Understanding ADHD in Children: Cognitive Processing, Language, and Implications for Intervention

1. COGNITIVE PROCESSING AND LANGUAGE OF CHILDREN WITH ATTENTION DEFICIT DISORDERS

2. I. ATTENTION DEFICIT DISORDERS** n A. Definitions/ Facts (CHADD, 2018) n Approximately 11% of children have ADHD n For ¾ of them, symptoms will continue into adulthood n --

3. CHADD, 2018:** • Due to a combination of factors— genetics, dopamine imbalance, insufficiency of neurotransmitters • Strong genetic link

4. American Psychiatric Association Delineates 3 types of ADHD:** n Primarily inattentive (20-30%) n Primarily hyperactive (less than 15%) n Combination inattentive/hyperactive (50-75%)

5. Relationship of SLI to ADHD: n 59% of ch with specific lang impairment (SLI) have ADHD n SLI ch with significant levels of receptive lang impairment most likely to be impulsive, distractible, overactive

6. Contributing factors…** n Basal ganglia, regions of cerebellum significantly smaller in ch with ADHD n Non-genetic factors: premature birth, maternal drugs and alcohol during pregnancy, exposure to high levels of lead in early childhood

7. ADHD is most likely due to…** • Impairment in the executive function portion of the brain that controls impulsivity

8. Researchers are showing that… n Watching TV/screen time before 2 years of age is strongly correlated with attention problems later

9. Time Children 8 to 18 years old Spend on TV, Video Games, and Computer-American Academy of Pediatrics, 2018** Today's children are spending an average of seven hours a day on entertainment media, including televisions, computers, phones and other electronic devices. That’s 49 hours a week, which is more than a full time job

10. How much time do adults spend watching TV alone?** • 4 hours and 30 minutes per day

11. Ch 3-5 years of age--only watch educational, nonviolent programs For ch exposed early, school is boring, noninteractive, slow TV topics presented briefly, lots of visual stimuli, varied settings, loud noises, movement, flashes of color

12. University of Michigan Health System, “Television and children” (www.med.umich.edu)** (not on exam) • By 18 yrs. old, the average American child will have seen 200,000 violent acts and 16,000 murders on TV

13. Computer Use and Executive Functioning Computer use--drawbacks which affect EF skills General browsing--multitasking and continuous partial attention--causes irritability, impair cognition

14. Playing computer games can impair the development of the frontal lobe, the part of the brain that inhibits anti-social behavior**

15. Every hour of TV/video Game (VG) use per day ↑ risk of attention problems Ch--wired for high speed stimulation

17. Difficult to think, plan, and reflect when exposed to a great deal of screen time in childhood Students and parents--unplug and get moving!

18. II. SYMPTOMS** Not diagnosed by standardized tests—”diagnosis is based on a careful assessment of the behavioral symptoms” Difficulties coping with everyday life

19. A problem with assessment: • Ch may not be identified on lang testing that ignores pragmatics

20. Youtube • How to Recognize ADHD Symptoms in Children

21. Specific Behaviors may Include: Difficulty remaining seated Poor follow through on tasks Excessive motor activity— fidgeting, squirming Short attention span Distractibility

22. Inability to delay gratification Shifting rapidly from one activity to another Loses things; “space cadet”

23. III. POSSIBLE SPEECH- LANGUAGE CHARACTERISTICS Poor auditory memory Continually saying “what?” “and”huh?” False starts, verbal mazes Disorganized story-telling Poor pragmatics—interrupting, non sequiters

24. IV. MANAGEMENT OF ADHD** Stimulant medication ↑ dopamine in brain Best: combo of pharmacological and behavioral approaches

25. Popular current medications include:** Cylert Adderall Strattera (not a stimulant; may not have much effect) Ritalin Concerta (time released—take one pill in the A.M., and lasts all day)

26. V. IMPLICATIONS FOR INTERVENTION Work on before, after, more than Help students use clocks to mark time List of tasks to be completed—check off as finished

27. Visual aids** Therapy rooms and classrooms should be highly structured “movement breaks”

28. Turntaking skills** Contingency—if they say something, must relate to what other person just said Memory, especially for info presented auditorially— often forget things

29. Minimize external distractions Discuss what “paying attention” is (listening, ask ?s when you don’t understand, sitting still, eye contact) Monitor output--speak in organized fashion Pragmatics, esp. ways to join groups effectively

30. Kowalski ASHA Schools Conference • Social etiquette posters • Have ch carry social etiquette cards • Video ch and show him

31. Kowalski: • Social autopsy—analyze social errors • Who was impacted by it? • How to correct it? • How to avoid it in the future?

32. Much better 1:1 Help them get organized Extra time to complete tasks— trouble on timed tasks

33. Section 504 of the Rehabilitation Act of 1973:** Civil rights statute that prohibits schools from discriminating against children with disabilities Eligibility is based on the existence of a physical or mental condition that substantially limits a major life activity Students with ADHD qualify for classroom accommodations if they can’t learn under typical circumstances

34. Remember… Research: African American students, esp. boys, referred for ADHD at much higher rates Don’t be racist

35. Remember the gifts of ADHD:** Creativity Ability to think outside the box

37. Support for individuals with ADHD:**

38. **Power Point Outline • I. Attention Deficit Disorders • II. Symptoms • III. Possible Speech-Language Characteristics • IV. Management of ADHD • V. Implications for Intervention