ADHD in NEPA CHADD associated www.adhdinnepa.com Kristina
Peary, Coordinator 570-493-0463 Learning with ADD/ADHD
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My goals To provide useable information about ADHD as executive
functioning deficits (EFDs) to improve recognition
&understanding of ADHD (all 3 DSM types & adult) to foster
on-point educational interventions & supports for students that
work (So we have more stamina for the work)
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Itinerary Introductions ADHD: Difficult to accept Executive
Functioning Co-existing Problems Interventions & Accommodations
Strategies for learning Strategy Checklist Resource list &
handouts Slide 4 Throughout Slides 14-36 Slides 37-51 Slides 52-68
Slides 69-80
Slide 4
Introductions Write on a piece of paper: 5 words describing the
teaching experience with students/parents who have ADHD 1-2
questions you have about ADD/ADHD
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The ADHD Question Why can they do better when they like the
task? For parents: Why cant they pay attention to this? They
certainly can pay attention to computer games! OUR conclusion: They
are just not trying/dont care STUDENTS conclusion is..?
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Answer: Inconsistency is ADHD Inconsistency: Problem of
PRODUCTION= GAP NOT of ability (that is a learning disability)
trouble generating & sustaining response Inconsistency: ADHD
profiles are unique & individual Inconsistency: ADHD causes
brain development & processes to mature more slowly, less
routed Inconsistency: Sensitive to demands of environment
EF/attention tires-Barkley
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STUDENTS get our attitude at HOME & at SCHOOL from peers,
siblings, teachers, grandparents, parents
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Why is ADHD hard to accept? We often think we already know what
it is.
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Whats up with the term ADHD? DSM: Diagnostic Manual of
Psychiatric Disorders ADD/ADHD are now the same- ADHD Describes
symptoms in general- not WHY Next revision underway and contested
Will include separate adult criteria Under-diagnosed/treated
POPULATIONS: Girls, adults, those without hyperactivity &/or
learning disabilities, mental health /other problems
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DSMs Characterization of ADHD ADHD
HyperactivityInattentivenessImpulsivity
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3 subtypes Combined (ADHD-C) Mostly In-attentive and Impulsive
features: disorganized, non-productive responses and poor
persistence over time Predominantly Inattentive- (ADHD-I) No
behavior flags other than poor production: poor completion and
organizing of work. Often undetected or later. Predominantly
Hyperactive and Impulsive - (ADHD-H) Usually able to be attentive.
Characterized by senseless and useless motor activity and poor
planning/insight.
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It is complicated! Physical movement can operate to keep the
self alert dropping pencil allows for movement example: college
student pinches self, repetitive chap stick -movement awakens &
overrides rut Focus- students with ADD/ADHD can hyper focus
Sustains an activity or topic longer than expected Trouble emerging
from it without dis-regulation, Often emotional outbursts when
young
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DSM vs. Exec Functioning DSM IVEFD Description of symptoms only
Hyperactivity, Inattention, Impulsivity Under dx of groups: Girls,
Adults, co- existing LD & MI/relational, w/out hyperactivity
Identifies specific behaviors EFD common feature of other
LD/Aspergers Everyone can relate to All students benefit from
classroom development-universal design classroom
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Exec Functions manage the self (emotions/cognitions/behavior)
for the benefit of the self
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ADHD & Executive Functioning ADHD is a physical, brain
based condition in which the prefrontal lobe activities (EFs) are
weaker Possible causes: Lower levels of neurotransmitters
(dopamine- pleasure/reward & norepinephrine-adrenalin) Notable
differences in brain structures, primarily pre-frontal but other
areas too Slower and less neuro development & speed
ADHDs brain differences but they certainly reinforce each
other
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Reinforcement: ADHD is Inherited 75% of the time ADHD is
genetic Other causes include: premature birth, fetal exposure to
toxins, pitocin use=complicated birth/stress Barkley, 2011 Students
ADHD is usually FAMILY ADHD
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Why is ADHD difficult to accept What are our norms for
comparison? ADHD is common- 7-10%, adults -4% Genetic condition-
75% of the time inherited Adult ADHD complicates parenting-
accounts for ODD/CD often, easy to blame how child being raised
Social and cultural changes and challenges to attention Directed
attention fatigue vs attention restoration
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Executive functioning Capabilities that allow people to
regulate/choose behaviors overt time for their own welfare Includes
capacities of self control, problem solving and persistence Creates
an internal representation & thus use of knowledge, including
memory of consequences EF deficits, especially working memory, are
part of other learning disabilities
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Executive Functions The individuals self directed actions that
inhibit instinctual reactions, delay gratification, anticipates
changes & adjusts responses to environment Most needed for less
routine activities EF produces self awareness & goal directed
behavior EF helps us experience time
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Why is ADHD difficult to accept? All of us experience some ADHD
symptoms Executive functioning is developing until our 30s All kids
have EFD, especially teens Executive functioning can be depleted
and restored studies about directed attention vs fascination ADHD
is a continuum & developmental disorder
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ADHD as Exec Functioning Deficit Barkleys Big 5- inhibition,
nonverbal &verbal working memory, self-regulation, response
http://www.childmind.org/en/posts/articles/2010-11-12-adhd-and-executive-function
Brownes 6 Clusters nicely applied & organized
http://www.chadd.org/AM/Template.cfm?Section=especially_for_adults&Template=/C
M/ContentDisplay.cfm&ContentID=5802 **SeeImpairments in
Executive Functioning chapter for both authors work nicely
summarized. The School Counselors Guide to ADHD Richard Loughy,
Silvia DeRuvo & David Rosenthal, MD
1- Inhibition FOUNDATIONAL to other EF Relates to DSM features
of H/Inattention/Impulsivity Defined: Ability to inhibit behavior,
to STOP, think- & make choices being aware of future
consequences Relates to preventing motor activity as a immediate
response (hyperactivity) and to ATTENTION= inhibiting focus from
flitting from stimuli to stimuli
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2 &3- Working Memory Defined: Like a clipboard, holds info
we are using Using creates Connections/meaning Storing creates
memories Two types: non-verbal (the minds YouTUBE) & verbalized
(language/audio) Non-verbal= quick prompts, images, speeds up
processes, developmentally first step towards language-VYGOTSKY
Verbal- assigns words to images, self talk & questions
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Working Memory-Minds Clipboard It creates the MINDmovie which
provides self talk, prompts for responses and reflection WM makes
learning/information significant because it gets connected while it
stays on clipboard
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Working Memory & ADHD ADHD- the clipboard gets wiped clean
quicker, there isnt enough neurotransmitter activity to sustain it
Accounts for Delay in internalization of speech Slower processing
speeds/response Impaired ability to learn from consequences
Impaired ability to realize successes, cohesive self Learning not
as connected
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4- Generating a Response: Emotional Regulation Defined:
self-regulation of affect, motivation and arousal Emotional
competence has 3 parts- expression, understanding and regulation
ADHD can dis-regulate any of these parts, processing before
reacting is difficult (due to weaker MINDs movie as well) ADHD-
transitions between stimuli can be hard
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Emotional Regulation & ADHD Emotions fuel motivation/drive-
if thwarted.. Impacts the significance of experiences/meaning When
intense- often disconnected, very distracting, furthers
dis-regulation Impacts our identity & relationships Expression
of emotions effect how others see us Significant factor in
immaturity and social isolation
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5- Generating a Response: Problem Solving Defined: Ability to
target behavior to benefit self by analyzing, being goal-directed,
flexible and creative ADHD prevents access to MINDs movie &
emotional modulation, persistence &planning poor To be GOAL
DIRECTED- several things that are necessary are weaker and break
down with ADHD
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Problem Solving & ADHD For GOAL Directed behavior to
persist need: Emotional investment often thwarted in ADHD, in part
due to the intensity and inaccuracy too Vivid self-talk- MINDs
Movie & Vygotsky Ability to link input & create meaning-
memory Anticipation of consequences based on prior experiences and
analysis, self-talk CONFIDENCE in abilities so willing to risk a
try, based on prior successes and feeling of reward (dopamine)
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The ADHD Question Why can my student with ADHD do better when
they like the task, but not at other times? For parents: Why cant
they pay attention to this? They certainly can pay attention to
computer games! OUR conclusion: They are just not trying/dont care
STUDENTS conclusion is..? STUDENTS GET our attitude AT HOME
&SCHOOL
Slide 34
Answer: Inconsistency is ADHD Inconsistency: Problem of
PRODUCTION= GAP NOT of ability (that is a learning disability)
trouble generating & sustaining response Inconsistency: ADHD
profiles are unique & individual Inconsistency: ADHD causes
brain development & processes to mature more slowly, less
routed Inconsistency: Sensitive to demands of environment
EF/attention tires-Barkley
Slide 35
What are some ADHD situations you encounter with students? In
the classroom On the playground or during less structured times
With their parents
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Scenario 1 A student often brings in their homework incomplete.
The answers they do finish are messy and the last ones generally
look like little effort was given to them. Often the last ones are
wrong entirely despite the abilities of the student. The parent
reports it takes the child hours to do something other students are
finishing in 20 minutes.
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Scenario 2 A student always arrives late to class and unable to
settle into morning routines. The parent reports every morning they
fight about the same things. The student doesnt seem to adhere to a
routine.
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Scenario 3 A student seems unable to participate in project
learning with on her own and with classmates. Her participation
seems to annoy other classmates. The results of her work are
incomplete and not well designed despite her initial interest. Her
parents report she waits until last minute and sometimes doesnt
even tell them about her assignment.
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Why is ADHD hard to accept? ADHD is a problem of production not
ability Behavior often perceived as a choice, not a symptom..
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Exec Functioning Depletion Normal that ability to direct our
attention becomes depleted Attention : Varies with kind Sensitive
to environment & demands ADHD- depleted quicker, less
modulation, transitions difficult, sensory issues
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Rates of Coexisting Problems 80% of people with ADHD also have
another disorder 50% have two or more disorders Learning
disabilities- 24-70% (Barkley) Sleep disorders-30-56% Mental Health
Issues Physical health Relational/Social Problems
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Other related LD/MH Conditions Anxiety 25-30% OCD up to 30%
Depression: range of severity 25-30% Oppositional Defiant Dx
35-70%, M= 55% Conduct Dx 30-75% Physical health problems: GI
esp-perhaps related to anxiety, poor motor development-clumsy
Learning disorders: 15-40% With reading, spelling, and handwriting-
can improve with stimulant medication 2009 Pearson Educational,
Inc.
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Implication of Family ADHD What is normal? Whole child &
learning processes at home Relationships: attentiveness,
consistency, cohesion, organization, successful impact/influence
Reward of relationships & efforts, problems with create core
issue problems and coping Ericksons Stages of Child Development-
Early esp
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Ericksons Stages
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Slide 46
Relational Disordering/ODD&CD Adlers phases
http://pws.cablespeed.com/htstein/dealing.htm
http://www.examiner.com/article/positive-discipline-
parenting-tool-adler-s-mistaken-goals-of-behavior Oppositional
behavior & ADHD connection When PARENT has ADHD Barkley- 4
factor model of defiant behavior
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ADHD or Learning disability ADHD: impairment is an
unavailability to learn & difficulty producing responses
socially and academically Learning disabilities: related to an
inability to learn due to an impairment
Slide 48
Learning Disabilities & ADHD Highly related to ADHD
Handwriting problems Comprehension deficits (working memory) Can be
related (working memory, organizational, Exec functioning
depletion) Math, spelling, reading errors
Slide 49
Secondary Features of ADHD/LD Responses to the primary
condition: effect whole child Sometimes more problematic than
primary Diminish motivation & self-efficacy beliefs Can become
depressed, ODD, CD, Anxiety Lower SES, job instability,
self-medicating: teens & college, poorer physical health due to
lack of routine
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Why is ADHD hard to accept? There is no one ADHD profile
Complex & varied individual profiles of EFD number of Exec
Functions-vary/grouped Range of Severity-symptoms &
compensations Lifelong compensation strategies/outcomes Secondary
and coexisting problems
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Barriers to accepting ADHD Executive functioning is
developmental- normal for kids to not always exhibit quality self
management It is a continuum disorder- has to cause impairment
beyond normal for age Common & genetic 75% of time (what is
your norm?) Not problem of ability. Problem of production.
Depletion of EF- we all get depleted sometimes, ADHD harder to
restore functioning, lower levels of Profiles of ADHD symptoms
unique to individual
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Interventions & Treatment Interventions- primarily family
driven, focused include diagnosis and treatment Treatments:
Stimulant or other medication Externalizing executive functioning
Behavioral plans &/or incentives For adults and teens:
cognitive behavioral therapy coaching-life skill develop.
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Reactions to a diagnosis of ADHD Parents: Relief- hope for
change, may seem minor Explains something otherwise personalized as
character Dismay, worry, overwhelmed with info/tasks Disbelief: may
be comparing in ways that normalize Already tired, feel loosing
child, struggle to relate/enjoy Student: Same as above, but with
diagnosis they may also feel hopeless, flawed & out of control
because of medical label It is a description for their
difficulties, not of them, that should mostly focus on creating
insight and strategy.
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A diagnosis How do we know when a diagnosis/perspective is a
helpful way to understand a student? How do we know when it is
unhelpful? How do we keep it helpful? How do we create
conversations and strategies about barriers to student growth that
are helpful?
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Metaphors for Exec Functions Supervisor/ CEO Factory manager
The brains brakes: your car is a Porsche, lets upgrade the brakes
Your evaluating & envisioning self
Others:__________________________
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Stimulant Medications Stimulates body to produce
neurotransmitters norepinephrine (adrenaline) & dopamine
(pleasure) MAKING ROUTING/learning more potent? Improves the
ability to sustain attention Improves verbal learning Doesnt
improve organizational/planning functions, interference control, or
processing speeds- improves with psycho-education and practice
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Stimulant medications Helps 70-80% of people Parents often need
teachers observations to assess medications effects accurately Side
affects usually wear off, but can look worse- increase amount until
symptoms re-appear ***See Changes in Students on Medications
section The School Counselors Guide to ADHD Richard Loughy, Silvia
DeRuvo & David Rosenthal, MD
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Psycho-ed for student & family Priority should be to
maintain a healthy, appreciative relationship with child Balance
change directed interactions/corrections with observations and
praise of positives/accomplishments Ratio of positive to
constructive/corrective can vary with tasks, but should be along
4-5:1 EXTERNALIZE executive functions: use management tools that
are auditory, visual and kinesthetic routinely Strategize with
child: name problem with them, id contributors, plan, implement and
track, evaluate/redesign and re-implement
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What is Helpful Know what ADHD can be- possible unique profiles
Externalize problems- separate ADHD from who child is and can be
Diagnosis & strategy- can bring breathing room, hope View of
whole child (needs strengths dreams) Build appreciation: of their
struggle and strengths Connection and relationship FIRST Identify
& appreciate strengths and attributes of child Identify &
appreciate your strengths and attributes and the environments /
requirements
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Educators Your most important job maybe to help student develop
a positive identity as a learner and tolerate process, not just
results ADHD students need to gain insight into how ADHD effects
them and to develop skills to manage ADHD students need to have
needs & challenges normalized- use Multiple Intelligences,
Learning Styles, study and organizational skills
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Your strengths- the Kolbe Index Schools developed with
expectations that are usually opposite from ADHD
strengths/attributes Teachers personally often have or developed
great organizational skills-match school environment Students with
ADHD & their families may feel like complete opposites from
school enviro/expectations LINK:
http://www.kolbe.com/assessmentTools/assessment-
tools.cfmhttp://www.kolbe.com/assessmentTools/assessment-
tools.cfm
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Kolbe Index Summary 4 instinctual ACTION MODES- can develop
conscious control over Fact finding Follow through Initiating
Implementing Individual behavior range within each of above is:
Initiating Responding Preventing
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We are motivated best by our successes.
Slide 64
Confidence & motivation Confidence comes after
accomplishment Accomplishment comes after application of self
Application comes after opportunity for involvement Opportunity
comes with real access Access allows for opportunity Opportunity
allows for application of self Application allows for
accomplishment Accomplishment allows for confidence
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Accommodations are the key Accommodations create the access
that beginning a process in which students experience SUCCESS,
building confidence which motivates further student effort despite
the extra challenges of a learning disorder Teaching is
accommodating-you find ways to make information and experiences
significant to students everyday
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Accommodations vs Modifications Accommodations: Addresses the
HOW Allows access Doesnt affect academic rigor Modifications:
Addresses the WHAT Adjusts expectations Changes content
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Accommodations = Access Consider alternate ways to present
material (based on strengths, interests, successes. Remember
auditory, visual, kinesthetic Consider alternate ways student may
respond and show work
Slide 68
ADHD & Accommodations Remember what ADHD is: 3 Subtypes:
Hyper/Impulsive, Inattentive & Combined A unique profile of
executive function deficits Inconsistency & poor production
despite ability All kids still developing EF-benefit from EF
instruction School performance effects & is effected
academically & socially & emotionally physically &
psychologically Goal directive motivation difficult to sustain
OTHER.
Learning styles & ADHD Auditory, visual and kinesthetic-
assess how your student likes input & output (expressing
learning) Vary modalities/presentation: avoid overusing auditory
Foster independence & privacy with visual cues, prompt cards,
use your physical presence, music/rhythm Uncommon Schools.org Build
in kinesthetic- movement & fidget tools
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More about our ARDVARKS ADHD students often have sensory
integration issues May tune out some senses to try to focus (no eye
contact when listening) May deliver another input (dropping pencil)
to try to make self alert May burn out on input/learning style that
is strongest quickly become over stimulating
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Teach Organizational Strategy Organize things (folders,
binders, notebooks) Organize space (desk, locker, home study spot)
Teach & practice principles of organization- use AVK prompts,
SMART goals & prioritizing Develop sense of time or use of
tools routinely to help (write estimated time prior and actual time
it took after) Monitoring and coaching- allocate time daily/weekly
for organizing
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Teach self- regulation Have a common classroom vocabulary Read
the room Whats your plan Freeze Time to make a shift Check &
Correct Would you like a do-over/rewind? How much time do you need
to get this done? Model & encourage self-talk (may be
whispered) for task initiation, planning, organization and
completion Teach self- administered rewards (Ill do this and then
reward myself by.. or take a break by.) Visualize, externalize, or
make concrete outcomes, Label internal states
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Teach Problem Solving Externalize by modeling & discussing
Prompt steps with multi-modal cues (AVK) 4 Steps: identify problem
(verbalize), generate options, choose action, monitor and realize
results Consider implementing class or school wide strategy
campaign to benefit all students
Helpful perspectives Think in terms of continuums &
development Create a profile of students unique strengths &
problem areas Allows for variance & normality of some aspects
of ADHD Highlight successes and PROCESS
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Strengths Resistance to labeling Strong developmental
perspective Teaching methods that vary learning modalities for
different input and output opportunities Multiple Intelligence-
values and utilizes students ways of expressing and approaching
knowledge Learning styles (A,V, K)- actively assess & use
Social experiences part of everyday learning Child is respected as
a whole and developing person The process of learning is attended
to & valued Others? How might these operate as barriers as
well?
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Strategy should address Whole child perspective &
developmental processes Academic, social, emotional, psychological,
physical Requirements of task: what happened prior to and what
needs to after Requirements that support positive relationships: to
learning, others and self Be MULTI-Sensory (AVK) for learning
styles
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Impact on the whole child Self- concept
AcademicSocialEmotionalCognitive
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. I hope you have more questions, curiosity and wonder about
ADD/ADHD after today.
