Learning with ADD/ADHD

1. Learning with ADD/ADHD ADHD in NEPA CHADD associated www.adhdinnepa.com Kristina Peary, Coordinator 570-493-0463

2. My goals To provide useableinformation about ADHD as executive functioning deficits (EFDs) to improve recognition &understanding of ADHD (all 3 DSM types & adult) to foster on-point educational interventions & supports for students that work (So we have more stamina for the work)

3. Itinerary Introductions ADHD: Difficult to accept Executive Functioning Co-existing Problems Interventions & Accommodations Strategies for learning Strategy Checklist Resource list & handouts Slide 4 Throughout Slides 14-36 Slides 37-51 Slides 52-68 Slides 69-80

4. Introductions Write on a piece of paper: • 5 words describing the teaching experience with students/parents who have ADHD • 1-2 questions you have about ADD/ADHD

5. The ADHD Question “Why can they do better when they like the task?” For parents: “Why can’t they pay attention to this? They certainly can pay attention to computer games!” OUR conclusion: “They are just not trying/don’t care…” STUDENT’S conclusion is…..?

6. Answer: Inconsistency is ADHD • Inconsistency: Problem of PRODUCTION= GAP NOT of ability (that is a learning disability) trouble generating & sustaining response • Inconsistency: ADHD profiles are unique & individual • Inconsistency: ADHD causes brain development & processes to mature more slowly, less routed • Inconsistency: Sensitive to demands of environment EF/attention tires-Barkley

7. STUDENTS get our attitude at HOME & at SCHOOL from peers, siblings, teachers, grandparents, parents…

8. Why is ADHD hard to accept? We often think we already know what it is.

9. What’s up with the term ADHD? DSM: Diagnostic Manual of Psychiatric Disorders • ADD/ADHD are now the same- ADHD • Describes symptoms in general- not WHY • Next revision underway and contested • Will include separate adult criteria • Under-diagnosed/treated POPULATIONS: • Girls, adults, those without hyperactivity &/or learning disabilities, mental health /other problems

10. DSM’s Characterization of ADHD

11. 3 subtypes • Combined– (ADHD-C) Mostly In-attentive and Impulsive features: disorganized, non-productive responses and poor persistence over time • Predominantly Inattentive- (ADHD-I) No behavior flags other than poor production: poor completion and organizing of work. Often undetected or later. • Predominantly Hyperactive and Impulsive- (ADHD-H) Usually able to be attentive. Characterized by senseless and useless motor activity and poor planning/insight.

12. It is complicated! • Physical movement can operate to keep the self alert dropping pencil allows for movement example: college student pinches self, repetitive chap stick -movement awakens & overrides rut • Focus- students with ADD/ADHD can hyper focus Sustains an activity or topic longer than expected Trouble emerging from it without dis-regulation, Often emotional outbursts when young

13. DSM vs. Exec Functioning DSM IV EFD Description of symptoms only Hyperactivity, Inattention, Impulsivity Under dx of groups: Girls, Adults, co-existing LD & MI/relational, w/out hyperactivity Identifies specific behaviors EFD common feature of other LD/Aspergers Everyone can relate to All students benefit from classroom development-universal design classroom

14. Exec Functions manage the self (emotions/cognitions/behavior) for the benefit of the self

15. ADHD & Executive Functioning ADHD is a physical, brain based condition in which the prefrontal lobe activities (EFs) are weaker Possible causes: Lower levels of neurotransmitters (dopamine- pleasure/reward & norepinephrine-adrenalin) Notable differences in brain structures, primarily pre-frontal but other areas too Slower and less neuro development & speed

16. Brain Activity in ADHD • http://www.akidjustlikeme.com/id92.htm • http://www.youtube.com/watch?v=u82nzTzL7To&feature=fvwrel http://www.nimh.nih.gov/science-news/2007/brain-matures-a-few-years-late-in-adhd-but-follows-normal-pattern.shtml

17. ADHD’s brain differences…but they certainly reinforce each other

18. Reinforcement: ADHD is Inherited • 75% of the time ADHD is genetic • Other causes include: premature birth, fetal exposure to toxins, pitocin use=complicated birth/stress Barkley, 2011 • Student’s ADHD is usually FAMILY ADHD

19. Why is ADHD difficult to accept What are our norms for comparison? • ADHD is common- 7-10%, adults -4% • Genetic condition- 75% of the time inherited • Adult ADHD complicates parenting- accounts for ODD/CD often, easy to blame how child being raised • Social and cultural changes and challenges to attention Directed attention fatigue vs attention restoration

20. Executive functioning • Capabilities that allow people to regulate/choose behaviors overt time for their own welfare • Includes capacities of self control, problem solving and persistence • Creates an internal representation & thus use of knowledge, including memory of consequences • EF deficits, especially working memory, are part of other learning disabilities

21. Executive Functions • The individual’s self directed actions that inhibit instinctual reactions, delay gratification, anticipates changes & adjusts responses to environment • Most needed for less routine activities • EF produces self awareness & goal directed behavior • EF helps us experience time

22. Why is ADHD difficult to accept? All of us experience some ADHD “symptoms” • Executive functioning is developing until our 30’s All kids have EFD, especially teens • Executive functioning can be depleted and restored studies about directed attention vs fascination ADHD is a continuum & developmental disorder

23. ADHD as Exec Functioning Deficit • Barkley’s Big 5- inhibition, nonverbal &verbal working memory, self-regulation, response http://www.childmind.org/en/posts/articles/2010-11-12-adhd-and-executive-function • Browne’s 6 Clusters – nicely applied & organized http://www.chadd.org/AM/Template.cfm?Section=especially_for_adults&Template=/CM/ContentDisplay.cfm&ContentID=5802 **See“Impairments in Executive Functioning” chapter for both authors work nicely summarized. The School Counselor’s Guide to ADHD • Richard Loughy, Silvia DeRuvo & David Rosenthal, MD

24. Kristina’s Presentation 5 • Inhibition- relates to attention & impulsivity & hyperactivity • Working memory- images & verbal • Response: emotional & response generation

25. 1- Inhibition FOUNDATIONAL to other EF Relates to DSM features of H/Inattention/Impulsivity Defined: Ability to inhibit behavior, to STOP, think- & make choices being awareof future consequences Relates to preventing motor activity as a immediate response (hyperactivity) and to ATTENTION= inhibiting focus from flitting from stimuli to stimuli

26. 2 &3- Working Memory Defined: Like a clipboard, holds info we are using Using creates Connections/meaning Storing creates memories • Two types: non-verbal (the mind’s YouTUBE) & verbalized (language/audio) • Non-verbal= quick prompts, images, speeds up processes, developmentally first step towards language-VYGOTSKY • Verbal- assigns words to images, self talk & questions

27. Working Memory-Mind’s Clipboard It creates the MIND’movie which provides self talk, prompts for responses and reflection WM makes learning/information significant because it gets connected while it stays on clipboard

28. Working Memory & ADHD • ADHD- the clipboard gets wiped clean quicker, there isn’t enough neurotransmitter activity to sustain it • Accounts for Delay in internalization of speech Slower processing speeds/response Impaired ability to learn from consequences Impaired ability to realize successes, cohesive self Learning not as connected

29. 4- Generating a Response: Emotional Regulation Defined: self-regulation of affect, motivation and arousal • Emotional competence has 3 parts- expression, understanding and regulation ADHD can dis-regulate any of these parts, processing before reacting is difficult (due to weaker MIND’s movie as well) ADHD- transitions between stimuli can be hard

30. Emotional Regulation & ADHD Emotions fuel motivation/drive- if thwarted….. • Impacts the significance of experiences/meaning • When intense- often disconnected, very distracting, furthers dis-regulation • Impacts our identity & relationships • Expression of emotions effect how others see us • Significant factor in “immaturity” and social isolation

31. 5- Generating a Response: Problem Solving Defined: Ability to target behavior to benefit self by analyzing, being goal-directed, flexible and creative ADHD prevents access to MIND’s movie & emotional modulation, persistence &planning poor To be GOAL DIRECTED- several things that are necessary areweaker and break down with ADHD

32. Problem Solving & ADHD For GOAL Directed behavior to persist need: Emotional investment – often thwarted in ADHD, in part due to the intensity and inaccuracy too Vivid self-talk- MIND’s Movie & Vygotsky Ability to link input & create meaning- memory Anticipation of consequences based on prior experiences and analysis, self-talk CONFIDENCE in abilities so willing to risk a try, based on prior successes and feeling of reward (dopamine)

33. The ADHD Question “Why can my student with ADHD do better when they like the task, but not at other times?” For parents: “Why can’t they pay attention to this? They certainly can pay attention to computer games!” OUR conclusion: “They are just not trying/don’t care…” STUDENT’S conclusion is…..? STUDENTS GET our attitude AT HOME &SCHOOL

34. Answer: Inconsistency is ADHD • Inconsistency: Problem of PRODUCTION= GAP NOT of ability (that is a learning disability) trouble generating & sustaining response • Inconsistency: ADHD profiles are unique & individual • Inconsistency: ADHD causes brain development & processes to mature more slowly, less routed • Inconsistency: Sensitive to demands of environment EF/attention tires-Barkley

35. What are some ADHD situations you encounter with students? • In the classroom • On the playground or during less structured times • With their parents

36. Scenario 1 A student often brings in their homework incomplete. The answers they do finish are messy and the last ones generally look like little effort was given to them. Often the last ones are wrong entirely despite the abilities of the student. The parent reports it takes the child hours to do something other students are finishing in 20 minutes.

37. Scenario 2 A student always arrives late to class and unable to settle into morning routines. The parent reports every morning they fight about the same things. The student doesn’t seem to adhere to a routine.

38. Scenario 3 A student seems unable to participate in project learning with on her own and with classmates. Her participation seems to annoy other classmates. The results of her work are incomplete and not well designed despite her initial interest. Her parents report she waits until last minute and sometimes doesn’t even tell them about her assignment.

39. Why is ADHD hard to accept? ADHD is a problem of production not ability Behavior often perceived as a choice, not a symptom…..

40. Exec Functioning Depletion • Normal that ability to direct our attention becomes depleted • Attention : Varies with kind Sensitive to environment & demands ADHD- depleted quicker, less modulation, transitions difficult, sensory issues

41. Rates of Coexisting Problems 80% of people with ADHD also have another disorder 50% have two or more disorders Learning disabilities- 24-70% (Barkley) Sleep disorders-30-56% Mental Health Issues Physical health Relational/Social Problems

42. Other related LD/MH Conditions • Anxiety 25-30% • OCD up to 30% • Depression: range of severity 25-30% • Oppositional Defiant Dx 35-70% , M= 55% • Conduct Dx 30-75% • Physical health problems: GI esp-perhaps related to anxiety, poor motor development-clumsy • Learning disorders: 15-40% With reading, spelling, and handwriting- can improve with stimulant medication 2009 Pearson Educational, Inc.

43. Implication of Family ADHD • What is normal? • Whole child & learning processes at home • Relationships: attentiveness, consistency, cohesion, organization, successful impact/influence • Reward of relationships & efforts, problems with create core issue problems and coping • Erickson’s Stages of Child Development- Early esp

44. Erickson’s Stages

45. Erickson’s Stages

46. Relational Disordering/ODD&CD • Adler’s phases http://pws.cablespeed.com/htstein/dealing.htm http://www.examiner.com/article/positive-discipline-parenting-tool-adler-s-mistaken-goals-of-behavior • Oppositional behavior & ADHD connection When PARENT has ADHD Barkley- 4 factor model of defiant behavior

47. ADHD or Learning disability • ADHD: impairment is an unavailability to learn & difficulty producing responses socially and academically • Learning disabilities: related to an inability to learn due to an impairment

48. Learning Disabilities & ADHD • Highly related to ADHD Handwriting problems Comprehension deficits (working memory) • Can be related (working memory, organizational, Exec functioning depletion) Math, spelling, reading errors

49. “Secondary” Features of ADHD/LD • Responses to the primary condition: effect whole child • Sometimes more problematic than primary • Diminish motivation & self-efficacy beliefs • Can become depressed, ODD, CD, Anxiety • Lower SES, job instability, self-medicating: teens & college, poorer physical health due to lack of routine

50. Why is ADHD hard to accept? There is no one ADHD profile Complex & varied individual profiles of EFD number of Exec Functions-vary/grouped Range of Severity-symptoms & compensations Lifelong compensation strategies/outcomes “Secondary” and coexisting problems