Thinking Outside the Box: Insights and strategies for living & coping with ADHD

1. Thinking Outside the Box: Insights and strategies for living & coping with ADHD Michael Paul Gallo: Minnesota State University Moorhead www.mnstate.edu/gallo/ gallom@mnstate.edu

2. Dedication Thank you Who am I? Why me? “Only the person who bears the sack knows the burden.” -Mexican Proverb Thank you Denny, Dee & Bigwood Event Staff.

3. Normal VS Abnormal • Stereotypes • Biases • Expectations • Societal Norms • Irritations • Wrongs and rights

4. “There are 2 ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle.” -Albert Einstein A matter of perspective • “Treat others as you would like to have others treat you.” • “Love others as yourself.” “I would always be hesitant about joining in and always thinking, ‘Am I good enough? Will the other kids laugh at me?… Even now I would prefer to be alone rather than a team player.” • “Treat others as they would like you to treat them.”

5. Does Anybody Really Know What Time it is? ADHD brains can have trouble measuring & monitoring time. • “Always late” • “Slow” “L8Again” • “Lost in space” • “Hurry up!” • “No respect for other people’s time!”

6. Strategies to Employ “Increasing hypothetical etiology has focused on the issue of not permitting sufficient time to think as one of the core problems for ADHD.” Sam Goldstein, Ph.D. Neurology, Learning & Behavior Center, Salt Lake City, UT • Be patient & relax • Provide ample warnings, reminders • Remember who is the adult • Don’t blame the victim • Use a variety of timers, clocks, and other methods of measuring the passage of time. • Remove time restrictions whenever possible • Help child to understand this difficulty

7. Movement creates & activates motor memories. -Jane Healey, Endangered Minds To move is to think. Do not give up when you still have something to give. Nothing is really over until the moment you stop trying. -Anonymous Cars & Drivers “Tootie Ta” Dr. Jean & Friends Movement, Movement, Movement www.mnstate.edu/gallo/ gallom@mnstate.edu

8. Pop Behaviorism • Danger of rewards • “Do this and you’ll get that.” • “D o this and you’ll getthat.” Ask yourself what do you want to accomplish with behaviorism? “We should seize every opportunity to give encouragement. Encouragement is oxygen to the soul.” George Matthew Adams

9. What my brain needs Unconditional acceptance The opportunity to succeed and permission to fail Input on how to develop lifelong skills for being successful. Stress management techniques www.mnstate.edu/gallo/ gallom@mnstate.edu 218-236-6293

10. What my brain needs Encouragement NOT praise Directed suggestions for improvement Feedback positive and constructive. Opportunity to reflect on my behavior and thinking…. metacognition “Just as a snake sheds its skin, we must shed our past over and over again.” -Buddah

11. 10 Steps to ADD-Friendly Habit Building: • Tie a new habit to an old one. • Make the habit as easy as possible • Make the habit hard to ignore • Put reminders everywhere • Visualize yourself doing the new behavior “Human beings can alter their lives by altering their attitudes.” -William James

12. 10 Steps to ADD-Friendly Habit Building: • Practice "instant corrections.” • Get back on the horse and ride • Problem-solve if it's not working • Practice the habit for at least thirty days in a row • Reward yourself “I can’t do it” has never yet accomplished anything; “I will try” has performed wonders.” -George P. Burnham

13. “When you go in search of honey you must expect to be stung by bees.” -Kenneth Kaunda Cognitive Behavioral Strategies • Employ self talk and repeat instructions • Positive self-talk “I can do it!”, “Remember it takes time to get it right.” ,“Is there another way I can do this?” • Repeat or rephrase instructions or rules • Use a “whisper-phone” • Repeat important info out loud • Encourage child to speak quietly or “in your head” but avoid criticism. ** Listen for negative self-messages! • Let child explain rules, instructions, to another child or into a tape recorder

14. Private speech & self-regulatory behavior • Private or self-directed speech is the primary means for transferring regulation of behavior from others to the self and is the fundamental tool for self-guidance and self-direction. (Vygotsky 1934/1987) • Self-regulation begins when children integrate adult prompts, demands, explanations, and strategies into their private speech. • Children use private speech to control such complex cognitive processes such as attention, memory, planning, and self-reflection, and to redirect their own behavior.

15. “Permission to speak freely captain?” Providing for success • Self-directed utterances increase with task difficulty, suggesting that children use them to surmount challenges. (Beaudichon, 1973; Berk & Landau, 1997; Deutsch & Stein, 1972; Murray, 1979) • Children who emit more task-relevant remarks while working on challenging problems engage in fewer self-stimulating and distracting behaviors, are more attentive, and gain in task performance. (Behrend, Rosengren, & Perlmutter, 1992; Berk, 1986; Berk & Landau, 1993, 1997; Bivens & Berk, 1990)

16. More Strategies & suggestions to consider Drinking water can increase brain functions & ability to focus, flush out toxins, allow meds to work more effectively. Provide word of inspiration and encouragement. Many children with ADHD suffer from low self esteem and negative self-messages like “I’m so stupid.”

17. More Strategies & suggestions to consider Build your own rhythm instruments to help the child get in-sync with herself and others. PLAY with the child. Play is therapy for the mind, builds self-confidence, creates social contacts, helps develop small motor skills, helps the child increase language skills and self-control.

18. More Strategies & suggestions to consider Music can help calm, focus, energize, and inspire. Provide a variety of types of music including classical, jazz, rock, country, new age. Read aloud to calm, help focus, provide language model, inspire.

19. Current Facts to Consider • Best predictors of successful adult outcome for ADHD children & adolescents connected to family variables including: • Family socio-economic status • Parental mental wellbeing • Stress levels at home • Educational level of parents Variables include child’s intelligence and child’s conduct problems

20. Empirically Proven Treatments • Education for parents about ADHD • Parent training in regards to behavior management • Problem solving & communication skill training with teens • Pharmacological therapies • Teacher education & training • Parent support groups • Cognitive behavioral strategies • Academic skills training • Multi-modal therapy

21. Modifying Antecedent Conditions • Changing the setting of the activity preceding disruptive behavior or inattention • Modify teaching style to fit learning style • Modify the physical environment of classroom • Consider location of student - near window? Near annoying peer? Near door? Nearby noise?

22. The POWER of complex sociodratic play Barkley (1997) has recently characterized ADHD as a biological deficit in behavioral inhibition, which interferes with a child’s ability to use language to self-regulate behavior. In their observations of 3-5 year olds, Kraft and Berk (1998) reported that open-ended activities – especially sociodramatic play - were associated with high rates of self-directed utterances. The extent to which children engaged in make-believe play involving interaction with peers was the strongest correlate of private speech and, in particular, task-relevant, self-guiding comments.

23. What did forget? “People need loving the most when they deserve it the least.” -Mary Crowley • gallom@mnstate.edu • www.mnstate.edu/gallo • W: 218-477-4331 H:218-236-6293 • Questions? • Personal stories: chair, tape, retard • Talking to self • Sense of humor

24. Medication… Drugs “Should Children Receive Medication for Symptoms of ADHD?” by Sherlyn Ezell Powell & Eileen Welch @ U of Louisiana Monroe. Dan Ezell & Colleen E Klein @ U of Central Florida-Brevard Campus Linda Smith @ Teacher Prep Academy U of Tennessee Chattanooga 2003 Peabody Journal of Education,78(3), 107-115.

25. Findings: Meds “ADHD is underdefined and meds are underutilized. Study of 3,4000 children only 12% of those who met diagnostic criteria were receiving appropriate treatment, including meds.” (Cohen, 1999) Inattentive type of ADHD, many who are girls, are never diagnosed and considered to be just lazy or unmotivated. (Widmeyer Group & Chesapeake Institute, 2000)

26. Types of Meds • Psychostimulants: • Ritalin • Dexedrine • Cylert • Adderall

27. Types of Meds • Antidepressants • Tofranil • Wellbutrin • prozac • Clonidine • Catapres AntipsychoticMedication * Mellaril * Thorazine * Haldol

28. Notes on various medications * Bupropion (Wellbutrin) - antidepressant, has demonstrated beneficial effect on ADHD children & adolescents. - Controlled trials differ on whether it is as effective as stimulants Clonidine (Catapres®) and Guanfacine (Tenex®) ADHD children with tics, aggressive, explosive, exciteable, hard to get to sleep. Small, poorly controlled trials Concern about lethal toxicity of clonidine used in combination with methylphenidate.

29. NIMH 14 month study results: 1998 • For medication-treated children 82% were normalized • For psychosocial treatment group w/no meds, 67% were normalized & no longer met ADHD diagnostic criteria • The combined treatment of meds/psychosocial was superior to medication alone or community treatment for symptoms related to anxiety, academic, academic underachievement, poor social skills. • Close involvement and feedback to parents and teachers seems essential to the child’s improvement and academic success.

30. Side Effects: Ritalin • According to the Physicians Desk Reference: • Nervousness *insomnia * hypersensitivity • Anorexia * nausea * dizziness • Palpitations *headache *drowsiness • Changes in blood pressure & pulse rate • Angina * Cardiac arhythmia *Abdominal pain • Weight loss *Tics *Toxic psychosis • Loss of appetite

31. Will the real Michael Paul Gallo please step forward! • Faculty Member at MSUM Elementary and Early Childhood Education Department • Offering personal perspective / insight into ADHD

32. A little help from my friends… Body Double: Sometimes all you need is the presence of someone else – a body double – in order to start organizing and keep organizing. A body double doesn’t have to do anything but keep you company while you organize. Their presence is a support and a reminder that you are there to focus on a particular organizing task. Paper Partner: For your paper partner, look for someone who is strong on organizing papers and filing.

33. Clutter Companion: Choose someone who is good at organizing possessions, clutter, closets, and storage areas in the home as your clutter companion. Time Tutor: Your time tutor should be someone who gets to places on time, seems to have a reasonable schedule, and accomplishes pretty much what they need to do in the course of a day