ADD and ADHD Solving the Mystery Joanne Capuano Sgambati, Ph.D.,BCBA August 20, 2011
Attention Deficit Disorder ADD- Primarily Inattentive Type ADHD- Primarily Hyperactive or Impulsive Type ADHD - Combined Type
Primarily Inattentive Type Six or more of the following symptoms: –Poor attention to detail, careless mistakes –Doesn’t listen –Poor follow-through –Poor organization –Trouble sustaining attention –Avoids tasks requiring mental effort –Easily distracted – Forgetful
Primarily Hyperactive/Impulsive Type Six or more of the following symptoms: Fidgets, squirms Difficulty remaining seated Runs or climbs excessively Blurts out answers Interrupts or intrudes on others Unable to work or play quietly Acts as if “driven” by a motor Talks excessively Difficulty awaiting his/her turn
Combined Type Meets both inattentive and hyperactive/impulsive
Identifying Children with ADHD ADHD usually begins in early childhood and continues into adulthood ADHD can affect all areas of a person’s life. ADHD is diagnosed in 3-5% of school- aged children (approximately 2 million) Boys outnumber girls 3 to 1 According to the DSM-IV, ADHD can be defined by behavior exhibited
Other Related Disorders Opposition Defiant Disorder Mood Disorders Obsessive Compulsive Disorder Autism Spectrum Disorders Tourettes Tic Disorder Learning Disabilities
Tips for Parents Believe in and support your child Keep things in perspective Pay attention to the siblings Communicate Connect with others Be consistent Set a good example Anticipate and avoid problems Praise good behavior Pick your battles Take care of yourself
Tips for Teachers Seating Structure & consistency Role model peers Transition preparation Creativity Connect with home Schedules Maintain eye contact Clear and concise instructions Simplicity Comprehension checks Positive guidance Calm tone
Gathering Information Interview the parents Meet the child - ask about interests, likes and dislikes etc. IEP - Individualized Education Plan BIP - Behavior Intervention Plan Behavior & Learning issues Medication Information
The Classroom Classroom routines should be kept as consistent, structured and predictable as possible
The Classroom Visuals are very helpful (schedules, charts, lists, pictures) Teach and model organizational skills. Color-code materials and highlight. Give note taking guides and other prepared materials Acknowledge appropriate behaviors. Work closely with parents. Daily communication.
The Classroom Take advantage of the child’s areas of special interests when teaching Build on the child’s strengths. Seat the child near you and maintain frequent eye contact Seat the child near a role-model peer Give clear instructions and make sure you have the child’s attention before you do so.
The Classroom Reduce noise and distractions (seating, cubicles, etc.) Offer breaks whenever possible (send on errands, break up difficult work) Offer choices Be prepared and informed Use concrete hands-on projects Allow extra time for task completion
The Classroom Insure all staff are familiar with child’s specific issues and needs Avoid escalating power struggles Have all materials handy Remove distractions Break down and modify work Check for understanding Summarize important points
The Classroom Post rules in positive language Plan for transitions Have a quiet spot Allow for 1:1 instruction when needed Provide immediate and explicit feedback for behaviors Use technology (smartboard, computer, books on tape, I-pads).
Skill Deficit or Performance Issue?? Skill Deficit- child has not learned the skill yet or has not mastered all the component skills –How do we address this? –Task analyze the skill –Teach to the skill –Provide models/ (variety of teaching methods) –Provide reinforcement –Program for generalization/maintenance
Skill Deficit or Performance Issue?? Performance issue- performance is at a low level, is inconsistent or is non-existent –Yet the child does have this skill in his/her repertoire. How do we address this? Make the instructions clear so behavior is more likely to occur. Vary the setting in which we practice to increase generalization Provide A LOT of reinforcement to motivate the child!!!!
Skills Eye contact transitioning dealing with winning/losing proximity staying on topic sharing waiting maintaining a conversation interrupting Awareness of others dealing with anger Social skills Tolerating NO compromising Offering help accepting criticism Taking turns
Challenging Behavior In order to decrease challenging behavior, we must first understand why it is occurring
Specific Deficits That May Predispose Individuals to Engage in Problem Behavior Limited access to reinforcement Low tolerance to change Difficulties with unstructured time Restricted leisure skills repertoire Selective attention by support staff Confusion Difficulties with waiting or delaying R+ Poor environmental congruence Inability to exercise appropriate control over their environment
A mother speaking about her three ADHD sons What stress? I feel we are all like plants in a garden. Some need lots of sunshine, some need shade, some need water all the time, others like it dry. I just happen to have three wild varieties you don’t see too often, but I love them more for their uniqueness”