ADHD, TBI, ASD & LITERACY

ADHD, TBI, ASD & LITERACY Selected slides in this lecture were provided by Martha Bridge Denckla, M.D. Rebecca Landa, PhD Joan W. Carney, MEd

The Mindset • In planning for the instruction of students with special abilities, disabilities and disorders, a gestalt attitude in planning is needed. The student is a combination of strength and need, preference, capacity, and source of a product that demonstrates mastery.

Do not isolate by labelThere are commonalities & ranges to consider capacity sensory engagement product pacing anxiety issues pref format ____________________________________________________________________________ ADHD x x x x x x ASD x x x x x x SLD x x x x x x TBI x x x x x x ____________________________________________

Literacy and the student with ADHD • Influences in planning instruction… • Type of ADHD – inattentive, hyperactive, combined • Level of impulsiveness • Deficits and strengths in executive function • Construction of the demand – • How much time will the activity take? • Does the activity allow for movement? • Are there choices or options in the activity? • Are distractions in the environment controlled? • Have you considered your real goal of the learning activity?

Are “Attentional Problems” Aptly Described as “Deficit?” • Deficit implies quantitative lesser amount of capacity • Best evidence for “problems” came from Continuous Performance Tests (CPTs) • CPTs imply ADHD associated with anomalous sustained attention

Attentional Paradigms EARLY LATER • “Bottom up” or early automatic perceptual attention • Synthetic learning • Attributes to Concepts to Principles to Applications • “Top-down” or late controlled attention (or executive attention) • Analytic learning • Breakdown of systems to recognize parts

Evoked Potential Studies of Children with ADHD • Studies reveal that “bottom-up” processing appears to be normal in children with ADHD • A “frontal filtering” or selective deficit is implicated with ADHD – impacts higher order or “top down” thinking

Where Does Data Suggest ADHD is “Attention Poor” • Little evidence for capacity shortage • Much evidence for allocation strategy being what is “deficit”

Aspects of “Attention” in ADHD • “Distractibility is really “attractability” • Intrinsically rewarding activities are attended to (these are “attractive”) • Cognitive impulsivity resembles inattention.

Another Metaphor for What Kind of Attention is Deficient • ADHD is compatible with intact (or overactive) radar beam sweep over surroundings • ADHD is weak in “spotlight” (narrow, steady, intense) unless intrinsically interesting/rewarding target

Response Preparation and Execution are the big problems associated with ADHD

The True ADHD Triad of Weakness • Motor control • Cognitive control • Emotional display control Control is Executive Function

Inattention Secondary Emotion-Cognition Regulation • Adverse impact of anxiety or stress (amygdala “detour”) • Competition between monitoring audiovisual environment (“radar” especially for threats) and focus on language-mediated classroom (“spotlight” enhanced by positivity, humor/entertainment)

What does this mean in demonstrating literacy? • Consider the balance of reading, writing, speaking and listening in delivering instruction, as well as designing the final product that you want from the learner. • Directing the attention of the learner to the text that provides the information is essential— • Highlighting • Underlining • Recorded directions • Periodic checks by teacher or paraeducator • Submission and resubmission of work

Literacy and the student with TBI • Keep in mind that this condition had a sudden onset and there is pre-injury information to access • Influences in planning instruction… • Location & type of injury– area of function, closed or open injury • Age at onset of injury • Duration of coma or loss of consciousness • Prior functions – what kind of learner was the student prior to injury? • How have discrete areas of function been assessed? • Residual effects and recuperative pattern

Neuropsychological Sequelae • Intellectual Functioning - PIQ < VIQ? • Attention - Disturbances common following TBI, sustained attention and ADHD-like symptoms • Memory - Deficits in both verbal and visual memory. Difficulty with initial encoding and organization of task. • Language - Aphasia not common • Pragmatics: set of rules governing conversation the social use of language • Discourse: connected communication of thought sequences

Neuropsychological Sequelae • Visuoperceptual/Spatial/Constructional skill • Few studies examining non-motor aspects • Often deficits related to motor skill, attention, and response time. • Constructional impairments related to organizational difficulties as well as motor skill and speed • Executive Functions • Goal-directed behavior such as development and implementation of strategies for problem solving. • Deficits often evident.

Neuropsychological Sequelae • Academic Achievement • Declines in performance and increased risk for special education. • Declines often not evident on standardized testing and poor performance may reflect behavioral or neuropsychological deficits rather than specific decrements in academics skills as measured by standardized testing.

Behavioral Sequelae • Emotional/Personality • Behavioral disturbance and personality change is often present following TBI • Problems include aggressiveness, hyperactivity, disinhibition, poor social judgement, apathy, increased dependency, and increased fears and phobias. • 50% if children develop novel psychiatric disorder (PC, ADHD, Depression, ODD, PTSD) • Emotional/Behavior problems less likely to recover over time

Literacy and the student with Autism • Be aware of the fact that this disorder is especially challenging in the school setting because of the subtle and sometimes not so subtle differences among students identified as being on the spectrum. • Written and spoken products may reflect a close alignment with the manifestation that the student shows as his or her specific pattern of communication, learning and capacity.

Implications for School • Uncooperative • Trouble shifting sets and making transitions • Sensory overload • Doesn’t understand • Fatigue and needs a break • Too much social input • Ignores • Does not stop behavior when told to do so • Does not get his work done • “Pesters” other kids • Does not pay attention • Does ‘weird’ things • Does not get homework done • Dawdles • Insists on being first in line. Tantrums if doesn’t get his way

Consider the strengths • Good rule learner • Likes predictability • Solitary and limited nature of imaginative play • Very large rote memory • Unique/original problem solving • Difficulty ‘getting started’

For success, find ways to build • Connection of meaning within and across activities • Flexibility (do it in a routine way then vary some component) • Confidence through experience (success) • Network of supports with peers

Targeting all of these and simultaneously building literacy Part 1: Before reading • Background knowledge • Personal connection making • Purpose setting Part 2: Reading (interactive and meaningful, motivating) Part 3: Practice, generalization, conceptually relevant use • Connect the new to the known

Books: cognition, language, social, literacy • Attention to salience: Picture walk (comment on the pictures and preview the book) • Talk about the title • Contemplate, imagine, predict, relate to what is known • What could it be about? • She is happy, so it must not be scary. • The dog is standing by the bowl. He might want some food. • Not asking “Wh” questions! • Use background knowledge and create a purpose for reading the book

Incidental Teaching Steps • Set up: Arrange the environment to contain favorite toys/objects and to encourage initiations • Look/Pause: Wait for child’s initiation • Talk-Up: Make comment related to child’s interest. If no initiation or response, then • Control Access: Interrupt child’s play briefly, wait for initiation (verbal, nonverbal) • Prompt: Provide level of prompting necessary to get the targeted response • Access: Provide access to related reinforcement

Direct Teaching vs Incidental Teaching DIRECT INCIDENTAL • Usually 1:1 • Teacher directed • Highly structured • Many instructional opportunities (trials) • Distractions minimized • Skills acquired quickly • Minimal social engagement • Data collection, precise and plentiful • Generalization restricted • Small/large groups, inclusive • Child-directed (child choice) • Less structured/natural environment • Typically fewer instructional opportunities (naturally occurring) • Natural distractions • Slower skill acquisition • Increased interactions, more spontaneous, activity-based • Data collection more challenging • Generalization enhanced

Instruction and the student with autism • The important things to address in planning instruction are these: • Pacing and schedule of assignments • Formatting of assignments for visual/auditory demands • Formatting of assignments for kinesthetic/tactile demands • Monitoring for overload • Choices and options • Level of independence of the learner • Ability of the learner to work with others

Best Practice • Employing best practices in instruction in literacy or any other area of learning depends on understanding the approach the learner needs, the areas of relative strength and need, what the student can give you to show mastery, and how long it takes to get the product that allows the student to progress through the curriculum. • The disorder is not the primary issue – needs are.

TBQ#3 • The discussion of instruction (for literacy or any other area) for all of the disorders mentioned in the third lecture, highlights the essence of the problem for teachers – managing to implement a curriculum for such diverse needs. Propose a solution to the difficulty in ranging the scope of disorders while still engaging students toward mastery of content. Your proposal cannot include eliminating standardized assessment.

ADHD, TBI, ASD & LITERACY