and
consequences
School Behavior InterventionHome School Notes
Reinforcer ExamplesWear an outfit of your choice to
schoolGet out of a choreTV/video games/telephone/computer
timeAllowanceToken toward weekend activity
School Behavior InterventionHome School Notes
ProceduresIdentify target behaviorsDesign school note formIdentify reinforcers and
consequencesEstablish criterion for reinforcement
School Behavior InterventionHome School Notes
ProceduresIdentify target behaviorsDesign school note formIdentify reinforcers and
consequencesEstablish criterion for reinforcementIncrease criterion as progress is
made
School Behavior InterventionHome School Notes
Procedures Identify target behaviorsDesign school note form Identify reinforcers and consequencesEstablish criterion for reinforcement Increase criterion as progress is madePlan for generalization and maintenance
School Behavior InterventionHome School Notes
What makes it effective:Frequent, immediate feedback
(school).Highly structured (short time).Salient consequences (home).
Self-Monitoring
• Gives motivated student sense of responsibility
• Less work for teacher
• Provides parent/physician with information
Date:
Cross off each picture each time you talk without raising your hand or having permission. Teacher will cross off two pictures if you don’t.
Teenagers with ADHD
• 80% still need medication (NIMH)
• Use a planner
• Keep a routine
• Study skills
• Sleep, Sleep, Sleep
Accommodations
• Seat placement (front is not always best)
• Small group activities
• Encourage students to pause before answering questions
• Keep assignments short or break them into sections
• Close supervision with frequent, positive, (subtle) cues to stay on task