How Do I Teach Strategies To Someone Who Has Trouble with Attention?

1. How Do I Teach Strategies To Someone Who Has Trouble with Attention? Mary Cole, M. Coun., Bonnie Blankert, M. Ed. (mcole@mtroyal.ca, bblankert@mtroyal.ca) Access Advisors, MRU March 4, 2010

2. Outline ADHD - What is it? What else looks like ADHD? How does this affect strategy instruction? How can we find out what’s up? Strategies Resources Discussion

3. GREAT News! Our powerpoint, links to video clips, downloads from excellent online resources and more will be available to you after this workshop!

4. Introductions • Us and You!

5. AD/HD QUIZ True False

6. True False

7. Awareness Test

8. Trouble with attention? What is ADHD? A problem with regulation of attention, not just a problem with inattention Experts agree: ADHD is a neuro-biological (developmental) brain disorder • Genetic and heritability studies • Brain functional and structural imaging studies • Supported by all major medical associations and government health agencies

9. http://www.driesen.com/prefrontal_cortex.htm What is ADHD? Con’t. It is an impairment of the executive function (regulation) component of the frontal lobes, that are involved in • Planning • Organization • Initiating or delaying a response.

10. With impairment of the frontal lobe, the limbic system may “hijack” thinking More information moves up from the “emotional” limbic system than flows down from the “thinking” cortex From ADD 2005 Hallowell and Ratey

11. Limbic system is like Will Ferrell playing with Blue Oyster Cult SNL Cowbell Clip

12. Mental health or other conditions that mimic or coexist with ADHD • Learning disorders • Oppositional defiant disorder • Conduct disorder • Anxiety, obsessive compulsive disorder, or PTSD • Depression • Bi-polar disorder • Tic disorder (Tourette’s disorder) • Adjustment disorder

13. Fetal alcohol spectrum disorders • Thyroid disease • Lyme disease • Early-onset Alzheimer’s disease • Iron deficiencies • Menopause • Brain Injury • Addictions

14. Diagnosis Requires comprehensive assessment • Physical exam • Psychoeducational assessment – including history from multiple sources • Thorough assessment for ADHD • Multi-modal approach is ideal but not always possible

15. Types of ADHD • Attention-deficit/Hyperactivity Disorder – Combined Type (most common) • Attention-deficit/Hyperactivity Disorder – Predominantly Inattentive Type • Attention-deficit/Hyperactivity Disorder – Predominantly Hyperactive-Impulsive Type (least common) (Changes are anticipated in the DSM – V)

16. Inattention careless mistakes poor sustained attention poor listening lack of follow through and work completion disorganized poor sustained mental effort loses things easily distracted forgetful

17. Hyperactivity/Impulsivity fidgets/squirms leaves seat runs/climbs a lot can’t play quietly “on the go” talks excessively blurts out answers difficulty waiting interrupt/intrudes

18. Symptoms usually occur over many different settings however they may not consistently occur in all settings

19. COLOUR TEST #1

20. COLOUR TEST #2

21. Prevalence in school-aged children • 5 – 12% of school-aged children • 8 – 10% of males • 3 – 4 % of females From www.caddra.ca Information for Educators

22. Prevalence in adults • 3% for NARROW diagnosis • meeting the DSM-IV criteria both as a child and as an adult and reporting that the symptoms occurred “often” vs. “sometimes or often” which put you into the BROAD Category • 16.4% for BROAD diagnosis • More prevalent in males Faraone and Biederman. J AttenDisVol 9 Nov 2005 p 384

23. ADHD in Adults: What does it look like? Rick Green - Totally ADD Clip

24. Estimated that 30-70% of those who are mandated to the criminal system have ADHD • Many undiagnosed • Women most often undiagnosed • 1 out of 3 persons charged with a crime have been diagnosed with ADHD • (adapted from Hurley & Eme, 2004)

25. ADHD and the Link to Criminal Offending • Academic Failure • Work Failure • Forgetfulness • Impaired Sense of Time • Failure to Learn from the Past • Failure to Plan for the Future • (Hurley & Eme, 2004)

26. Impulsivity Plan poorly May try to run Inconsistent/unpredictable behaviour Immediate gratification Irritability/defiance Mind bounces around – hard to sustain focus (adapted from Hurley & Eme, 2004) ADHD and the Link to Criminal Offending

27. ADHD and the Link to Criminal Offending • Working Memory and Time Management • Holding events in mind • Using sense of time to prepare for upcoming events • Judging the passage of time • Accurately estimating time • (adapted from Hurley & Eme, 2004)

28. ADHD and the Link to Criminal Offending • Organization • Fail to keep appointments • Loses stuff (including important things required by law enforcers, educators, probation officers…) • Chronic procrastination • Trouble prioritizing • May look as though indifferent to rules/requirements • (adapted from Hurley & Eme, 2004)

29. Red Flag Traits • Create elaborate or unconvincing scenarios for what occurred (bounce around) • Difficulty keeping their story straight • Trouble keeping secrets • Not good at successful lying (faces may flush, nonverbals betray them) • Gang member wannabe • Brag • (adapted from Hurley & Eme, 2004)

30. Addiction • 40 – 50% of people with untreated ADHD have problems with substance abuse • Substance abuse has a neurological basis in ADHD and may be seen as a way of treating an “itch that you can’t scratch” • Often used as a way to self-medicate and quiet the brain Hallowell and Ratey, ADD 2005

31. Transitioning to Post-Secondary • Documentation of disability is required to receive supports and services • IEP’S are helpful but not sufficient • Supports and services are tailored to recommendations/needs documented in the documentation • AEI may provide funding for new or updated assessment • AET and/or AEI may provide funding for supports and services

32. Transitioning to Post-secondary • Students with ADHD may receive supports and services such as: • Adaptive technology (text to speech, speech to text) • Note takers • One-to-one Academic Strategist support • Exam accommodation • Classroom accommodation

33. Transitioning to Post-secondary con’t. • Transition planning from school to post-secondary is beneficial – especially for those with disabilities • Transition materials are available on the LDAA website (ldaa.ca) or ALIS website ALIS.gov.ab.ca

34. Transitioning to Post-Secondary Con’t. • All publicly funded post-secs. in AB are required to have someone in place to assist students with disabilities access supports and services (e.g., SAIT, BVC, MRU, UofC) • Both the student and the post-sec. have rights and responsibilities in the process

35. Reading Activity

36. STRATEGIES • Positive reinforcement that is as immediate and concrete as possible related to use of strategy • Strategy instruction – collaboratively work with student to determine ways that they learn and strategies that fit with their approach and strengths to help compensate for challenges • Don’t be afraid to revisit old strategies

37. Try not to overwhelm student; teach, reinforce and integrate into daily work a strategy or two at a time • Encourage student reflection – what is working…why it is working…how can the strategy be changed to be a better fit…. • Post strategies on the wall/visual reminders so the student isn’t expected to hold the information in memory

38. SPECIFIC AREAS • Reading Comprehension • High interest • Adaptive technology (text to speech; reading pen for decoding) • Reduce quantity; focus on quality • Time limits • Enlarge text/white space • Extra time • Directions in writing and verbal • Key words and concepts highlighted before reading • (adapted from Alberta Education and Calgary Learning Centre – Focusing on Success, 2006; Mary Cole, 2009)

39. Written Expression • Reduce volume • Adaptive technology (speech to text) • Combine oral and written demonstration of knowledge • Break down tasks (create a rubric to check off) • Alternative assignments (multi-modal opportunities) • Homework at school • Word processor • (adapted from Alberta Education and Calgary Learning Centre – Focusing on Success, 2006)

40. Print and Handwriting • Adaptive technology (on screen versus paper) • Pencil grips • Slant boards • Stand instead of sit • Templates for note-taking (outline) • Carbon/NCR paper • Extended time • Increase space for answers • Oral response in addition to/instead of always written response • (adapted from Alberta Education and Calgary Learning Centre – Focusing on Success, 2006)

41. Concentration Activity

42. Attention • Alternative seating (placement; standing; different chair) • Reduce distractions (headphones; earplugs; study carols; proximity to teacher/mentor; minimize visual distractions) • Movement while listening/working • Directions both verbally and in written form • Paraphrasing • Set time limits; keep lessons brief • Big picture then details • Multiple testing sessions for longer tests • Graph paper; placement markers; checklists; use of colour to assist with organization of written material • Visual cues (stop sign/arrows) on tests • (adapted from Alberta Education and Calgary Learning Centre – Focusing on Success, 2006; Mary Cole, 2009)

43. Explicit instruction to begin • Tasks that require a high response rate (e.g., partial outline provided so student fills in blanks while listening) • Increase student choice in the way they will demonstrate understanding • Games • Break tasks multi-modally • Consistent use of words to cue listening (I’m going to tell you 3 things) • No more than 2 directions at a time without checking for understanding • “think aloud” modeling • Keep blackboard/whiteboard only current information • Teach active listening skills/reinforce/model

44. Organization/time management • Graphic organizers for writing • www.inspiration.com and other Assistive Technology • Colour code • Agenda/palm pilot • Something that dings • Reinforce verbally anything in writing • Use computer for note-taking (table format)\ • Practice guesstimating time

45. Memory • Memory is attention is memory is… • Written outline and directions • Teach short hand/note-taking strategies (Cornell, split page) • Mnemonics, acronyms, verbal/movement rehearsal, loci, pegword • Use of colour to cue and pair with new concepts • Routine for turning in assignments • Checklists/rubrics • Review directions/paraphrase at beginning of examination • Reference aids • http://www.calgarylearningcentre.com/main/page.php?page_id=23 • (adapted from Alberta Education and Calgary Learning Centre, 2006; Calgary Learning Centre, 2010;Mary Cole, 2009)

46. Concepts that stick after 12-24 weeks will likely stick forever.

47. Von Restorff Effect “You’ll always remember something better if it grabs your attention by arousing one (or more) of your senses or stimulating your emotions.”

48. Please feel free to contact us if you have questions or would like more information at Mount Royal University (Accessibility Services): Mary Cole 403-440-6491 mcole@mtroyal.ca Bonnie Blankert 403-440-5959 bblankert@mtroyal.ca Thank you for the privilege of working with you!