Alyson H. Sheehan, PhD - ASPIRE Center

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1 The 5 W s of ADHD Supports and Services: A Crash Course in System Navigation Alyson H. Sheehan, PhD Clinical Coordinator, Licensed Psychologist ASPIRE Center for Learning and Development CHADD of Nassau County Educational Workshop April 27, 2015 A Little About Me... Conduct consultation, diagnostic evaluation, treatment (individual, parent, family, group) at small, unique outpatient center Dual- training in adult and child psychology Specialize in ADHD, ASD, complex and co- occurring concerns (e.g., diﬀerential diagnosis, disruptive behavior, trauma, BFRB s) CHADD Executive Board Importance of strength- based understanding and interventions Really thrilled to be presenting on this topic!!! Alyson H. Sheehan, o PhD SPIRE Center ***Handout f a- All workshop slides will be posted on ASPIRE Center website ( under Speaking Engagements à Handouts and Resources 1

.. Conduct consultation, diagnostic evaluation, treatment (individual, parent, family, group) at small, unique outpatient center Dual- training in adult and child psychology Specialize in ADHD, ASD,

2 A Little About You Interest in Children vs. Adults? Stage in ADHD Journey? Workshop Overview Constructing a clear, individualized roadmap for: Gathering data and observations Obtaining a diagnosis Identifying key supports and providers Outlining a clear, individualized plan Executing recommendations Troubleshooting (aka oﬀ- roading) Additional resources Q & A 2

observations Obtaining a diagnosis Identifying key supports and providers Outlining a

3 Gathering Data and Observations * Initial step everyone in attendance already here * Detecting difficulties or differences * Searching for explanation and/or strategies to bring about positive change * Seeking personal, community, educational, and/or professional support * Approach to education and advocacy begins at this point * However, never too late to fine- tune! * Document, document, document * Best way to predict future behavior is past behavior * Diagnosis and recommendations rooted in background * Creativity allowed (and encouraged!) * Ongoing component in addressing ADHD symptoms, and promoting ADHD strengths, over time Obtaining a Diagnosis Considerations * Not always a one- time shot * Make sure that the evaluator will document diagnosis as part of assessment! * Emphasis on expertise in ADHD * Professional provider glossary to follow * Many tools for assessing symptoms does not mean that they are valid! * E.g., continuous performance tests, informal questionnaires * Other possible explanations * Seek to rule- out as well as rule- in * ADHD is not based on a single symptom or symptom cluster! * Medical * Situational * Mental health 3

* Document, document, document * Best way to predict future behavior is past behavior * Diagnosis and recommendations rooted in background * Creativity allowed (and encouraged!

4 Obtaining a Diagnosis Best Practice in Diagnostic Evaluation * Preliminary review * Reason for request * Developmental history * Interview and observation * Individual being evaluated * Parent(s) or informant(s) * Preference for semi- structured * A LOT of forms and questionnaires * Collaborative feedback * Clear recommendations oral and written * Cognitive testing - recommended * Aka IQ * Provides baseline and opportunity for structured observation * Adaptive assessment recommended * Skills for independent completion of day- to- day tasks * Achievement testing if warranted * Rule out learning disorder Who s Who? Professional Provider Glossary * Physicians (MD s) All receive medical training and place emphasis on biological processes * Neurologist * Emphasis on biological functioning of brain and other parts of nervous system * Diagnosis may assess through interview and possibly questionnaires; currently no medical tests (e.g., EEG) that accurately detect presence of ADHD * Treatment may prescribe medication and/or make referrals to other professionals; do not provide therapeutic interventions * Pediatrician * Emphasis on general medical care for children * Diagnosis usually know basics; may administer questionnaires and/or collect background information; rarely have specialized training in ADHD * Treatment may prescribe medication and/or make referrals to other providers * Psychiatrist * Emphasis on identifying and distinguishing between physical and psychological causes for behavior; provide medical interventions for managing symptoms * Diagnosis trained/qualified to conduct diagnostic interview and administer questionnaires; able to rule out or account for underlying medical conditions Alyson H. Sheehan, * Treatment PhD - ASPIRE Center primarily medication management; occasionally (though rarely) trained in other therapeutic interventions 4

Provides baseline and opportunity for structured observation * Adaptive assessment recommended * Skills for independent completion of day- to- day tasks * Achievement testing if warranted * Rule out

5 Who s Who Professional Provider Glossary (cont d) * Psychologists (PhD s or PsyD s) * Receive general or specialized training in relationship between brain (structures, thoughts, feelings) and behavior * Licensed Psychologist * Emphasis on identifying, explaining, and modifying behavioral and emotional patterns * Diagnosis trained/qualified to administer full battery; can investigate additional or differential mental health- related contributors to difficulties (e.g., depression, anxiety, ASD) * Treatment generally offer therapeutic interventions * Board Certified Neuropsychologist * Emphasis on relationship between physical brain structure and behavior/disorder * Diagnosis trained/qualified to administer full battery; can investigate organic contributors to difficulties (e.g., brain damage) * Treatment may or may not offer therapeutic interventions * School Psychologist* * Only type of psychologist that may have MS or MA; does not require doctoral- level training (although some school psychologists pursue) * Diagnosis trained in cognitive and achievement testing; rarely diagnosis ADHD; often Alyson H. Sheehan, limited PhD - ASPIRE to assessing Center for learning disorders (by training or by school district) * Treatment works with school team; implements school- based counseling Who s Who Professional Provider Glossary (cont d) * ADHD Coaches * Specialized training in ADHD symptoms and management; use collaborative and goal- oriented approach to promote skill development and strategies for addressing areas of difficulty * Social Workers * Very broad field; licensed clinical social worker (LCSW) may make diagnosis but is limited in scope of assessment; primarily provide therapy interventions or direct to supportive services * Mental Health Counselors * Broad and limited training in mental health conditions; may specialize in ADHD and provide psychotherapeutic interventions * Nurse Practitioners * Primarily provide medication management; will make diagnosis in certain settings or circumstances 5

additional or differential mental health- related contributors to difficulties (e.g.

6 Outlining and Executing a Plan * You are the expert on yourself or your child * Ideal to have a point person to maintain smooth dialogue and coordination among providers and supports * Combination of what you already know and what you learn over time * Recognizing risk factors * Promoting strengths Outlining and Executing a Plan * Individual considerations * Activity level * Learning and studying * Social skills * Research- based approaches * Multimodal treatment * Strength in numbers! * Medication versus therapy 6

Recognizing risk factors * Promoting strengths Outlining and Executing a Plan * Individual considerations * Activity level *

7 Troubleshooting * Trial- and- error is often a necessary evil * Ebb and flow of symptoms and profile * Roles of hormones and life stages * Not fixing what isn t broken may not be ideal mindset * Ongoing research and development of interventions * Do not fear 2 nd (or 3 rd, or 4 th ) opinion * Go with your gut * Although limit jumping around through as much preparation and research as possible Relevant Resources Organizations * CHADD (Children and Adults with ADHD) * * ADDA (Attention Deficit Disorder Association) Adults * * ADDitude Magazine * * Strongly recommended to follow above on social media! 7

limit jumping around through as much preparation and research as possible Relevant Resources Organizations * CHADD (Children and Adults with ADHD) * www.chadd.

8 Relevant Resources Books General ADHD Information * Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood by Edward M. Hallowell and John J. Ratey * A New Understanding of ADHD in Children and Adults: Explaining Inadequate Executive Functioning by Thomas E. Brown * Executive Functions: What They Are, How They Work, and Why They Evolved by Russell A. Barkley Relevant Resources Books Parenting Children with ADHD * Taking Charge of ADHD: The Complete, Authoritative Guide for Parents by Russell A. Barkley * ADHD Parenting by Beth Burba and Pauline Johnson * Executive Function Dysfunction Strategies for Educators and Parents by Rebecca A. Moyes * Smart but Scattered Teens by Richard Guare, Peg Dawson, and Colin Guare * Bright Kids Who Can t Keep Up by Ellen Braaten and Brian Willoughby * The ADD/ADHD Checklist: A Practical Reference for Parents and Teachers by Sandra F. Rief * From Chaos to Calm: Effective Parenting of Challenging Children with ADHD and Other Behavioral Problems by Janet E. Heininger and Sharon K. Weiss * The Everything Parent s Guide to Children with Executive Functioning Disorder by Rebecca Branstetter, PhD 8

Brown * Executive Functions: What They Are, How They Work, and Why They Evolved by Russell A.

9 Relevant Resources Books - Adults with ADHD * Taking Charge of Adult ADHD by Russell A. Barkley * Driven to Distraction at Work by Edward Hallowell * Fast Minds: How to Thrive if You Have ADHD (or Think You Might) by Craig Surman and Tim Bilkey * More Attention, Less Deficit by Ari Tuckman * The CEO of Self: An Executive Functioning Workbook by Jan Johnson- Tyler * Lifting the Fog: A Specific Guide to Inattentive ADHD in Adults by Michael Carr * The Mindfulness Prescription for Adult ADHD by Lidia Zylowska * You Mean I m Not Lazy, Stupid, or Crazy? The Classic Self- Help Book for Adults with Attention Deficit Disorder by Kate Kelly and Peggy Ramundo * The Everything Health Guide to Adult ADD/ADHD by Carole Jacobs and Isadore Wendel Questions??? ***Handout Alyson H. Sheehan, of PhD all - ASPIRE workshop Center slides will be posted on ASPIRE Center website ( under Speaking Engagements à Handouts and Resources 9

Tuckman * The CEO of Self: An Executive Functioning Workbook by Jan Johnson- Tyler * Lifting the Fog: A Specific Guide to Inattentive ADHD in Adults by Michael Carr * The Mindfulness Prescription for

For more than 100 years, extremely hyperactive

8 WHAT WE KNOW ADHD Predominantly Inattentive Type For more than 100 years, extremely hyperactive children have been recognized as having behavioral problems. In the 1970s, doctors recognized that those