1. Discussion Naomi Steiner, MD Developmental-Behavioral Pediatrics nsteiner@tuftsmedicalcenter.org Institute of Educational Science June 29, 2010

2. Conflicts of Interests  Naomi Steiner Has NO relevant financial relationships to disclose or Conflicts Of Interests to resolve.

3. Attention  Attention skills are complex Different areas of the brain affect other areas  Attention affects learning Early attention problems in kindergarten  poor reading outcomes  Attention is a developmental process Brain plasticity

4. Target Population StudyTarget Population Two models of preschool training All children in a Head Start classroom Computer attention training in 1 st graders Students with inattentive symptoms Response-to- treatment paradigm in 2 nd graders Students with executive function deficits

5. Attention training to preschool- aged children  ALL child-parent dyads in Head Start harmless, cost-effective intervention  Specifically in this generation (fast- paced information processing) Affecting attention in ways we do not yet fully understand Affecting future ability to attend to lengthy academic assignments

6. Attention deficit as a spectrum?  Attention spectrum disorder  Enrolled children with attention symptoms as per Conners’ Teacher Ratings Inattentive Scale  Children who scored at least 1.0 standard deviation above the sample mean  Subgroup analysis in children with 6 or more symptoms

7. Executive Function in 2 nd graders  Executive function affects in the complex process of writing.  Support interventions: students with writing difficulties and executive function deficits issues will react differently

8. Support services  Should we be thinking of attention issues for all students with academic difficulties?  The role of assessments  Break down learning into smallest steps to identify the true deficit

9. Age StudyAge Two models of preschool training Preschool age Computer attention training in 1 st graders 1 st graders Response-to- treatment paradigm in 2 nd graders 2 nd graders

10. Age  Attention development starts in infancy  Is there a minimal age to start to train attention functions in children?

11. What is going on developmentally?  Children with SLI have deficiencies in selective auditory attention  Gestalt: A deficit in one area associated with a deficit in another  Plasticity: with improvement in speech and language do the auditory channels of attention also improve?

12. Work using different angles  Courtney Stevens: Indirect Teach the parents how to support their children’s development Teacher mediated interventions to support positive classroom behavior and learning  Desiree Murray: CAT and CAI  Steve Hooper: support services

13. Shortcomings of medication therapies for ADHD  Short term  Helps students get their work done in the moment  does not help learn how to focus long term or develop executive functions/ organization  Need for other techniques to teach children with attention issues

14. Conclusion: ADHD affects learning  ADHD is not a trivial diagnosis  The presentation is complicated Multiple co-morbidities  Affects academic learning  Students with ADHD may struggle in regular education activities  Positive interventions early on and throughout their school carriers

15. Take home message  Importance of research on how students with ADHD learn  General education classroom: how to help students with ADHD adapt  Individualized interventions: identify what kind of specific and individualized interventions work best for students with ADHD

16. The end