A Peek Inside the Mystery. ADD/ADHD Students. June, 2015 Presented by: Bryan Harris, Ed.D.

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1 A Peek Inside the Mystery Understanding andteaching ADD/ADHD Students June, 2015 Presented by: Bryan Harris, Ed.D. But, by the time think about it, I ve Ive already done it.

2 Question: Can you identify the one with AD/HD?

3 Answer: None of the above. The one with AD/HD was late for class and missed bi being in the picture. it

4 Take Home Messages AD/HD is not a disease nor is it a joke; do not blame the person nor trivialize the condition. Students with moderate to severe AD/HD are highly at risk for behavioral, emotional and academic failure. Those with AD/HD can and do succeed with proper diagnosis, intervention and support.

5 Goals Overview, Definitions, Symptoms Myths & Facts, Causes Successful Strategies t Summary & Action Plan

6 First, An Overview Let s get a critical understanding of the condition with its associated features and a discussion of key diagnostic issues.

7 Clinical Definition (1 of 2) AD/HD is a persistent disabling pattern of behavior. It occurs more frequently and with greater consequences than is typically observed in others at a comparable level l of development. Handout - CLOZE

8 Clinical Definition (1 of 2) AD/HD is a condition characterized by: Poor short term memory Hyperactivity Impulsivity Poor time management Handout

9 Clinical Definition Key All AD/HD behaviors can be considered normal for some people, at some age for a certain time. With AD/HD, these behaviors are the rule and not the exception and they are age inappropriate. i Source: DSM-IV-TR, 2000 Handout

10 Clinical Qualifiers 1. Onset before age 7 yrs. 2. Diagnosis often delayed until problems in school 3. In two of three settings -home, e,school,,office 4. Rule out other potentially look-alike psychiatric disorders such an oppositional disorder, sensory integration disorder, central auditory processing disorder, learning delays, schizophrenia, stress disorders, psychosis or trauma. Source: DSM-IV-TR, 2000 Handout

11 U.S. Government Definition Attention deficit-hyperactivity disorder (ADHD) is a neurobehavioral disorder that interferes with a person's ability to stay on a task and to exercise age- appropriate inhibition (cognitive alone or both cognitive and behavioral). Source:

12 Diagnosis (1 of 2) The AD/HD diagnosis carries with it significant implications for families, educators and of course, the child. Only a licensed professional, such as a pediatrician, psychologist, neurologist, psychiatrist py or clinical social worker, can make the diagnosis that a child, teen, or adult has AD/HD.

13 Diagnosis (2 of 2) Health care professionals use the Diagnostic and dstatistical Manual of Mental Disorders, 5th Edition, Text Revised (DSM-V-TR) as a guide (APA, 2013).

14 Important People Quotes Please read the quotes on page 4 of your handouts

15 Some still doubt

16 Brain Differences in AD/HD Subjects Neurotransmitter imbalances Lower cerebral blood flow Lou, et al., (2004) Anatomical differences between healthy brains and those with AD/HD Castellanos, et al. (2002), Castellanos and Acosta,(2004)

Brain Differences in AD/HD Subjects Magnetic

lobes, temporal gray matter, posterior inferior

17 Brain Differences in AD/HD Subjects Magnetic Imaging Resonance (MRI) found a range of abnormalities in brain development associated with AD/HD Brains are 3-4% smaller in more frontal lobes, temporal gray matter, posterior inferior vermis, caudate nucleus and cerebellum. Castellanos F. Acosta M. (2002)

18 Functional Differences Typical Brain AD/HD Brain etkin, et al., Zam PET studies suggest abnormalities in catecholamine function in AD/HD. Under-activity of the aminergic system in such regions may lead to deficits i in attention and activity level. Depressed release of dopamine has role in AD/HD (Volkow et al, 2003). The rate at which brain uses glucose, its main energy source, is lower in subjects with AD/HD than those without. (Zametkin et al, 1990)

19 Differences are Both Anatomical & Chemical Brain Structures Involved With AD/HD anterior cingulate frontal lobes basal ganglia reward pathways hippocampus cerebellum

20 AD/HD Behaviors/Symptoms Poor short-term memory Weak at following directions Asking another what was just said Looking at others to figure out what was said Late for time commitments Desk is a mess--poorly organized Forgetting about promises made Knowing what and how but not knowing when and where to do it--it s appropriateness

21 Myths & Facts Myth Fact ADD is just a fad Over diagnosed Hyper boys American Invention 100+ years 3-10% (2%) 7 types All over the world Handout

22 Myths & Facts Myth Fact Caused by bad Everyone outgrows Minor problem No link Some never do 35% never finish HS 25% repeat a grade 3 x the divorce rate Handout

23 Causes Bottom line we don t know for sure Genetic & non-genetic components Dysregulation of Serotonin and Dopamine Not related to IQ It is context-dependent Head injuries FAS and drug abuse by mothers

24 AD/HD and Other Disorders 25% of children diagnosed with AD/HD also qualify for a diagnosis of oppositional defiant or conduct disorder (CD). Nearly 20% of children with AD/HD also have a depressive disorder. More than 25% of children with AD/HD qualify for a diagnosis of anxiety disorder. Almost 33% of children with AD/HD also have more than one comorbid condition.

disorders Depression Learning disorders Tourette s disorder Obsessive-compulsive disorder (OCD) Attention

25 Comorbidity (appearing together) More often than not, AD/HD presents itself with other cognitive i and dbehavioral lissues including: Oppositional defiant disorder Conduct disorder d Dyslexia Anxiety and mood disorders Depression Learning disorders Tourette s disorder Obsessive-compulsive disorder (OCD) Attention Deficit Hyperactivity Disorder: A Decade of the Brain Report , (1996). Bethesda, MD: National Institute of Mental Health.

26 Question What is your best, clearest understanding of what is different in the brains of those with AD/HD?

27 Risk Factors of AD/HD Academic underachievement Legal problems Substance abuse Social difficulties Risky behaviors

28 Your Choices 1. Changes within the student (meds, skill-building, nutrition, self-awareness, etc.) 2. Changes in the environment (more mobility, change in teachers, cooler room, etc.) 3. Changes in the teacher s behavior (more awareness, accommodations, skill-building, etc.) 4. Changes in the overall school culture (awareness, greater appreciation for differences, etc.) 5. Influence parenting (less nagging, greater support, more consistency, etc.) NOTE: Where do you have the most control? Handout

29 When You Treat AD/HD What s the Goal? To change behavior, of course but how? All AD/HD-related behavior change focuses on strengthening the capacity of the frontal lobes. This can be done chemically or behaviorally.

30 Spot the difference time! Student A Student B

31 Mainstream Treatments When AD/HD is moderate to severe, the typical, mainstream, multimodal treatment plan is likely to include medication. The typical multi-modal treatment approach consists it of ffour core interventions: ti 1. Patient, parent, and teacher education about the condition 2. Medication (usually from the class of drugs called stimulants) or nutritional support 3. Behavioral therapy 4. Environmental supports, including an appropriate classroom accommodations.

used, but many medical staff are untrained in a wide

32 Actual Mainstream Treatments Used Medications Medications Medications Some behavioral therapy is used, but many medical staff are untrained in a wide range of behavioral strategies (and follow through is problematic)

33 Six Alternative Treatments When AD/HD is mild to moderate, these interventions may be highly effective without the use of medications. Nutritional Support Lifestyle Skill-Building Neurofeedback Environmental Changes Student t Asset-Building Handout

34 Building Student Assets (1 of 3) Overall Approach Put your efforts on internal empowerment rather than external control. Help support students in discovering i their inner resources. Remember we all have differences. Focus on what the student can do and work to build on strengths. Handout

strong self-esteem Use short-term contracts for behaviors Teachproblem problem-solving

35 Building Student Assets (2 of 3) Teach positive self-talk skills Helpthe child understand human differences Show them how they are different from and are similar to others Support strong self-esteem Use short-term contracts for behaviors Teachproblem problem-solving Helpstudents recognize non-verbal language and unwritten rules to enhance social and friendship skills Handout

36 Building Student Assets (3 of 3) Focus on the student s interests and build passion Teach study skills and how to use clocks, calendars and Post-its How to organize and to highlight information Teach your child to visualize and focus Use effective communication i skills, social skills, peer tutoring, cooperative learning, etc. Handout

37 Nearly every accommodation you are being asked to make is simply high quality teaching. It does not give AD/HD students any advantage; it simply levels the playing field.

38 20 Strategies that can help right now! #1 Maintain a Positive Attitude Be Brief, Be Positive, Be Gone Check In Statements Looks Like, Sounds Like, Feels Like Planted Questions/Planted Answers A Head Start Closed Fist 2 x10 Statements vs Questions Concrete Reminders Three More Minutes, and Handout

39 20 Strategies that can help right now! #1 Maintain a Positive Attitude Advance Organizers Learn to Ignore Checklists Headphones Start Statements Sentence Starters Stand and Stretch Energizers Rating Scales SLANT Handout

40 Take Home Messages AD/HD is not a disease nor is it a joke; do not blame the person nor trivialize the condition. Students with moderate to severe AD/HD are highly at risk for behavioral, emotional and academic failure. Those with AD/HD can and do succeed with proper diagnosis, intervention and support.

41 Plan of Action The idea(s) that is the most applicable for my work setting is Based on what we ve discussed / done, I will I d Id still like more information about

42 Free Newsletter & Resources - website For more information:

Attention Deficit Hyperactivity Disorder: Module 2

Attention Deficit Hyperactivity Disorder: Module 2 Programmed Learning Forms Handbook The information in this training module was taken from an online article by the National Institute of Mental Health.