Attention Deficit Disorder/ Attention Deficit with Hyperactivity Disorder and Executive Function Difficulties Dr. Danielle Morris Psy. D. - Clinical Psychologist Marybeth Fussa M.S.Ed. Special Educator/Social Cognition Specialist ADD/ADHD AND EF
A persistent pattern of inattention and/or hyperactivityimpulsivity that interferes with functioning or development. Individuals with ADHD may present with both inattention and hyperactivity/impulsivity, or one symptom pattern may predominate. WHAT IS ADHD?
Combined presentation all three core features are present and ADHD is diagnosed when 6 symptoms of hyperactivity/impulsivity and 6 symptoms of inattention have been observed for 6 months Predominantly inattentive presentation diagnosed if 6 symptoms of inattention (but <6 symptoms of hyperactivity/impulsivity) have persisted for 6 months Predominantly hyperactive/impulsive presentation diagnosed if 6 symptoms of hyperactivity/impulsivity (but <6 symptoms of inattention) have been present for 6 months. SYMPTOM PATTERNS OF ADHD
Difficulty giving attention to detail, resulting in mistakes being made Trouble sustaining attention to tasks/activities May seem to not listen even when spoken to directly Fails to follow through or complete work Difficulty organizing tasks and activities Appears to avoid or dislike tasks that require sustained mental attention Frequently loses important items Is forgetful in daily activities Easily distracted by things around them SYMPTOMS OF INATTENTION
Squirms and fidgets in seat or taps hands and feet often Often leaves seat when expected to stay in seat Often runs and climbs when not expected Often can t play quietly or engage in quiet leisure activity Is always on the go as if driven Often talks excessively Often blurts out answer before question is completed Frequently has difficulty waiting for their turn Often interrupts or intrudes on others SYMPTOMS OF HYPERACTIVITY/IMPULSIVITY
Mild few, if any, symptoms in excess of those required to make the diagnosis are present, and symptoms result in no more than minor. impairments in social or occupational functioning Moderate symptoms or functional impairment between mild and severe are present. Severe many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe, are present; or the symptoms result in marked impairment in social or occupational functioning. Partial Remission noted if for past 6 months or more that less than 6 symptoms have been observed in children, but significant impairment to daily living and school still exist. CURRENT SEVERITY OF ADHD SHOULD ALSO BE SPECIFIED
How do we know when someone is paying attention? But they can play video games all day long.. WHAT DOES ATTENTION LOOK LIKE?
Symptoms of inattention can be seen related to other issues such as anxiety, auditory processing issues, autism spectrum disorders, depression, sensory processing issues, stress, and trauma (as well as other issues). Important to rule out other contributing factors as response to the inattention or the hyperactivity may vary. CAUTION
Counter Intuitive, but the distracted mind is often seeking more input and needs more to do. The example of the baby origami cranes. Productive undoing (paperclip chains, uni-fix cubes, taking stickers off of things, untangling strings, etc. Teacher or parent helper, give more tasks to do that involve movement. THE ACTIVE MIND MAY NEED MORE
For the hyperactive person, they need to move and we need to provide them with movement opportunities or other input. For the inattentive, we need to find what will work to sustain their attention. Telling them to stop is like telling someone with allergies not to sneeze. SIMPLY TELLING THEM TO STOP OR PAY ATTENTION WON T HELP
Both stimulant and non-stimulant types of medication are used with ADHD with good results. Side effects are always a concern and everyone responds differently. Stimulant based meds are easy to test, they work quickly and are out of the system quickly. Many individuals can attest to how they feel on meds. TO MEDICATE OR NOT TO MEDICATE?
Made up of different and separate functions Executive, meaning in control of coordinating all of the functions and creating use from them working together Like a conductor. WHAT IS EXECUTIVE FUNCTIONING?
Do good stuff that helps you meet your goal. Organization, Shift, prioritizing, task initiation, self-monitoring Don t do bad stuff Impulse control, emotional control/regulation, focusing attention, maintaining optimal levels of arousal ACTION-INHIBITION
Ability to stop and think before acting Staying in area of expectation Resisting urge to blurt Impulsivity can be a symptom of ADHD IMPULSE CONTROL
Modulation or control of emotional responses Managing sensitivity to feedback Being able to move on after an upset EMOTIONAL REGULATION
Cognitive Thinking of a new idea when encountering a problem Accepting another person s idea Social/Behavioral- Dovetails with attention Stopping an individual activity when expected to orient to another person or group Being okay with not finishing SHIFT
Ability to hold information for long enough to plan and execute multiple steps. WORKING MEMORY
Task Monitoring Assessing own performance Interpersonal awareness ONGOING awareness of the effect one is having on others SELF-MONITORING
Steps needed to complete a task or project Setting Goals Organizing points in writing Time awareness PLANNING/SEQUENCING
Compiling list of tasks by importance, impact or expectation. Deciding what to do first! Can be impacted by extrinsic factors like grades or money, or by intrinsic factors like expectations of others. PRIORITIZING
That first push to get started! Once going, many can keep up the momentum! Have you ever had so much to do that you just get paralyzed? TASK INITIATION
Chronological order Cause/effect and conditionals Sorting! Topics, era, dates, people involved Physical materials for use in certain contexts Notebooks, desk items, horseback riding stuff, etc.. ORGANIZATION
LIKE CONDUCTING AN ORCHESTRA
Predict what the outcome will look like. Can be a picture FUTURE ME (SARAH WARD)
Episodic Plan FUTURE ME WelI, I have a study hall 8 th period and the teacher has Chromebooks for us to use there. I ll get on my teacher s website where she posted a Jeopardy game for us to practice with. That s better for me than staring at my notes. Then, after track practice, I have to go to dinner for mom s birthday. I ll get myself into my homework spot in my room by 7:00 and I ll call John so we can go through the study packet together. He always has good tricks for remembering this stuff. I m going to rock this test and celebrate by playing some Pokemon Go with Dad this weekend.
DEFICITS DO NOT ENCOMPASS ALL FUNCTIONS! THANK YOU TO ALL ENLIGHTENED OT S!
Autism Spectrum Disorder Sensory Integration Dysfunction ADD/ADHD- some experts believe that nearly ALL kids with ADHD have difficulties with executive functioning Dyslexia Prefrontal Cortex- Most of these functions are controlled by this region of the brain. Genetic differences, brain injury, can affect. WHY DO KIDS HAVE DEFICITS IN EXECUTIVE FUNCTIONING?
Academic Notes, backpack, agenda, verbal plans for breaking apart assignments Home/Life Bedroom, playroom, entry, finding belongings when needed, getting ready on time Social/Behavioral Shifting attention from self to others, planning activities with others, planning day DIFFERENT APPLICATIONS OF EXECUTIVE FUNCTIONING
WHAT PARENTS/TEACHERS SEE
WHAT PARENTS SEE
WHAT PARENTS/TEACHERS SEE
If your child has executive functioning issues, any task requiring these skills could be a challenge. That could include doing a load of laundry or completing a school project. Having issues with executive functioning makes it difficult to: Keep track of time Make plans Make sure work is finished on time Multitask Apply previously learned information to solve problems Analyze ideas Look for help or more information when it is needed Amanda Morin WHAT PARENTS SEE **ALL of this is important in the social domain as well!
First: BRIEF Wechsler Then: Build Awareness! Build Intrinsic Motivation! Workout the prefrontal cortex! (practice) Apply accommodations and strategies WHAT DO WE DO NEXT?
For more strategies for addressing both ADD/ADHD and EF issues, please contact Danielle or Marybeth and see the final slides! THANK YOU FOR COMING!
Physical Awareness Self- Awareness Interpersonal Awareness Time Awareness AWARENESS CHECK!
AWARENESS CHECK MAP
ZONES FOR TASKS
QUADRANT PRIORITIZING