ADHD: MORE THAN ATTENTION PROBLEM JULIE STECK, PH.D., HSPP CRG/CHILDREN S RESOURCE GROUP

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1 ADHD: MORE THAN ATTENTION PROBLEM JULIE STECK, PH.D., HSPP CRG/CHILDREN S RESOURCE GROUP

2 UNDERSTANDING THE NATURE OF ADHD IS CRITICAL TO TREATING THE DISORDER HYPERACTIVITY IS JUST THE TIP OF THE ICEBERG

3 HYPERACTIVITY Hyperactive and impulsive behavior emerges first in those with Combined Type Inattention does not emerge until 2 to 3 years later With age, hyperactivity often declines but difficulty with inattention and inhibition does not Verbal impulsiveness more impairing in adulthood than hyperactivity

4 SYMPTOMS VARY DEPENDING ON SITUATION BETTER Fun, exciting Immediate consequence Frequent feedback High interest Early in day Supervised situation WORSE Boring Delayed consequence Infrequent feedback Low interest Later in day Unsupervised situation

5 ADHD IS... Not an input disorder A disorder of performance, not skill Not a matter of knowing what to do Doing what you know Responding more to stimuli than others do Paying more attention to task irrelevant information

6 ADHD IS... Time blindness Living in the moment Difficulty using knowledge of the past at the point of performance Inattention to mental events and the future

7 ACADEMIC DIFFICULTIES CAUSED BY ADHD Reading comprehension Written expression Speed and accuracy of math calculation Handwriting Listening comprehension

8 AREAS OF DEFICIT IN ADHD Inhibition Self-regulation Executive functioning

9 INHIBITION Inhibiting the dominant response Interrupting ongoing behavior Protecting the executive functions from interference/distraction

10 EXECUTIVE FUNCTIONS Working memory and recall Activation, arousal and effort Internalizing language Emotional self-regulation Planning and problem-solving

11 DEFICITS IN WORKING MEMORY Difficulty holding information in mind to guide one s actions Poor at multi-tasking Difficulty using hindsight to guide actions Little use of forethought to plan/adjust Poor sense of time cannot estimate time or plan over time

12 DEFICITS IN WORKING MEMORY More impairing with age due to increased volume and complexity of information Deficits also seen in menopausal women

13 DEFICITS IN ACTIVATION, AROUSAL AND EFFORT Procrastinates getting started on tasks not of their choosing Difficulty stopping preferred tasks Becomes sleepy/sluggish on non-preferred tasks Gives up easily Trouble maintaining effort once frustrated

14 POOR USE OF INTERNALIZED LANGUAGE Delayed use of the mind s voice Impairs ability to follow through on own plans Interferes with reading comprehension and written expression Impairs ability to contemplate events and own behavior

15 POOR EMOTIONAL REGULATION Emotions are not inappropriate but are made public Unable to keep emotions private and moderate them Difficulty with self-motivation Easily frustrated

16 DEFICITS IN PROBLEM-SOLVING Trouble taking an issue apart Difficulty planning and generating options toward a goal Poor verbal and nonverbal fluency Diminished flexibility in finding solutions

17 IMPLICATIONS FOR TREATMENT Need more positive than negative consequences Need more frequent consequences Behavioral treatment does not last once it is discontinued Information should be externalized Time should be externalized

18 IMPLICATIONS FOR TREATMENT Long-term tasks should be broken down into many small tasks Motivation should be externalized Allow/encourage manipulation of tasks to improve learning Expectations need to be decreased

19 THE MORE YOU ASK FOR SELF- ORGANIZATION, THE MORE HE/SHE WILL FAIL. AND YOU ARE THE PROBLEM. WHY DID YOU ASK? RUSSELL BARKLEY, PH.D.

20 TOP 10 THINGS TO KEEP IN MIND For individuals with ADHD, time is the enemy. If they are doing something they enjoy, there is not enough time. If they are to do something they don t enjoy, they will procrastinate or just not do it. Individuals with ADHD have difficulty sustaining mental effort. They also have trouble remembering to do what they need to do when they need to do it.

21 TOP 10 THINGS TO KEEP IN MIND ADHD causes a 30% delay in the acquisition of skills requiring self-regulation The greater the requirement for self-regulation and organization across time and space, the greater the likelihood for failure An individual with ADHD performs well once and we hold it against them forever

22 TOP 10 THINGS TO KEEP IN MIND Those with ADHD live in the moment they don t reflect on the past to remember what happened last time or look to the future to think of the consequences of their behavior. ADHD causes individuals to have trouble stopping a behavior in the middle of a behavior. Most of what we know about ADHD is based on research on males but females with ADHD are just as much at risk for problems in all areas of functioning

23 BIBLIOGRAPHY Barkley, R.A. (1998) Attention-Deficit Hyperactivity Disorder Second Edition. New York, NY. The Guilford Press. Barkley, R. A. & Gordon, M. (2002). Comorbidity, cognitive impairments, and adaptive functioning in adults with ADHD: Implications of research for clinical practice. In S. Goldstein & A. Teeter (Eds.), Clinical interventions for adult ADHD: A comprehensive approach (pp.46-69). New York: Academic Press. Barkley, R., Murphy, K., & Fischer, M. (2008). ADHD in adults: What the science says. The Guilford Press mbc8efl6ux5_wwgp8i0mas-cvy

24 BIBLIOGRAPHY Froehlich, et al. (2007) Prevalence, Recognition and Treatment of Attention-Deficit/Hyperactivity Disorder in a National Sample of US Children. Archives of Pediatrics and Adolescent Medicine, 161 (9): Mannuzza, S. & Klein, R.G. (2000) Long-term prognosis in attention-deficit/hyperactivity disorder. Child and Adolescent Psychiatric Clinics of North America, 9, The new CHADD information and resource guide for AD/HD. (2005) Published by CHADD. Wilens, T. ADHD and the SUD in Adolescents. Paradigm Magazine, Fall 2006.

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