A Look Inside. Executive Functioning Deficits. Wendy Kelly, M.A., C. Psych. Assoc. Psychological Services, Kawartha Pine Ridge DSB

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1 A Look Inside the ADHD Brain: Executive Functioning Deficits Wendy Kelly, M.A., C. Psych. Assoc. Psychological Services, Kawartha Pine Ridge DSB October 19, 2013 Parent Conference

2 Nature of AD/HD Subtypes: 1) AD/HD: Primarily Inattentive 2) AD/HD: Primarily Hyperactive/Impulsive 3) AD/HD: Combined Type Current thinking suggests that all cases of AD/HD are of the combined type (Barkley, 2007) and that the pure inattentive subtype may be a distinct disorder.

3 Diagnostic Criteria: AD/HD AD/HD Predominantly Inattentive Type Fails to give 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 sustained mental effort. Loses things. Is easily distracted. Is forgetful in daily activities

4 Diagnostic Criteria (cont d) AD/HD Predominantly Hyperactive/Impulsive Type Fidgets with hands or feet or squirms in chair. Has difficulty remaining seated. Runs about or climbs excessively. Difficulty engaging in activities quietly. Acts as if driven by a motor. Talks excessively. Blurts out answers before questions have been completed. Difficulty waiting or taking turns. Interrupts or intrudes upon others

5 Prevalence Approximately 5 per cent of children/adults have AD/HD. Many of these cases also have other, comorbid disorders: mood (18%), anxiety (25%), and behaviour (35 50%). Estimates ranging from 12 to 60 per cent of AD/HD children have learning disablities (reading, writing, math).

6 Brain Dysfunction 1. Disruption in regulation of brain chemicals (neurostransmitters: dopamine and norepinephrine) in the synapses of the frontal lobe and the basal ganglia. These areas are associated with focusing attention, blocking distractions, and inhibiting behaviour.

7 Brain Dysfunction 2. The frontal area of the brain and the basal ganglia are up to 10 per cent smaller in children diagnosed with AD/HD. 3. Approximately 75 per cent of cases are due to genetic transmission/heredity; 25 per cent, due to acquired brain injuries.

8 The key characteristic of AD/HD is not INATTENTION but rather, DISINHIBITION.

9 I prefer to distinguish ADD as attention abundance disorder. Everything is just so interesting... remarkably at the same time. Frank Coppola, MA, ODC, ACG

11 Core Deficits in AD/HD: Executive Functioning Executive functions.. are mental processes that direct a child's thought, action and emotion, particularly during active problem solving. are characterized as metacognition in the sense that they orchestrate numerous subdomains of thought and action.

12 Executive Functions Behaviour Regulation Inhibit Shift Emotional Control Metacognition Initiate Working Memory Plan/Organize Org. of Materials Monitor

13 Executive Function: Inhibit Definition: Not acting on an impulse or appropriately stopping one s own activity at the proper time Dysfunction: Has trouble putting on the brakes on behaviour; acts without thinking

14 The Stroop Test red blue yellow green blue green yellow red green red blue green red yellow red green green blue red yellow blue green blue red red blue red yellow

15 The Stroop Test red blue yellow green blue green yellow red green red blue green red yellow red green green blue red yellow blue green blue red red blue red yellow

16 Executive Function: Shift Definition: Freely moving from one situation, activity, or aspect of a problem to another as the situation demands Dysfunction: Gets stuck on a topic or tends to perseverate

17 Wisconsin Card Sort

18 Executive Function: Emotional control Definition: Modulating/controlling one s own emotional response appropriate to the situation or stressor Dysfunction: Is too easily upset, explosive; small events trigger big emotional response

19 Executive Function: Initiate Definition: Beginning a task or activity Dysfunction: Has trouble getting started on homework or chores

20 Executive Function: Working Memory Definition: Holding information in mind for the purpose of completing a specific and related task Dysfunction: Has trouble remembering things, even for a few minutes; when sent to get something, forgets what he or she is supposed to get

21 I m going to say some numbers, and when I m finished, I want you to say them to me backwards in reverse order. I m going to say some numbers and letters, and I want you to say them back to me numbers first, in order from smallest to largest, and letters in alphabetical order.

22 Executive Function: Planning Definition: Anticipating future events, setting goals and developing appropriate steps ahead of time to carry out an associated task or action Dysfunction: Starts assignments at the last minute; does not think ahead about possible problems

23 Executive Function: Organization/Organization of Materials Definition: Establishing or maintaining order in an activity or place; carrying out a task in a systematic manner Dysfunction: Has a scattered, disorganized approach to solving problems; is easily overwhelmed by large tasks or assignments

24 Executive Function: Monitoring Definition: Checking on one s own actions during, or shortly after finishing, the task or activity to assure appropriate attainment of goal Dysfunction: Does not check work for mistakes; is unaware of own behaviour and its impact on others

25 Executive Functions Behaviour Regulation Inhibit Shift Emotional Control Metacognition Initiate Working Memory Plan/Organize Org. of Materials Monitor

26 Individuals with executive function deficits are left with a form of temporal nearsightedness or time blindness that produces substantial social, education, and occupational problems. Those with AD/HD often know what they should do or what they should have done before, but knowing provides little consolation to them, little influence over their behaviour, and often much irritation to others. Russ Barkley, 1988

27 Tips for Parents Think positively Define schedules and routines Set clear rules and expectations Give clear instructions Discipline, rewards and consequences Use time out effectively Ignore, within reason

28 Tips for Parents Develop organizational aids Eliminate distractions Set small, attainable goals Focus on one or two challenging behaviours at a time Find areas in which the child excels Promote a healthy lifestyle Show your unconditional love Take care of yourself

29 Take aways 1. AD/HD is a brain disorder, and is not caused by lack of motivation, laziness, or having a bad attitude. 2. Deficits in executive function are hallmark characteristics of AD/HD. 3. Disinhibition is the problem, not inattention. 4. Many students with AD/HD also have specific learning disabilities and other disorders. 5. You can make a difference in the academic, social, and emotional status of these students.

30 Relevant Web Resources to ldsadhd/

About ADHD in children, adolescents and adults

About ADHD in children, adolescents and adults About ADHD ADHD is not a new disease. ADHD and other disorders with similar symptoms have been described for more than a century. Although ADHD may seem more