John Laing APSY 658
John Laing APSY 658
John Laing APSY 658
Overview
Overview of ADHD description, core characteristics, prevalence and course Theories and Causes Executive functioning deficits and ADHD Assessment of ADHD
Intervention Summary
Overview of ADHD
2 distinct behavioural dimensions Inattention Hyperactive-Impulsive Behavior Subtypes of ADHD Predominantly inattentive type (ADHD-PI) Predominantly hyperactive-impulsive type (ADHD-HI) Combined type (ADHD-C)
Overview of ADHD
Prevalence 3% to 5% of all school-age children in North America (about 1 student in every class) one of most common referral problems in North America more frequent in boys than girls
boys 6% - 9% girls 2% - 4%
Overview of ADHD
Prevalence Culture and Ethnicity
all social classes, although slightly higher in low SES groups Identified in countries around the world
Overview of ADHD
Course and Outcome symptoms change with development
infancy?? Preschool
Elementary school
Adolescence
Adulthood
Overview of ADHD
Course and Outcome Impaired academic functioning Social problems
Reduced behavioural inhibition as core deficit of ADHD Impaired inhibitory mechanisms interfere with operation of 4 critical executive functions Working memory; self-regulation of affect-regulation-arousal; internalization of speech; and reconstitution (behavioural analysis and synthesis) Deficits at executive level leads to problems of inattention, socially inappropriate behaviour, disorganized behaviour, and other observable ADHD symptoms and become the target of intervention
Impaired Reconstitution
Children experience delayed maturation of executive functions and will outgrow ADHD Learn to compensate for ADHD Fail to compensate and experience ongoing difficulties into adulthood
Screening teacher rating of ADHD symptoms Multimethod assessment of ADHD parent/teacher interviews; review school records; behaviour rating scales; observations; academic performance Interpretation of results ADHD symptoms; deviance from norms; age of onset and chronicity; pervasiveness across settings; degree of functional impairment; rule out other disorders Develop treatment plan based on severity; functional analysis of behaviour; presence of associated disorders; response to prior treatment; community-based resources Assessment of treatment plan periodic collection of assessment data; revision of treatment plan as needed
Intervention
Conceptual Underpinnings Proactive and reactive strategies Intervene at the point of performance Individualized Collaboration
Intervention
Classroom-Based Interventions Contingency management procedures
Token reinforcement programs Contingency contracting Response cost Time-outs Home-Based contingencies
Intervention
Self-Management Strategies Self-monitoring Self-reinforcement
Intervention
Effective Instructional Strategies Teach classroom rules and expectations Instruction and remediation in basic skill areas
Intervention
Home-Based Intervention
Parent training Family therapy Homework interventions Parent support groups
Medication Therapy
Intervention
Important considerations
Modify the environment for those with EF deficits Immediate response to behaviour Intervene at the point of performance
working Give frequent physical exercise breaks throughout the school day Give smaller quotas of work at a time with frequent breaks Seat the child with ADHD close to teaching area to permit more supervision and frequent accountability for conduct and performance
Conclusion
Those with ADHD have underlying executive
functioning deficits which are the target of intervention Understanding specific executive functioning deficits is important to designing individual treatment plans Combination of several treatment modalities is most effective including collaboration Early and prolonged intervention is key to help avoid academic and social difficulties at school and later in life
References
Barkley, R. (2010). 80+ classroom accommodations for children or teens with ADHD. The ADHD Report, 16(4), 7-10. Barkley, R. (2003). Attention-deficit/hyperactivity disorder. In E. Mash, & R. Barkley (Eds.), Child psychopathology (2nd ed., pp. 75-143). New York: The Guilford Press. Dupaul, G., & Stoner, G. (2003). ADHD in the schools: Assessment and intervention strategies. New York: The Guilford Press. DuPaul, G.J., Stoner, G., & OReilly, M.J. (2002). Best practices in classroom interventions for attention problems. In Thomas, A. & Grimes, J. (Eds.), Best practices in school psychology (pp. 1115-1127). Bethesda, MD: NASP Publications. Lynch, S., Sood, R., & Chronis-Tuscano, A. (2010). The implementation of evidence-based practice for ADHD in pediatric primary care, The ADHD
Report, 18(5), 1-6. Mash, E., & Wolfe, D. (2005). Abnormal child psychology (3rd ed.). Belmont, CA: Thomson Wadsworth Ylvisaker, M. & DeBonis, D. (2000). Executive function impairment in adolescence: TBI and ADHD. Topics in Language Disorders, 20(2), 29-57.