ZaccheoTM is a trademark protected copywrite ADHD Co-existing Problems Interventions P resented b y: D ianne Z accheo MSW FTC M edical F amily T herapy

ZaccheoTM is a trademark protected copywrite

ADHD Co-existing Problems

Interventions

Presented by:

Dianne Zaccheo MSW FTC

Medical Family Therapy Consultant

The Coaching Centre, London England


This Presentation Will

Explain ADHD Characteristics Comorbidity & Related Problems Children with ADHD Experiences Academic underachievement & failure What is Best Treatment The Zaccheo Coach model A Call for Increased Recognition


What is ADHD?

A Neurobiological DisorderBrain Regions and Genetic FactorsTwin Studies: highly genetic in twins Cardinal Symptoms: Inability to Sustain AttentionDistractibilityHyperactivity Three Sub-Types DSM-IV vs. ICD-10


Historical Overview

Dr George F Still, British Paediatrician, Original Quotes Lancet, 1902:

A persistence in a degree unusual

not corresponding to environment

Abnormal incapacity for sustained attention, parents & teachers notice these children are

a danger to self & others

Below average degree of moral control

Call for active recognition


Research Findings Research confirms

Studies show the rate of brain utilising glucose is lower in ADHD

Significant evidence of brain regions: Prefrontal cortex which regulates attention, distraction leading towards ‘self regulation’ B.

Developmental delays up to 3 years, Dr Shaw Chicago

Exercise and its enormous benefits

Newer medications to fine tune effects non stimulant types

The uses of Coaching approaches

Boy to girl ratio increasing ‘4 to 1’


DSM-IV ADHD & Subtypes

Innattentive Type Hyperactive Impulsive Type Combined Type ADD highlighted by daydreaming forgetful under activity difficulty sustained effort ADHD highlighted by over-activity racing Impulsivity, excessive behaviours fidgety Combined Type both inattentive & hyperactive

impulsive usually adolescents


Children, Adolescents & Adultswith ADHD Have Problems:

Hyperactivity, Inattention, Impulsiveness Trouble sustaining mental effortsPoor working memory forgetfulnessInternal motivation goal directed self-talkOrganisation losing thingsMaking & prioritising decisions Readiness towards responsibility Remaining on task Communication and articulation skills Social interaction skills


Comorbidity: Co-Existing & Related Disorders

Self development, Behaviour, Education, Social, Family & Community

Low Self Esteem & Low Self Worth Faulty distorted self perception Oppositional Defiant Disorder/Conduct Disorder Tourette’s, Autistic Spectrum & Asperger’s Language & Communication disorders Development Delay Social and relationship problems Academic under performance and achievement Depression, Anxiety, OCD, Substance Abuse, Self Harming, Eating Disorders, Suicidal Criminality, Gambling


Adolescents with ADHD at Risk

ADHD PoorachievementAcademic Failure

Motor problemsDyspraxia

ASDAspergers

Emotional MaturityIntelligence

ODD

Conduct Disorders

Learning Disorders

Substance Abuse

Trouble withThe Law

Speech and Language


AN IMPARED SENSE OF TIME

Has no 'sense of time' Does not get ready on time Does not plan for future Does not estimate time

correctly Crises may be frequent This affects Planning Prioritizing Scheduling Following a Plan


We Know what ADHD is……

Hey Stupi

d

We just don’t agree about what to do about it…

Treatments?

Punishments?

Parent-Child Strategies

Psychotherapy

Ritalin????

Vitamins

GodHelp us!

Pray


Statistics

Long term studies over 30 Years 70 -80% of Children with ADHD developed Conduct

Disorder & Oppositional Defiant Disorders Links between aggression in Boys to skill deficits

especially Executive Functions: poor planning, abstract reasoning, problem solving, attention span, concentration, inability to delay gratification, controlling short term behaviour to achieve long term

goals


Statistics

30 -50 % of Adolescents with ADHD will exhibit pervasive conduct problems into adulthood

35- 55% Adolescents with ADHD show significantly higher arrest rates

Conduct Disorder increases risk of criminality 55%

35 % of Children with ADHD leave school with no qualifications


Statistics taken from Prison

Untreated ADHD and Co-existing Problem?

Prisoners: Personality disorders & reading disorders cause problems of great magnitude

56% found positive for ADHD scores 48% exhibit neurological impairment 62.% Positive for Dyslexia ADHD & Conduct Disorder highly associated

with Driving Offences


What Evaluations can be done

Medical Diagnosis & Testing Medication for Symptom Relief Psychological & Mental health for Comorbidity Intellectual Assessment Academic assessment, interventions & support IEP Speech and Language Assessment Learning Disorders Assessment Neurological Assessment 12 to 37 % may have: Chromosome abnormalities, thyroid Neurofibromatosis, other neurological disorders


What works Best? Treatments & Interventions

Gain as much information as possible Learn about individual ‘uniqueness’ Be Consistent, patient & flexible Structure environments at home & school Teach appropriate behaviour Prompt and Reward appropriate behaviour Academic support


Interventions and Treatments

Interventions for Home Environment Skill Building for Developmental Delays Self Esteem building Coaching (versus Traditional Therapy) Exercise, Relaxation Techniques Social Skills Training Art & Music Therapy, Support Groups Equine & animal therapy Neurofeedback


Forms of Therapeutic Help

Direct planning & instructions Role modelling situations Role play Positive reinforcement Therapist and Coach giving feedback Peer feedback Peer interaction Conversational, social, emotional skills training Frequent Coaching and maintenance


Family Management

Parents learning about ADHD Child management strategies Parental ADHD Under Control Juggling ADHD & Sibling Issues Parent Teacher Child Relations Parent Advocacy Programmes ADHD Support Groups Consensus & Continuing Education


Designing Interventions Knowledge Trust & Respect Clear Rules & Routines Structure & Boundaries Fair but Firm ADHD is an explanation not an excuse Accept Differences & Uniqueness Learn About Medication Protection From Risk factors & Potential Threats Consistency, Reliability, Responsibility Reframing ADHD builds hopes & bridges


Multi-Disciplinary Team Approach

Reaching Consensus in Service delivery Education for professionals Advocacy for children & families Appropriate Courses and Skill Building Community Outreach Local Support Groups Self education for sufferers


Is it ADHD, ASD, Aspergers, HFA, Depression,

ODD, CD, OCD, PDD, LD, MR, RAD, Gifted, ???

Statistics 70% will have 2nd or 3rd disorder Assessments must be multi-disciplinary Intellectual, psychological, language, social,

behavioural, overshadowing symptoms There are more than 10 possible co-existing

conditions to test for


How to make comparisons Make complete lists of all behaviours Check off the similarities to other disorders Understand stages of childhood development Seek out Specialists Doctors, Psychologists, etc. http://www.childdevelopmentinfo.com/development/erickson.shtmlt http://www.childdevelopmentinfo.com/disorders/depression_in_child

ren_and_teens.htm http://www.childdevelopmentinfo.com/disorders/anxiety_disorders_i

n_children.htm http://childdevelopmentinfo.com/disorders/tourette_syndrome.shtml

http://childdevelopmentinfo.com/disorders/child_OCD.htm


Compared to ADHDProblems in Communication

Here follows a list for Aspergers Syndrome:

Monopolises discussionOf topic with own agendaUnable to read non-verbalcuesMonotoneAdvanced vocabularyLimited facial gesturesAnd facial expressionsTrouble joining in with conversationsBland emotional expressionsLimited range of topics


AS Problems with Play & Social Friendship

Little Imaginative play Poor cooperative play Dominates play Insists other play same Way as them Trouble with play group Invades personal space Plays along side not w-peers Uses playmates as objects Difficulty sharing things Poor sportsmanship Wants complete control over whatever is happening

Poor eye contact Little interest in others Lacks empathy Egocentric bubble May prefer to be alone Fails to compliment peers, friends,

others Cannot function in groups Lacks social sense Unable to read social cues/ feedback Better w-younger peers Better with adults Emotionally detached Lacks reciprocity in relationships


AS Social Skill Deficits

Repetitive organising of toys Does not repair conflicts May prefer to play alone Does not accept views others Limited pretend or thematic play Cannot tolerate criticism Lacks flexibility in play Does not initiate contact Ritualistic forms of play Does not express joy easily Rigidity in rules /everything Limited shared enjoyment Limited play interests Accepting suggestions 4 play Accepting others mistakes Apologising Voice volume may be loud Accepting losing at games


Tips to help you calm upset Remain calm regardless of how out of control Prompt to use cool down methods- breathing Intervene before the upset know the patterns Attempt to redirect with pleasurable tasks Praise attempts at cooling down/successfully Find persons he/she can talk to when upset Provide safe calm spaces to go when upset Stay out of power struggles Be a soothing presence Reduce your language lower the tone of your voice Find the root of the problem No demands except for safety Don’t try to talk during full blown upset Use a problem wheel to look at what patterns exist


123 Problem Wheel shows what the pattern is

2

3

1

Every pattern has a triggerWhen same repeatsSame happens

There is a pointof no return

There is manipulation

There are habits that driveBehaviours wanted or other

There is a pay-off

Honeymoontime


A Call For Urgent Recognition

Uniformity among all professionals Awareness & Education re: ADHD Early Recognition of children in Schools Parents Training Programmes Awareness in the community Police, Dept SS all Service Delivery Appropriate Provisions in Health Care Mental Health Care Doctors Police, Prisons,

Documents

ZaccheoTM is a trademark protected copywrite ADHD Co-existing Problems Interventions P resented b y: D ianne Z accheo MSW FTC M edical F amily T herapy