Gloucester Township Public Schools October 2015 Dr. Kerri Tomasello BCBA-D, COTA/L

Gloucester Township Public Schools October 2015 Dr. Kerri Tomasello BCBA-D, COTA/L

Many great accomplishments can be credited to people with ADHD: * Dwight D. Eisenhower * Galileo * Alexander Graham Bell * Thomas Edison * Winston Churchill * Henry Ford * Leonardo da Vinci * Jules Verne * General George Patton * Walt Disney * Alexander Graham Bell * Michael Phelps * Robert Kennedy * Jim Carrey * George C. Scott * Robin Williams

ADHD is the most commonly diagnosed childhood neurobehavioral disorder Boys are more likely than girls to be diagnosed with ADHD (3:1) Most children are diagnosed between the ages of 5 and 9 Intellectually children with ADHD can range in ability from gifted to being typical or having some delay There are no medical tests for ADHD

Genetics/hereditary predisposition Certain areas of the brain may be less active in children with ADHD (areas associated with executive functions) There is strong scientific evidence to suggest that ADHD may be due to an in-balance in neurotransmitters or brain chemicals and /or reduced metabolic rates in certain regions of the brain There is lower metabolism of glucose (the brain s energy source) in the frontal region of the brain (Reif, 2005)

Other disorders may co-occur with ADHA The most common coexisting disorder is Oppositional Defiant Disorder (ODD) ODD is an ongoing pattern of uncooperative, defiant, and hostile behavior Other possible coexisting disorders include anxiety and mood disorders

Together or separately there are three main symptoms of ADHD inattention, impulsivity, and hyperactivity In the DSM-V behavioral symptoms are divided into two sets 1)inattention and 2) hyperactive impulsive. There are nine specific inattention symptoms and 9 specific hyperactive-impulsive symptoms Behaviors must have been exhibited prior to age 12 and must be displayed across two or more settings

Symptoms must be present for at least 6 months and to a degree that is inconsistent with developmental level Need for a clinically significant impairment indicated by clear evidence that the symptoms interfere with, or reduce, the quality of social, academic, or occupational functioning. (Reif 2005) Rule out alternative explanation for symptoms - not better accounted for by another disorder

Inattentive Presentation: Fails to close attention to details or makes careless mistakes Has difficulty sustaining attention Does not appear to listen Struggles to follow through on instructions Has difficulty with organization Avoids or dislikes tasks requiring a lot of thinking Loses things Is easily distracted Is forgetful in daily activities

Hyperactive-Impulsive Presentation Fidgets with hands or feet or squirms in chair Has difficulty remaining seated Runs about or climbs excessively in children; extreme restlessness in adults Difficulty engaging in activities quietly Acts as if driven by a motor; adults will often feel inside like they were driven by a motor Talks excessively Blurts out answers before questions have been completed Difficulty waiting or taking turns Interrupts or intrudes upon others (National Research Center on ADHD: A Program of CHADD (NRC))

ADHD-Combined type - Exhibit at least six of the nine inattention symptoms and at least six of the nine hyperactive-impulsive symptoms ADHD-Predominantly Hyperactive-Impulsive type- Exhibit at least six hyperactive-impulsive symptoms but fewer than six inattention symptoms ADHD-Predominantly Inattentive type significant problems with inattention with the absence of notable hyperactivity and impulsivity. Exhibit at least six of the nine inattention symptoms but fewer than six of hyperactive-impulsive symptoms

Russell Barkley, Ph.D., ABPP,ABCN is a Clinical Professor of Psychiatry and Pediatrics at the Medical University of South Carolina. Dr. Barkley is one of the leading authorities on ADHD, his theory supports: Children with ADHD fail to monitor situations, assess whether an action is appropriate to the situation, act planfully, or consider the consequence of their actions. This results in impulsive behavior. ADHD is not the result of a lack of skills or knowledge, ADHD is not a problem with knowing what to do, rather it s a problem with doing what one knows (Barkley, 2005)

The core deficit in ADHD is impulsivity, which is an impaired ability to inhibit immediate reactions to what is happening at the moment ADHD is a developmental disorder of self-control Poor self-control of emotions in regards to selfregulation of frustration, impatience, and anger (Barkley, 2015) Poor self-control with regard to time and thinking ahead to the future, shifting focus from what is happening now to focus on what comes next. ADHD is primarily not a disorder of paying attention but one of self-regulation

A key deficit for children with ADHD is the inability to engage in self-control by using the brain s executive functions (EF) EF are described as cognitive processes necessary for complex goal-directed behavior (Reid & Johnson, 2012) EF is an umbrella term for the neurologically-based skills involving mental control and self-regulation (Cooper-Kahn & Dietzel, 2008) EF can be developmentally delayed in children with ADHD Weaknesses in EF can have an negative impact on academic performance

Inhibition the ability to stop from acting on impulse Emotional Control regulate our emotional responses Initiation the ability to independently begin working on a task, implement problem-solving strategies, generate ideas Planning/organization involves future oriented tasks Organization of materials giving order to things Self-monitoring the ability to monitor one s own performance and measure against what is expected (Cooper-Kahn & Dietzel, 2008)

Following are school behaviors that require executive function skills: * pay attention to the teacher * organize your desk * remember and follow directions * write down homework assignments * socialize at the appropriate times * follow a schedule * interact with a range of peers * remember your locker combination * bring the correct books and materials to class

Require executive function skills: * remember to bring important papers home and return to school * adapt to change in schedule or routine * work quickly and efficiently on timed tasks * work slowly and carefully on more complex tasks that require sustained attention * transition easily from subject to subject and area to area within and outside of the classroom

Main areas of concern: 1) Academic performance the amount of school work a student with ADHD is able to complete and the skill level demonstrated. Issue may be more of a performance deficit as opposed to a skill deficit 2) Behaviors in the classroom setting - such as disruptive, noncompliant, off task behaviors. Behaviors related to social relationships (social skills) can also be problematic (approximately 50% of children with ADHD have difficulty with peer relationships) (Barkley, 2013)

Situational factors can interfere with the ability of a child with ADHD to initiate and sustain attention to a task Time of day earlier is usually better The more complex the task the more difficult it will be to maintain attention Delayed rewards (gratification) Absence of supervision Less preferred tasks Distractions in the surrounding environment Working in a group When behavioral restraint is required Delays or disruptions while performing the task Infrequent feedback

Structure and routine: have specific times for chores, homework, bedtime, playtime, meals Provide information in advance of any changes to the established routines Rules and consequences that are simply stated and enforced consistently by all members of the household Instructions should be clear, brief, and when possible provide visual supports (chore list on the refrigerator, sticky notes) Have child repeat instructions/directions back to you Give concise one or two step directions. Avoid overloading with too much information

Morning Schedule for Getting Reading for School (visual) Review with your child and post the schedule * 7:05 Get Ready Wash face, comb hair and get dressed ( clothes can be laid out the night before) * 7:20 Breakfast Time-Offer two choices * 7:40 Brush Teeth * 7:55 Time to Go Shoes, Hat, Coat, and Book Bag (keep shoes and book bag by the door to prevent having to search the house when it is time to go out the door

Tell the child how much time they have to comply with instructions, provide visual support with clocks or timers Because children with ADHD are operating in the moment praise and rewards should be frequent and immediate. Delayed gratification is difficult Have a quiet area in your home where your child can go if they need an area with limited distractions Designate a specific area for completing homework Break work down into smaller sections Make a list of what has to be accomplished during homework time, check off as completed

Give choices Make sure you have the child s attention before giving instructions, you may want to place you hand on their arm or shoulder to gain attention Allow for restlessness and movement Develop communication strategies (listening ball when they are holding the ball they are listening) Allow fidget toys (koosh ball) something tactile to keep hands occupied this can help with listening and attending Sharing information between home and school

Common problems associated with homework and students with ADHD: Forget to write assignment down Write down the wrong assignment Bring home the wrong books or no books Forget their agenda book Forget the materials needed Take hours to do what should be minutes of homework Battle over when and where to do homework Require constant supervision and help Forget to take completed homework in to school

In school a homework checklist can be developed and reviewed with the student each day, checking off each task as it is completed In school teacher or a peer buddy will go over homework assignments and check to see they are written in the agenda book correctly At pack-up time teacher or peer buddy will check the student s book bag to make sure the agenda book and all necessary books/folders required for the assigned homework are packed Reverse this process in the morning

At home parent will know to check the agenda book for homework assignments Establish a schedule for doing homework start time, designated area, amount of time expected to work (use timers for visual support) Review homework and breakdown lengthy assignment into parts, give choices as to what order work will be completed (math first, writing second) Allow for movement breaks if needed, build into the schedule Provide the teacher with any needed information about the homework Develop a checklist for tasks to be completed and what items need to go back in the book bag, check off as completed

He or She Could Do It If They Really Wanted To This misconception is based on the belief that a child with ADHD is capable of doing what is required but they choose not to. One of the core problems of children with ADHD is that they are consistently inconsistent. For children with ADHD, wide variations in performance is the norm not the exception. The expectation that a child with ADHD can simply decide to perform at their personal-best-level everyday if he really wanted to is unrealistic (Reid & Johnson, 2012)

Please Remember: ADHD is a brain-based biological disorder and an individual with ADHD is not making a choice to be inattentive, hyperactive or impulsive. The inconsistent performance of children with ADHD is not willful, but rather it is a result of problems inherent to ADHD (Reid & Johnson, 2012) Thank you

Barkley, Russell, (Attention-Deficit Hyperactivity Disorder, 2015) Barkley, Russell, (Taking Charge of ADHD, 2013) DuPaul & Stoner (ADHD in the Schools, 2014) Flick, Grad L., (ADD/ADHD Behavior-Change Resource Kit, 1998) Grossberg, Blyth, (Focused: ADHD and ADD Parenting Strategies, 2015) National Resource Center on ADHD: A Program of CHADD (NRC) Reif, 2005 Reid & Johnson, (Teacher s Guide to ADHD, 2012)