Attention Deficit Disorder Objective Assessment & Treatment Options

Attention Deficit Disorder Objective Assessment & Treatment Options
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Attention Deficit Disorder Objective Assessment & Treatment Options Bruce Michael Cappo, Ph.D. Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Topics Covered Medication Treatment Clinical Overview
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Topics Covered Medication Treatment Brain Involvement Controversial Treatments School Interventions Family Interventions More on qEEG if time and interest Questions Clinical Overview Diagnostic Criteria Comorbidity Issues Assessment Causal Thinking Non-Medication Treatment Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

ADD or ADHD? 1994 DSM-IV: official term changed from ADD to ADHD:
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 ADD or ADHD? 1994 DSM-IV: official term changed from ADD to ADHD: Attention Deficit/Hyperactivity Disorder (ADHD): Types of ADHD Primarily Inattentive Type (314.00) Primarily Hyperactive-Impulsive Type (314.01) Combined Type (314.01) Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Attention Deficit Disorder - Objective Assessment & Treatment Options -- Dr. Bruce Michael Cappo
4/14/2017 A Brief History of ADHD GF Still. ‘Some abnormal psychological conditions in children.’ Lancet, 1902; i: He discussed 43 cases of children with aggression, defiance, emotionality, limited sustained attention, and deficient rule governed behavior. He suggested “inhibitory volition”… … ‘underdeveloped capacity to exercise good judgment’. s… called ‘minimal brain dysfunction’… symptoms thought to be a result of head injury, infection, or toxic damage (i.e., lead toxicity) 1960s… “hyperactivity”… “poor impulse control” No underlying organic damage had been identified. s… ‘hyperkinetic reaction of childhood’…  hyperactive child syndrome. …  ADD, with and without hyperactivity s.. ADHD with subtypes Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Prevalence 1 1999 estimates range from 3% - 5%
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Prevalence 1 1999 estimates range from 3% - 5% The 2001 Mayo Clinic studies use 7.5% 2002 CDC Estimates 3.3% - 7% Study In Australia took 3000 school age kids at random and found 10% prevalence Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Prevalence of ADD increasing
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Prevalence of ADD increasing % office visits increased from 1.1 % in 1990 to 2.8% in 1995 2.3 % increase when corrected for population increase Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Symptoms present & diagnosable by age 7
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Symptoms present & diagnosable by age 7 ADD Symptoms decrease with age Comorbidity increases with age Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Symptoms present & diagnosable by age 7
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Prevalence % Symptoms present & diagnosable by age 7 ADD Symptoms decrease with age Comorbidity increases with age Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Characteristic Behaviors of ADHD
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Characteristic Behaviors of ADHD Inattentive Distractible Restless, Overactive Messy, Disorganized Impulsive Uncooperative Emotional Lability Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

4/14/2017 Change in Thinking ADHD is no longer thought of as a disorder involving lack of attention so much as a disorder arising from a developmental failure in brain circuitry that underlies the inhibition of self control. This loss of self control impairs other important brain functions such as attention and delay of gratification. Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

DSM IV Criteria (summarized)
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 DSM IV Criteria (summarized) Inattention, impulsivity or hyperactivity Onset by age 7 Symptoms seen in at least 2 situations (home, school, etc.) Significant impairment in functioning Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Course Adult symptoms Persists through adolescence Early onset
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Course Persists through adolescence Early onset Adult symptoms Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Inattention Difficulty sustaining attention Does not seem to listen
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Inattention Difficulty sustaining attention Does not seem to listen Makes careless mistakes Fails to complete tasks without being oppositional Difficulty organizing activities Easily Bored Loses things Forgetful Easily distracted Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Hyperactivity Runs about inappropriately
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Hyperactivity Runs about inappropriately Has difficulty staying in seat Fidgets or squirms Does not play alone quietly “Motor Driven” Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Impulsivity Interrupts others
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Impulsivity Interrupts others Blurts out answers in class before called on Has difficulty awaiting his/her turn Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Comorbidity Factors 50% - 80% have some comorbid condition
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Comorbidity Factors 50% - 80% have some comorbid condition Oppositional Defiant Disorder Conduct Disorder Impaired Academic Functioning Mood Disorders Tic Disorders Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Oppositional Defiant Disorder
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Oppositional Defiant Disorder 40% of children 65% of adolescents Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Conduct Disorder 21% - 45% of children 44% - 50% of adolescents
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Conduct Disorder 21% - 45% of children 44% - 50% of adolescents Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Impaired Academic Functioning
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Impaired Academic Functioning 40% in special education classes 19% - 26% with at least one learning disorder Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Mood Disorders 15% - 20% with Depression 20% - 25% with Anxiety
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Mood Disorders 15% - 20% with Depression 20% - 25% with Anxiety Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Tic Disorders 10% with Tourette’s Syndrome
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Tic Disorders 10% with Tourette’s Syndrome Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Assessment Detailed history Objective assessment devices
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Assessment Detailed history Objective assessment devices Norm-based symptom scales for parents Norm-based symptom scales for teachers Clinical impressions / interview Brain imaging / scanning Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Detailed History Early growth & development Social Behavior
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Detailed History Early growth & development Social Behavior Academic functioning Family functioning Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Objective Assessment Devices
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Objective Assessment Devices Continuous Performance Tests (CPT) Intelligence Tests Achievement Tests SPECT, PET, qEEG* Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Norm-based symptom scales for parents & teachers
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Norm-based symptom scales for parents & teachers Conners Auffenbach Yale & Many Others Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

What Causes ADHD? Research supported explanations
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 What Causes ADHD? Research supported explanations Genetic predisposition in family of origin 80% heritability - frat vs identical twin studies 3 genes isolated from human genome project Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

What Causes ADHD? Gene Mutations From ...
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 What Causes ADHD? Gene Mutations From ... Prenatal exposure to chemicals Exposure to toxins in environment Premature birth complications Lead Brain Injuries Maternal alcohol and tobacco use Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

What Causes ADHD? (cont.)
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 What Causes ADHD? (cont.) Explanations NOT supported by research Watching too much T.V. Poor home life Excess sugar Food allergies Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

dopamine norepinephrine seratonin Brain chemistry
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Brain chemistry dopamine norepinephrine seratonin Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Genetic associations & dopaminergic genes
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Genetic associations & dopaminergic genes Dopamine D2 receptor (DRD2) Dopamine b-hydroxylase (D beta H) Dopamine transporter (DAT1) ADD Stuttering ODD Tics Conduct disorder Obsessive-compulsive Mania Alcohol abuse General anxiety Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Brain Regions Believed to be Involved
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Brain Regions Believed to be Involved Prefrontal Cortex Basal Ganglia caudate nucleus & globus pallidus smaller in add kids Vermis Region of Cerebellum smaller in ADHD kids Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

4/14/2017 Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Treatment Parent Training Social Skills Training
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Treatment Parent Training Social Skills Training Educational Consultation Psychopharmacologic Treatment Brain Training* Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Non-Medication Interventions
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Non-Medication Interventions Control Setting Variables Control Task Variables Token System Self-Monitoring Contracting Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Control Setting Variables
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Control Setting Variables Individual desk rather than table Seat close to teacher Non-open classroom Structured classroom Daily schedule posted Rules posted Feedback charts posted Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Control Task Variables
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Control Task Variables Match demands on child with abilities Increase interest through uniqueness, color, texture, etc. Mix low-interest and high-interest tasks Match length of assignment with attention span Break up into parts Harder subjects in morning Use computers to generate interest / task change throughout day Mix lecture with hands-on tasks Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Token System Give tokens at prescribed intervals
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Token System Give tokens at prescribed intervals Backup rewards at prescribed periods Response - Cost procedures for negative behavior Home based system as well as school Child brings card back & forth between teacher & home for tie-in rewards Use peer contingencies when this competes with teacher Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Self-Monitoring Define behaviors
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Self-Monitoring Define behaviors Check off chart for child to use at desk Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Contracting Define behaviors Specify mutual responsibilities
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Contracting Define behaviors Specify mutual responsibilities Specify how contract is verified Sign contract Give rewards based on contract e.g. Finish 5 homework assignments on time then get to choose dinner e.g. Receive 5 “on-task” coupons from teacher then use computer 15 min that night Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Dietary Factors Sugar Caffeine Increases activity level
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Dietary Factors Sugar Increases activity level Exacerbated when sugar combined with carbohydrates No increase when sugar combined with protein Hyperactive kids may have trouble metabolizing sugar Sugar does NOT cause ADHD Caffeine Minimize Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Pharmacology Indications - STIMULANTS
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Pharmacology Indications - STIMULANTS Objective Evaluation with multiple sources of data At least 4 years old less effective & increased side effects under 4 years old Alternative / Adjunct treatments considered Severity of symptoms Less severe symptoms generally show less response Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Pharmacology Contraindications - STIMULANTS
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Pharmacology Contraindications - STIMULANTS History of Tics, Psychosis or Thought Disorder Stimulants can facilitate tic activity Long term use of stimulants does not increase tic activity vs short term use Parent / Child Negative Attitude towards medications Risk of inadequate supervision / Non-Compliance / Abuse Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Pharmacology Contraindications - STIMULANTS
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Pharmacology Contraindications - STIMULANTS Severe & Negative side effects in previous adequate trial History of Cardiac or Cardiovascular Abnormalities Younger than age 4 Less severe symptoms generally show less response to pharmacological intervention Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Effects of Stimulants Short-term effects are clear and well documented
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Effects of Stimulants Short-term effects are clear and well documented Long-term research continues to build Best on Behavioral Measures Weaker on Cognitive and Academic Measures The pill does NOT make anyone SMARTER! It allows child to perform at ability on a level playing field Eyeglass analogy - Academic improvement sometimes accompanies improved vision but glasses don’t make you smarter. Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Comorbidity & Stimulant Use
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Comorbidity & Stimulant Use Equally effective for Aggression & Hyperactivity Antidepressants often used in combination for aggression Less effective with comorbid anxiety Can trigger tics if personal or family history present Can trigger depression if family history of bipolar disorder Kids with mood disorder and ADHD benefit as much as kids with ADHD alone in response to stimulants Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Commonly Prescribed Stimulants
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Commonly Prescribed Stimulants Ritalin / Concerta (methylphenidate) Adderall (dextroamphetamine sulfate compound) Dexedrine (dextroamphetamine) Catapres (Clonidine – BP med) Antdepressants Cylert (pemoline) [very rarely used] There is poor correspondence between clinical effects & blood levels Test / Re-Test Paradigm better than mg/kg body weight dosing Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Ritalin (methylphenidate)
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Ritalin (methylphenidate) 5 mg to 60 mg per day in divided doses Mixed experience with sustained release but works well in combination with non SR Onset minutes; Peak 90 minutes; lasts 4-6 hours High proportion of kids who do not respond to an initial stimulant will respond to a subsequent alternative stimulant Kids with mood disorder and ADHD benefit as much as kids with ADHD alone in response to stimulants Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Lawsuit Thrown Out April 2000, Pontiac, Michigan
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Lawsuit Thrown Out April 2000, Pontiac, Michigan Dr. Ljubisa Dragovcic, medical examiner, concluded 14 y/o boy died of heart attack ‘likely caused’ by 10 yrs of taking Ritalin “Conclusion unfounded” - Dr. Biederman, Harvard, Mass General Novartis, CHADD, APA Named Eventually thrown out – no evidence Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Concerta (methylphenidate)
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Concerta (methylphenidate) 18mg, 27mg 36mg & 54 mg tabs swallow whole with liquids 12 hours Longest lasting Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

4/14/2017 Concerta Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Adderal / Adderal XR Considered ‘first line’ drug
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Adderal / Adderal XR Considered ‘first line’ drug 5,10,20 & 30 mg double scored tablets 6 - 8 hours coverage 10-12 hours coverage XR No differences between Adderall single dose and two doses of Ritalin Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Metadate Diffucaps Two types of beads Peaks at 5 hours & lasts 8 hrs
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Metadate Diffucaps Two types of beads Peaks at 5 hours & lasts 8 hrs Can be sprinkled on food Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Dexedrine (dextroamphetamine)
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Dexedrine (dextroamphetamine) Better experience with sustained release Onset minutes; Peak 75 minutes; lasts 4-6 hours No differences between dextroamphetamine and methylphenidate in efficacy Dextroamphetamine associated with more side effects Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Daytrana Skin Patch Methylphenidate Approved for kids 6-12
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Daytrana Skin Patch Methylphenidate Approved for kids 6-12 Skin sensitization Commercial release was delayed due to concerns but was approved after extended tests Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Focalin / Focalin XR Methylphenidate One isomer removed
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Focalin / Focalin XR Methylphenidate One isomer removed Mirror isomers in Ritalin, Concerta, Metadate, etc Detro isomer is active – Levo is not May be metabolized differently Switching means starting with half as much dosage Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

4/14/2017 SPD 465 Shire (Adderall) working on a 16 hour compound for adults and children Mixed salt of dextroamphetamine Coming soon….. Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

4/14/2017 Cylert (pemoline) FDA recommends change to different drug due to liver failure possibility 18.75mg to mg per day Longer half-life Not used any longer Liver enzyme profiles recommended Other drugs are less trouble Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

NRP 104 New River Pharmaceuticals Probably marketed by Shire
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 NRP 104 New River Pharmaceuticals Probably marketed by Shire Amphetamine bonded to lycine (amino acid) that is digested in body Not active until converted Peaks later (longer lasting?) Unlikely to be abused Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Other Classes of Medications Used
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Other Classes of Medications Used Antidepressants Tofranil (imipramine) Zoloft Often in combination with Ritalin Other SSRIs used Buproprion (Wellbutrin) Tricyclics Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Non-Stimulant Medication
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Non-Stimulant Medication Strattera (atomoxetine HCL) Norepinephrine Effective less often in comparison to MPH 24 hr coverage Nausea – take with food Builds up over time Several days to 6 weeks Take daily Not a scheduled drug – easier, convenient Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Other Classes of Medications Used
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Other Classes of Medications Used Others Tenex (guanfacine) Catapres (clonidine) Buspar (buproprion) Lithium Carbonate Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Up and Coming ? Provigil (modafinil) Cholinergic agents
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Up and Coming ? Provigil (modafinil) Narcolepsy drug Increases wakefulness Small study implied effectiveness Larger study showed no difference from placebo Cholinergic agents Facilitate nerve impulses Combination of medicines Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

The “comparable” study
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 The “comparable” study Dr. Waxmonsky found results of Strattera ‘comparable’ to that of stimulants Most studies find stimulants effective 95% of the time and Strattera about 70% of the time Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Randomized & Controlled studies
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Randomized & Controlled studies Adderall XR vs Strattera All scores significantly better for Adderall group Score reductions almost twice those of Strattera group Adverse events (AE) similar for both Similar results with Concerta (25% or more) Strattera definitely useful in particular cases Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Adolescent driving performance
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Adolescent driving performance Young drivers with ADHD are 2-4 times more likely to have accidents 3 times more likely to have injuries 6-8 times more likely to have license suspended Driving scores improved for those on stimulants Evening driving performance declined sharply for those taking immediate vs sustained release Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Prognosis (if treated)
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Prognosis (if treated) Better self-esteem, less social ostracism Better social skills Less likely to become delinquents as compared to untreated Not more likely to become addicts of other substances Berkley study? Contrary results ? Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

“Experimental” Treatments
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 “Experimental” Treatments EEG biofeedback electrodes attached 20-40 ‘sessions’ of minutes each Not for everybody Better research now available Before 2004 I listed this as “controversial” – more and better research has been completed and continues to be published Results continue when treatment stops Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Proven effective Behavior management Parent training Psychostimulants
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Proven effective Behavior management Parent training Psychostimulants Anti-depressants EEG Neurofeedback (with qualifications) Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

4/14/2017 Dietary Intervention Over the years, proponents of the Feingold Diet have made many dramatic claims. They state that the diet - which promotes the elimination of most additives from food - will improve most (if not all) children's learning and attention problems. In the past 18 years, dozens of well-controlled studies published in peer-reviewed journals have consistently failed to find support for the Feingold Diet. Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Dietary Interventions
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Dietary Interventions While a few studies have reported some limited success with this approach, at best this suggests that there may be a very small group of children who are responsive to additive-free diets. At this time, it has not been shown that dietary intervention offers significant help to children with learning and attention problems Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Megavitamins and Mineral Supplements
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Megavitamins and Mineral Supplements The use of very high doses of vitamins and minerals to treat ADHD is based on the theory that some people have a genetic abnormality which results in increased requirements for vitamins and minerals. Although vitamins are virtually synonymous with health, there is a complete lack of supporting scientific evidence for this treatment. There are no well-controlled studies supporting these claims, and of those studies in which proper controls were applied, none reported positive results. Both the American Psychiatric Association and the American Academy of Pediatrics have concluded that the use of megavitamins to treat behavioral and learning problems is not justified. Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Anti-Motion Sickness Medication
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Anti-Motion Sickness Medication Advocates of this theory believe that there is a relationship between ADHD and problems with coordination and balance, attributed to problems in the inner-ear system (which plays a major role in balance and coordination). This approach is not consistent in any way with what is currently known about ADHD, and is not supported by research findings. Anatomically and physiologically, there is no reason to believe that the inner-ear system is involved in attention and impulse control in other than marginal ways. Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

4/14/2017 Candida Yeast Advocates of this model believe that toxins produced by yeast overgrowth weaken the immune system and make the body susceptible to ADHD and other psychiatric disorders. There is no evidence from controlled studies to support this theory, and it is not consistent with what is currently known about the causes of ADHD. Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

4/14/2017 Applied Kinesiology Advocates of this approach - also known as the Neural Organization Technique - believe that learning disabilities are caused by the misalignment of two specific bones in the skull which creates unequal pressure on different areas of the brain, leading to brain malfunction. This theory is not consistent with either current knowledge of the cause of learning disabilities nor knowledge of human anatomy, as even standard medical textbooks state that cranial bones do not move. No research has been done to support the effectiveness of this form of treatment. It has no place in the treatment of learning-disabled children. Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Optometric Vision Training
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Optometric Vision Training Advocates of this approach believe that visual problems - such as faulty eye movements, sensitivity of the eyes to certain light frequencies and focus problems - cause reading disorders. Scientific studies of this approach are few in number and flawed in design. In 1972, a joint statement highly critical of this optometric approach was issued by the American Academy of Pediatrics, the American Academy of Ophthalmology and Otolaryngology, and the American Association of Ophthalmology. Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Legal Public Law 94-142, Part B of the IDEA
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Legal 4/14/2017 Public Law , Part B of the IDEA Indiv with disabilities education act Section 504 of the National Rehabilitation Act of 1973 Disabilities Act (ADA), enacted in 1990 1991 memo listed ADHD specifically eligible under “other health impaired” category Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Schools REQUIRED to 4/14/2017 provide a “free and appropriate education” to qualified kids with disabilities Modified interpretations identify & evaluate using multi-disciplinary team (criteria for eval) Qualify child for an IEP even if ADHD is only Dx (focus on impairment not Dx) Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Specifics (1/2) 4/14/2017 Law also sets parameters as to appropriateness through IEP reflecting nature & severity of each disability and specify aids and services to meet child’s unique needs least restrictive regular class then mixed then special ed Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Specifics (2/2) 4/14/2017 Section 504 protections extend further than the IDEA because 504 does not consider a need for special education as an eligibility requirement, as is the case under Part B of the IDEA. Rather, Section 504 applies to any person who has a "physical or mental impairment which substantially limits a major life activity." ADA requires ALL educational institutions to meet the needs of children with ADHD Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

School Based Interventions (1/2)
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo School Based Interventions (1/2) 4/14/2017 Behavioral difficulties likely to be seen at school because the child is asked to maintain attention for long periods of time and sustain a persistent effort. Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

School Based Interventions (2/2)
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo School Based Interventions (2/2) 4/14/2017 Focus on academic skills completing tasks making transitions interacting with others following through on directions producing work consistently organizing multi-step tasks. Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

inability to stay with play activities for sustained periods.
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Preschool 4/14/2017 excessive activity inability to stay with play activities for sustained periods. Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

demands on the child to pay attention increase fidgety, out of seat
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Elementary school demands on the child to pay attention increase fidgety, out of seat talkative and interrupting performing inconsistently. Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

not necessarily obviously hyperactive
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Middle and high school not necessarily obviously hyperactive fidgety, restless, often looking about academic problems under-developed social skills - poor peer relations. Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

School Intervention Overview
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo School Intervention Overview 4/14/2017 About 50% of children with ADHD can be taught in the regular classroom without services. About 50% require some degree of special ed and related services Of this 50%, about 35-40% will be in regular classrooms with additional support personnel and/or "pull-out" programs that provide special services outside of the classroom The most severely affected, 10-15%, may require self-contained classrooms. Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Classroom characteristics which promote success
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Classroom characteristics which promote success predictability structure shorter work periods small teacher to pupil ratio more individualized instruction interesting curriculum use of positive reinforcers Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Teacher characteristics seen as helpful
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Teacher characteristics seen as helpful 4/14/2017 positive academic expectations frequent monitoring and checking of work clarity in giving directions warmth, patience and humor consistency and firmness knowledge of different behavioral interventions willingness to work with a special education teacher Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Behavior management techniques
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Behavior management techniques 4/14/2017 develop behaviors that lead to academic and social success. Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Self-monitoring techniques
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Self-monitoring techniques 4/14/2017 most effective when tied to rewards and accuracy checks. Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Behavior Modification
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Behavior Modification 4/14/2017 charting child time Progressively more active responses simple & brief commands and directions Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

define the behavior observe count Charting
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Charting 4/14/2017 define the behavior observe count increase awareness of behavior & reward change Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Progressively more active responses
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Progressively more active responses 4/14/2017 ignore behavior natural consequences not replacing a toy left out in the rain logical consequences loss of tv time if the child leaves the room without turning the tv off time-out sit quietly in a designated place for a specific time after he has misbehaved. explain why Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Assess & diagnose properly Medication is a primary intervention
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Summary Assess & diagnose properly Medication is a primary intervention Multi-modal approach is preferred to meds only Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Treatment using a multi-modal approach
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Treatment using a multi-modal approach parent training behavior management environment management classroom interventions Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

decreased frustration increased performance
Parent training Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 adaptation success focused decreased frustration increased performance Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

positive reinforcement
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Behavior management 4/14/2017 positive reinforcement Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Environment management
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Environment management 4/14/2017 Parents, teachers and therapists work together create an environment that maximizes the child's probability of success. Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

ADHD Mediating Factors in Outcome Outcome Protective Factors Risk
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Mediating Factors in Outcome Protective Factors Outcome ADHD Risk Factors Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Biological Psychological Risk Protective Factors Factors Environmental
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Risk Factors Protective Factors Biological Psychological Environmental Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Protective Factors - BIOLOGICAL
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Protective Factors - BIOLOGICAL intelligence activity level frontal lobe function Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Protective Factors - ENVIRONMENTAL
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Protective Factors - ENVIRONMENTAL 4/14/2017 parent / family health social supports educational “fit” occupational “fit” Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Protective Factors - PSYCHOLOGICAL
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Protective Factors - PSYCHOLOGICAL healthy self esteem low depression low anxiety Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Risk Factors - BIOLOGICAL
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Risk Factors - BIOLOGICAL hyperactivity ADHD Tourett’s substance-related disorders Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Risk Factors - ENVIRONMENTAL
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Risk Factors - ENVIRONMENTAL 4/14/2017 chaotic family inadequate parenting deprivation educational deficits occupational deficits Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Risk Factors - PSYCHOLOGICAL
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Risk Factors - PSYCHOLOGICAL adversity disrupted development low self esteem depression anxiety Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Healthy Self Esteem Initiative Success Approval Self Esteem
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Healthy Self Esteem Initiative Success Approval Self Esteem Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

defiance criticism adversity self doubt Compromised Self-Esteem
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Compromised Self-Esteem 4/14/2017 defiance adversity self doubt criticism Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Families & ADHD All for one and one for all parents and stress
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Families & ADHD All for one and one for all parents and stress siblings and rivalry compensating & overcompensating Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Imbalance family organized around ADHD
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Imbalance family organized around ADHD family does not acknowledge the ADHD Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Balance Imbalance dad dad Functional & Dysfunctional Family Systems
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Functional & Dysfunctional Family Systems Balance Imbalance dad dad mom mom child child child child Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

What meds can do decrease aggression
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 What meds can do decrease aggression increase responsiveness to parents decrease negativity decrease impulsivity decrease disruptiveness improve peer relations by increasing reception to social learning Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Psychological Interventions
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Psychological Interventions Parent initiated Active Consistent Persistent Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Parents should have a POSITIVE attitude
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Parents should have a POSITIVE attitude Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Systematic praise and ignoring
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Systematic praise and ignoring specific brief frequent positive comments praise observable behavior ignore negative behaviors Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Parent characteristics seen as helpful
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 positive expectations frequent monitoring and interactions clarity in giving directions warmth, patience and humor consistency and firmness knowledge of different behavioral interventions willingness to work with from others’ points of view Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Parent interventions... 4/14/2017 approaches to parenting that work well with children who do not have ADD, do not work as well -- or at all -- with children who have ADHD. helplessness, frustration & exhaustion family members become angry and withdraw Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Parent Interventions... identify child’s strengths
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Parent Interventions... identify child’s strengths focus here to develop confidence and skills to attempt more difficult situations do not overreact to mistakes attend a meeting of a parent support groups Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Parent Interventions 4/14/2017 parent training to apply strategies to manage their child's behavior and improve their relationship with their child provide consistent structure & clearly defined expectations and limits Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Child time 10 to 15 minutes each day focus on being with the child
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Child time 4/14/2017 10 to 15 minutes each day focus on being with the child attend, listen, provide positive feedback. positive reinforcement attend to desired behavior ignore negative behavior Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Understand social strengths and weaknesses
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Understand social strengths and weaknesses Reinforce use of social skills in family Provide social skills training, modeling and opportunity to practice Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Social skills make eye contact act interested
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Social skills make eye contact act interested respect physical boundaries read body language start a conversation handle rejection avoid disagreements Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Peer Relations - Problems...
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Peer Relations - Problems... 4/14/2017 Making and keeping friends is sometimes difficult talk too much dominate activities intrude in others' games quit a game before its done not respond when someone else tries to initiate an interaction other inappropriate behavior Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Peer Relations - Problems
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Peer Relations - Problems 4/14/2017 facilitates loneliness low self-esteem depressed mood increased risk for anti-social behavior Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Peer Relations - Intervention...
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Peer Relations - Intervention... 4/14/2017 provide opportunities for positive interactions with peers reward program that focuses on one or two important social behaviors observe child in peer interactions & identify problem behaviors coaching, modeling and role-playing important behaviors "catching the child" at good behavior Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Peer Relations - Intervention
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Peer Relations - Intervention 4/14/2017 structure activities for child & a friend that are not highly interactive short breaks from peer interactions when the arousal level becomes high working to reduce aggressive behavior in the home Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

practice in safe setting
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 practice in safe setting provide feedback reinforce appropriate skills Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Environmental Interventions
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Environmental Interventions 4/14/2017 Parent directed Child takes active role Family oriented Family priority Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Routines organization effective use of time
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Routines 4/14/2017 organization effective use of time design routines to overcome specific problems remember - repeat - remind Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Examples up and dressed on time
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Examples up and dressed on time getting out of the house without leaving anything Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Environmental Changes - HOME
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Environmental Changes - HOME 4/14/2017 Homework location site should be well chosen Timing consistent with strengths and daily rhythms Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Characteristics which promote success
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Characteristics which promote success predictability structure shorter interaction periods small versus large group activities one on one interactions interesting to all involved use of positive reinforcers Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Change The Task alter how chore requests are made
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Change The Task 4/14/2017 alter how chore requests are made help child estimate how long a task will take break down into small parts improve focus on directions alter / reduce written workload Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

4/14/2017 Feedback systems or…this seemed pretty easy when we read about it on those nice colorful slides…. so…what so we do when it doesn’t work…. keep it simple clear tracking of behaviors prompt reinforcement Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Use of time out time out from positive reinforcement
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Use of time out 4/14/2017 time out from positive reinforcement select a few behaviors for which this applies choose an effective location for time out keep it brief use clear signal for start and end maintain the child in time out Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Token reinforcement systems
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Token reinforcement systems 4/14/2017 clear rules immediate rewarding of token kids should earn more points than they lose response cost systems start out with tokens and lose for unwanted behaviors Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Progressively more active responses
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Progressively more active responses ignore behavior natural consequences not replacing a toy left out in the rain logical consequences loss of tv time if the child leaves the room without turning the tv off time-out sit quietly in a designated place for a specific time after he has misbehaved. explain why Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Resources Available Books/Tapes at local library Support Groups
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo Resources Available 4/14/2017 Books/Tapes at local library Support Groups School Resources Legal Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

4/14/2017 A Brief History of ADHD GF Still. ‘Some abnormal psychological conditions in children.’ Lancet, 1902; i: He discussed 43 cases of children with aggression, defiance, emotionality, limited sustained attention, and deficient rule governed behavior. He suggested “inhibitory volition”… … ‘underdeveloped capacity to exercise good judgment’. s… called ‘minimal brain dysfunction’… symptoms thought to be a result of head injury, infection, or toxic damage (i.e., lead toxicity) 1960s… “hyperactivity”… “poor impulse control” No underlying organic damage had been identified. s… ‘hyperkinetic reaction of childhood’…  hyperactive child syndrome. …  ADD, with and without hyperactivity s.. ADHD with subtypes Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Time For Your Questions
Attention Deficit Disorder - Objective Assessment & Treatment Options Dr. Bruce Michael Cappo 4/14/2017 Time For Your Questions Clinical Associates, P.A Bluejacket, Suite 100, Lenexa, KS

Attention Deficit Disorder Objective Assessment & Treatment Options

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