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www.DrNowell.com<br />Lend Me Your Brain:<br />Practical Strategies for Managing ADD/ADHD,<br />Executive Dysfunction, and...
….a challenge<br />
Perspective of this workshop…..<br />
“Making distinctions”<br />
301.13,  rule out 296.89<br />
“Top – down” dysfunction<br />ADHD<br />Executive dysfunction<br />
“Bottom - up” dysfunction<br />Central auditory processing problems<br />Sensory processing problems<br />
What’s the kid’s deal?<br />
Normal and Abnormal Sensory Processing and Attentional Functioning<br /> <br />The Physiology of Motivation and Reward<br ...
Normal and Abnormal Sensory Processing and Attentional Functioning<br />
Sensory Processing Disorder<br />
Jean Ayres<br />
Sensory Integration Terminology<br />Sensory Processing<br />
Hard signs and soft signs<br />
Developmental soft signs<br />
Developmental considerations<br />Auditory    .<br />Visual<br />Tactile<br />Proprioceptive<br />Vestibular<br />Motor<br />
Sensory Processing/Integration Disorder and DSM-V<br />
What’s the kid’s deal?<br />
What’s the kid’s deal?<br />
Strategies<br />
Regulatory-Sensory Processing Disorders<br />Treatment<br />“top down”<br />“bottom up”<br />
X<br />
Regulatory-Sensory Processing Disorders<br />Treatment<br />“top down”<br />“bottom up”<br />
Monitoring<br />Percepts<br />Top – down <br />factors<br />Emotion and Motivation<br />Sensory input<br />RAS<br />Aleman...
Monitoring<br />Percepts<br />Top – down <br />factors<br />Emotion and Motivation<br />Sensory input<br />RAS<br />Aleman...
Role of the Mental Health Clinician in SPD<br />Primarily “top down”<br />Normalizing<br />Patient and family education<br...
Role of the Mental Health Clinician in SPD<br />Compensatory strategies<br />Self-esteem<br />Planning for success experie...
Central Auditory Processing Disorder<br />
Central Auditory Processing Disorder<br /><ul><li> Auditory discrimination (same/different)
Auditory closure (fill in missing bits)
 Auditory localisation(locate source of sound)
 Auditory performance with degraded acoustic</li></ul>signal<br /><ul><li> Auditory figure-ground (perceiving sounds in</l...
Central Auditory Processing Disorder<br />CAPD refers to a deficit observed in one or more of the central auditory process...
Central Auditory Processing Disorder<br />- Poor "communicator" (terse, telegraphic). - Memorizes poorly.- Hears better wh...
Central Auditory Processing Disorder<br />	- Often needs remarks repeated. - Difficulty sounding out words.- Confuses simi...
CAPD or ADHD?<br />
What’s the kid’s deal?<br />
Strategies<br />
(C)APD<br />Treatment<br />“top down”<br />“bottom up”<br />X<br />
Treatment for CAPD<br /> Environmental modifications<br />
Treatment for CAPD<br />Compensatory Strategies<br />strengthening higher order central resources  (language, memory,  att...
Treatment for CAPD<br />Compensatory Strategies<br />Metalinguistic strategies include: schema induction, context-derived ...
Treatment for CAPD<br />Compensatory Strategies<br />Metacognitive strategies include self-instruction, cognitive problem ...
Attention Deficit Hyperactivity Disorder<br />
Increase salience<br />
Attention Deficit Hyperactivity Disorder<br />
(85 – X) x 365<br />
“I’m gonna eat all the gum and candy I want!”<br />
Core symptoms<br />Inattention / distractibility<br />
Core symptoms<br />Hyperactivity / impulsivity<br />
….and the rest of the criteria<br />Onset before age 7<br />Impairment in 2 or more settings<br />Significant functional i...
Functional impact of core symptoms<br />Arousal / alertness<br />Mental effort<br />Determination of saliency<br />Focal m...
Functional impact of core symptoms<br />Arousal / alertness<br />Mental effort<br />Determination of saliency<br />Focal m...
Functional impact of core symptoms<br />Arousal / alertness<br />Mental effort<br />Determination of saliency<br />Focal m...
Functional impact of core symptoms<br />Arousal / alertness<br />Mental effort<br />Determination of saliency<br />Focal m...
Functional impact of core symptoms<br />Satisfaction control<br />Previewing<br />Inhibition<br />Tempo control<br />Self-...
Functional impact of core symptoms<br />Satisfaction control<br />Previewing   .<br />Inhibition<br />Tempo control<br />S...
Functional impact of core symptoms<br />Satisfaction control<br />Previewing<br />Inhibition<br />Tempo control<br />Self-...
Functional impact of core symptoms<br />Satisfaction control<br />Previewing<br />Inhibition<br />Tempo control<br />Self-...
Functional impact of core symptoms<br />Satisfaction control<br />Previewing<br />Inhibition<br />Tempo control<br />Self-...
Subtypes of ADHD<br />ADHD, predominantly inattentive type<br />ADHD, predominantly hyperactive type<br />ADHD, combined t...
Subtypes of ADHD<br />ADHD, predominantly inattentive type<br />ADHD, predominantly hyperactive type<br />ADHD, combined t...
Common comorbidities with ADHD<br />Learning disorder<br />Behavioral disorder<br />Anxiety<br />Depression<br />Substance...
Common comorbidities with ADHD<br />Learning disorder<br />Behavioral disorder<br />Anxiety<br />Depression<br />Substance...
ADHD and girls<br />
ADHD and women<br />
ADHD and women<br />More tasks<br />More diffuse<br />More parental responsibility<br />Less likely to have an “executive”...
Executive Functioning:An Overarching Theme<br />Sensory Processing Disorder<br />Central Auditory Processing Disorder<br /...
The Executive Functions<br />Internalizing speech<br />Previewing<br />Prioritizing<br />Tempo control<br />Inhibition<br />
The Executive Functions<br />Determining salience (what’s in it for me?)<br />Blocking out distractions<br />Self-monitori...
Appropriate expectations<br />
Age-appropriate expectations<br />Preschool<br />1-step errands<br />Chores with cues<br />Basic inhibition<br />
Age-appropriate expectations<br />K – 2nd grade<br />2-3 step directions<br />Bring papers home<br />20-30 minute assignme...
3rd – 5th<br />Simple shopping list<br />Keep track of personal items<br />Longer homework assignments<br />Simple project...
6th – 8th<br />complex chores<br />Babysitting<br />Organizing system<br />Complex schedule<br />Longer term projects<br /...
Teenage – mid 20s<br />Independent with assignments<br />Make adjustments based on feedback<br />Longer term goal setting<...
“what is” vs. “what could be”<br />
“what is” vs. “what could be”<br />
Introduction to Neuroanatomy<br />Inter-connectedness of systems<br />Cortico-striatal system, for example<br />
Strategies<br />
Pharmacotherapy<br />X<br />
Behavioral Supports<br />
A<br />B<br />C<br />
A<br />B<br />C<br />behavior<br />
A<br />B<br />C<br />consequences<br />
A<br />B<br />C<br />antecedent<br />
A<br />B<br />C<br />antecedent<br />
A<br />B<br />C<br />antecedent<br />
easy<br />hard<br />
A<br />B<br />C<br />consequences<br />
Time Out<br />Select target behavior<br />Set place<br />Determine how much time<br />Dress rehearsal<br />Measure the tim...
Token economy<br />Good balance<br />Precursor to adult reinforcement system<br />Lots of work to do well<br />Even more w...
Intrinsic motivation<br />
A<br />B<br />C<br />behavior<br />
Metacognition<br />Metacognitiveknowledge<br />Metacognitivestrategies<br />
“Lend Me Your Brain”<br />
The Physiology of Motivation and Reward<br />
Preferred States:  What Does Dopamine Feel Like?<br />Great experience<br />Kodak moment<br />The feeeeling<br />
Broaden and Build<br />
“NeuroMalleability”<br />
The Brain’s Reward and Planning System<br />
The reward-and-planning system<br />Anticipate goal<br />Identify tasks<br />Sequence / problem-solve<br />Block out distr...
“what is” vs. “what could be”<br />
“what is” vs. “what could be”<br />
The reward-and-planning system<br />Anticipate goal<br />Identify tasks<br />Sequence / problem-solve<br />Block out distr...
Ways the reward-and-planning system can go wrong<br />Alicia R. Ruelaz, M.D.: “the biggest issue for me, and others I've s...
Ways the reward-and-planning system can go wrong<br />Jacy, a freelance artist from Connecticut,: I get so excited about a...
Ways the reward-and-planning system can go wrong<br />Juzer :“my biggest problem is that I want to do everything all at on...
Ways the reward-and-planning system can go wrong<br />Inna: “I just get blank. I usually start sitting more slouched, hold...
Ways the reward-and-planning system can go wrong<br />Hank: “I have things I need to do to improve my marriage, my health ...
Ways the reward-and-planning system can go wrong<br />Alice, a oach from Long Island: The difference between a dream and a...
Ways the reward-and-planning system can go wrong<br />Anticipate goal (state)<br />Identify tasks<br />Sequence / problem-...
Ways the reward-and-planning system can go wrong<br />Anticipate goal (state)<br />Working memory<br />Insight<br />Alexit...
Ways the reward-and-planning system can go wrong<br />Identify tasks<br />Working memory<br />Intelligence / development<b...
Ways the reward-and-planning system can go wrong<br />Identify tasks<br />Working memory<br />Intelligence / development<b...
Ways the reward-and-planning system can go wrong<br />Sequence / problem-solve<br />
Ways the reward-and-planning system can go wrong<br />Sequence / problem-solve<br />Verbal working memory<br />Nonverbal w...
Ways the reward-and-planning system can go wrong<br />Sequence / problem-solve<br />Verbal working memory<br />Nonverbal w...
Ways the reward-and-planning system can go wrong<br />Block out distractions<br />
The best defense against the manipulation of our attention is to determine for ourselves – in advance - how we want to inv...
Ways the reward-and-planning system can go wrong<br />Block out distractions<br />Field dependent (sensitive to novelty)<b...
Ways the reward-and-planning system can go wrong<br />Get the reward<br />
Ways the reward-and-planning system can go wrong<br />Get the reward<br />Satisfaction control<br />Picked wrong task<br /...
Instant gratification vs. executive gratification<br />
PREFERRED    STATES  <br />INVENTORY<br />David D. Nowell, Ph.D.<br />189 May Street<br />Worcester, Mass. 01602<br />DrNo...
Identify 20 peak experiences.<br />For each peak experience, identify the highlight moment – the snapshot.<br />Go to the ...
Find a word, a label, for each of the groupings.<br />Check for accuracy (“gut” check).<br />Those are your preferred stat...
PREFERRED    STATES  <br />INVENTORY<br />
A<br />B<br />C<br />behavior<br />x<br />
Self-Talk Proficiency<br />
Self-Talk Proficiency<br />• -“How are you going to know when to be ready?”<br />• -“How are you going to stop yourself fr...
Self-Talk Proficiency<br />• -“How are you going to know what you need?”<br />• -“How are you going to know what is most i...
Self-Talk Proficiency<br />• -“How will you continue when you are tired?”<br />• -“How did that work out?”<br />• -“How lo...
Match the Picture<br />
Distraction Delay Training<br />
Executive Estimates Training<br />X<br />
Learning Time:<br />What is the “felt” experience of time?<br />What is the “frontal” aspect of time?<br />
Learning Time:<br />
Learning Time:<br />
Learning Time:<br />Theres no such thing as procrastination….there’s just choosing.  And choosing again.<br />
Asking two questions…<br />Am I having fun now?<br />And is this what I set out to do?<br />
Am I having fun now?<br />Is this what I set out to do?<br />
Am I having fun now?<br />Is this what I set out to do?<br />
Key Features of Video Games<br />Clear expectations<br />Behavioral specificity<br />Build on small changes in behavior<br...
Key Features of Video Games<br />Always follow up on rules, no exceptions<br />Consequences are immediate<br />Punishment ...
Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human BrainVolkow, et al. 2004<...
Increase salience<br />
Increase salience<br />
Quarterly QI review<br />
Homework problems<br />Fails to write down assignments<br />Forgets the assignment book<br />Forgets necessary materials<b...
Homework challenges<br />School / parent communication<br />Routine<br />Limit distractions<br />Chunking<br />Support the...
Homework challenges<br />School / parent communication<br />Routine<br />Limit distractions<br />Chunking<br />Support the...
The post-mortem<br />
Your #1 Organizational Tool<br />
Your #1 Organizational Tool<br />Yoga / read<br />Phone calls<br />Staff meeting<br />Planning<br />session<br />billing<b...
Your #1 Organizational Tool<br />Vh:  jeff w/ puritan oil<br />Vc:  kate re: brimfield<br />TC umass dermatology.  Spoke w...
Your #1 Organizational Tool<br />
Learn French<br />Be a better spouse<br />Stop smoking<br />
The “Big Five” <br />Daily focus time<br />Values/motivational clarity<br />Nutrition<br />Movement<br />Connection<br />
The “Big Five” <br />Daily focus time<br />Values/motivational clarity<br />Nutrition<br />Movement<br />Connection<br />
The “Big Five” <br />Daily focus time<br />Values/motivational clarity<br />Nutrition<br />Movement<br />Connection<br />
The “Big Five” <br />Daily focus time<br />Values/motivational clarity<br />Nutrition<br />Movement<br />Connection<br />
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Lend me your brain easter seals

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Presentation to Easter Seals staff on 7/12/11

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  • MYSTERY BOXHAVE ST / VP PUT NAMES OF ATTENDEES IN HATAPPENDIX A p. a2: TO DO
  • What does this have to do w/ my clients?Identify 2 clients w/ whom you can apply + psych tools we’ll review today.EXPLAIN WKSHOP’S PURPOSE, INCREASE SALIENCE, RELATE TO PRIOR K’LEDGEWhat do you already know about executive functioning? Attention, memory, organization? Why are 16 yo drivers less safe? Why do we have legal drinking age? In your own life, where are you most impulsive, and where do you have the best behavioral control? APPENDIX B p. a3: THIS WKSHOP WILL BE A SUCCESS FOR ME IF…“in avoiding what needs to be done, how can I can I start the project early, not the 11th hour?”“…how to make my dtr &gt; I with adls homework etc”
  • Scott peck: diagnostician. DI vs. intake, etc.NLP: distinctions.
  • Round pegsRespectful but not slavish.Hx:Make dx reliable across providersGuide researchMoving b/t static dsm categories and dynamic human beings.
  • Dx approach
  • APPENDIX C pa4: ANY TERMS OR WORDS U DON’T UNDERSTAND, JOT ON LIST.WORD WALL
  • APPENDIX D p.a5: IDENTIFY SOMETHING YOU’D LIKE FOR YOURSELF. HOW WOULD THAT MAKE U FEEL? WHAT ARE A COUPLE OF WAYS YOU COULD GO ABOUT CREATING THAT? WHICH WAY SEEMS MOST LIKELY TO WORK FOR YOU? WHAT WOULD BE THE VERY FIRST STEP YOU COULD TAKE TOWARDS THAT? AND THE SECOND STEP? WHAT OBSTACLES WD U LIKELY ENCOUNTER IF U TRIED THAT? WHO COULD HELP YOU PROBLEM SOLVE AROUND THAT OBSTACLE? WHAT RESOURCES DO U HAVE TO HELP U REACH THAT GOAL? DO U HAVE MORE FRIENDS OR MORE MONEY? MORE INTELLIGENCE OR MORE PERSISTENCE? IF U DID TAKE THIS GOAL ON AS A PERSONAL PROJECT, HOW LONG DO U THINK IT WOULD TAKE U TO REACH YOUR GOAL? WHAT WOULD BE THE TWO BIGGEST DISTRACTIONS ALONG THE WAY? WHAT WILL IT FEEL LIKE WHEN YOU DO GO AHEAD AND HAVE THIS THING THAT YOU KNOW YOU’D LIKE TO HAVE?
  • Good news ands bad news: it’s 2009.
  • proprioceptive
  • CNS Development: Sensory input contributes toDevelopmentSensory input is necessary for brainFunctionActive engagement in sensory experienceproduces an adaptive responseAdaptive responses to sensory inputs optimize function
  • Neurological hard signs, soft signs, and developmental soft signs
  • The softest of them all!
  • Infants: R to loud noise, R to bells or whistles, R to lullabies, R to peek a boo, sound source locationDifferentating among people, R to lights and colors; eye contactManipulating toys, feeding, R to touch, investigating world with hands and mouthPlaying with toes, grasping objects, experimenting w diff. body positionsSitting up, lifting headSitting up, lifting head, kicking, truncal stability
  • A very high threshold of empirical data has been set for adding a new disorder to DSM-V in order to insure that only diagnostically valid disorders are added to the system. The types of data that would be required include 1) evidence that sensory processing disorder describes a condition that is not adequately covered by an existing DSM-IV disorder; 2) evidence supporting its diagnostic validity; 3) evidence supporting its clinical utility; and 4) evidence supporting that there is a low risk of false positive diagnoses that might result if sensory processing disorder were to be added.
  • Motor d/o: Decreased muscle tone􀂄 Delay in motor milestones􀂄 Delay in hand use and fine motor skills􀂄 Delay or poorly executed self-care skills – q activity has stepsOT model of proprioception and vestibular sense
  • Douglas. 6 yo w h/o school avoidance. Picky eater. Wears sunglasses outdoors. ? Of adhd. w/drawn, sullen after giving up on peewee football b/c the helmet was stinky.
  • Carlos, 5 yo boy. …. M c/o tantrums, stubborness. Bedtimes difficult. Pushes his sister. Per OT pt performs poorly on measures of sensory modulation, esp tactile. Suggests he is easily overwhelmed.You learn that mom suspects he is in cntrol of tantruming? he negotiates. Often ? Of Primary or Secondary gain.The less cntrl he seems to have over this behavior, the more concern we have re: sensory or some other overload.
  • Parents’ goal: well adjusted 18 yo….or 21 yo
  • 1st we need to consider construct validity b/f we “tx” a conditionIn small N studies Specific tx interventions have proven more effective than no tx, but no diff. from other alternative tx. Note problem of placebo.
  • adults routinely adjust for their sensory processing irregularitiesw by carefully making choices that allow them to honor their nervous systems w/o intruding on others. Swedish shoes, diesel, glare when fatigued, tight clothing, short shirtsleeves.Kids: less independent, poorer insight, poorer abstraction. OT can increase insight, normalize their sensory prefernces. Have their defensiveness in the presence of a supportive adult. K.o. like going off the high dive.
  • PUSHING ICE CUBE ON A TRAYFEELY GAME AROUND THE HOUSEHOT DOG IN A BLANKETTIC TAC TOE IN SHAVING CREAMBOPPING A BALLOON BUCKET BEANBAG CATCHER
  • CUTTING PLAY DOH WITH SCISSORS
  • 1st we need to consider construct validity b/f we “tx” a conditionIn small N studies Specific tx interventions have proven more effective than no tx, but no diff. from other alternative tx. Note problem of placebo.
  • 9:40 a.m.
  • A Central Auditory Processing Disorder (CAPD) exists when achild has apparent difficulty in processing auditory informationwhile possessing normal hearinglittle consensuson a definition, criteria for assessment and diagnosis, andthe efficacy of remediation and management.
  • A Central Auditory Processing Disorder (CAPD) exists when achild has apparent difficulty in processing auditory informationwhile possessing normal hearinglittle consensuson a definition, criteria for assessment and diagnosis, andthe efficacy of remediation and management.
  • What teacher might notice
  • Dx approach
  • Jennifer, 4 yo. Limited language. Expressive better than receptive. Makes prefernces known. Intense eye contact but ? Understanding. Plays well with cousins and sister, less well with others at daycare seting with some older children.
  • Parents’ goal: well adjusted 18 yo….or 21 yo
  • Guy berard – aitAlfred tomatis – tomatis auditory training
  • Environmental modifications􀂫 Reduce ambient noise CARPET RUBBER TIPS ON CHAIRS CLOTH AND MAT POSTER BOARDS􀂙preferential seating AWAY FROM SOURCES OF NOISE FANS CORRIDOORS OUTSIDE TRAFFIC􀂫 Frequent checks for comprehension
  • 􀂴 ACTIVE LISTENING􀂴 CHECKS FOR COMPREHENSION􀂴 MULITISENSORY INSTRUCTION􀂴 MNEMONIC DEVICES TO ASSIST MEMORY
  • 􀂴 ACTIVE LISTENING􀂴 CHECKS FOR COMPREHENSION􀂴 MULITISENSORY INSTRUCTION􀂴 MNEMONIC DEVICES TO ASSIST MEMORY
  • 􀂴 ACTIVE LISTENING􀂴 CHECKS FOR COMPREHENSION􀂴 MULITISENSORY INSTRUCTION􀂴 MNEMONIC DEVICES TO ASSIST MEMORYPING PONG BALL / COFFEE CANBEANS, BUTTONS IN TOOTHPASTE BOXESIPHONE VOICE RECORDER APP, VARIOUS HOUSEHOLD SOUNDSPRETENDING TO BE A RADIO WITH VOLUME KNOB WHAT’S MISSING? (TWINKLE TWINKLE…) WHAT COMES BEFORE “I BELIEVE IN YESTERDAY”HOW DOES IT END? (FAMILIAR STORY)MR POTATO HEAD W/ METAPHORS: IN ONE EAR AND OUT THE OTHER. EYES BIGGER THAN STOMACH. I’M ALL EARS. YOU TOOK THE WORDS RIGHT OUT OF MY MOUTH. YOU’RE PULLING MY LEG.
  • EXPLAIN WKSHOP’S PURPOSE, INCREASE SALIENCE, RELATE TO PRIOR K’LEDGE
  • 85-x*36540 yo = 16425 28 yo = 20805 52 yo = 12045“gonna eat all the gum and candy I want”It is a most mortifying reflection for a man to consider what he has done, compared to what he might have done.  ~Samuel Johnson, in Boswell&apos;s Life of Johnson, 1770
  • The full existential horror of being an adult
  • Distracted by whatever’s eye-catching in the moment? Or engaging in specifric and familiar activites whose fx it is to maintain sensory homeostasis?
  • Sleep problems FatigueFidgety when needs to concentrateInconsistent/erratic patterns of attnTx: sleep hygeine
  • Has trouble getting started w workWorks only on thihngs that are partic. Interesting to him/herEffort is unpredictableTx: use hi-interest topics, Premack principle, cueing, R cost (tokens)
  • Cant tell important from unimp.Recalls irrelevant detail rather than pertinentDistracted by irrelevant background noisesConcentrates on visual stimlui that others would ignoreTx: vary potency of stimli; highlighting certain words/phrases; explicit training in id’ing “what’s most important” (picture completion subtest)
  • Cassidy is working on master’s thesis. When she sits down 2 do ork, felt need to clean apt. Didn’t esp. like cleaning the apt but felt the urge whenever she needed to write. She actually fet she could not work unless e.t. in her apt was cleaned and in order.
  • Not a good listenerNot in volitional control of the process of focus: can overfocus, can fail to concentrate long enoughMisses key parts of directions / explanationsTx: keep verbalizations short and simple; check for understanding; use bookmarks that facilitate focus
  • Hard to satisfy, wants things all the time; needyRestless, craves excitementConcentrates well only on exciting stimuliPoor delayed gratificationTx: provide stimulating learning situations; do not r+ inappropriate or off-task behav.
  • Fails to look ahead and predict consequences, Task approach is seemingly w/o plan, w/o regard to time needed, w/o regard to resources needed. Difficulty w transitions, Difficulty foreseeing solutionsTx: train in self-talk and problem solving. R+ instances of behav,. Inhibition and planning ahead (e,.g. raising hand, packing umbrella); modeling. EG: tom, 8th grader, procrastination. TS . worked with mom, who coordinated w/ school 2 b notified of any longer term projects. LONG TERM PROJECT PLANNING SHEET. Eg report on dangerous sea animal. Brainstorm, choose, id materials needed, subgoals, assign dates, plan R+ for meeting goals.
  • Inappropriate behaviors, Does things the hard way, breaks things, Blurts inappropriate comments, prim. Proc.Tx: use DRO to increase soc. Appropriate behav.; be explicit; use + px (w many repetitions)EG: circle time a struggle for kristin, 2nd grader. Despite clear rules about turn taking, kristin wd blurt out while others were talking. Tchr introduced a talking stick. Then gave each child 2 chips (to ask ?s). If pt blurts, lose chip. FADE over time.
  • Does things slowly, or recklessly … barkley and time perceptionTrouble organizing time needs during taskDawdles, misses deadlinesLevel of activity seems inappropriate to actual urgency of taskTx: age approp. Time mgt tools; organizational charts, sub-goals, checklistst; px time estimates; beat the clock
  • Loses track during taskEasily derailed – responds to r+ in the moment rather than using mental representation of future r+ or p+Careless mistakesTx: give ongoing supportive feedback; encourage post-mortem reviews of behav; nag tapes
  • Ocd? Luvox? Cbt for ocd?
  • Stronger social support for being nice, developing emotional intelligence. Locker or desk mt be messy. Handwriting mt be messy. Mt be sensitive to visual stimuli and physical mvmt. Shy/wdrawn. If hyper, mt be hypertalkative and chatty.
  • More tasks, more diffuse
  • Who called the caterer? Designed and order tshirts? Considered potential hurt feelings re: invitation list. Set up the evite? Remembered that the reunion would coincide with 20th wedding reunion of one couple? Made sure the paper plates and cups match? Managed the household mood in the days leading up to the reunion?More tasksMore diffuseMore parental responsibilityLess likely to have an “executive” partnerLess likely to have assistants at workLess likely to focus on a narrow areaMore likely to feel shame about disorganization
  • Lay out the pork chops
  • 22”
  • LADY GAGA AND 4 WORD LIST
  • FIGHTING NUN IN MYSTERY BOX: WHY IS THIS FUNNY? WE HAVE EXPECTATIONS BASED ON AGE, STATUS, ETC.Preschool Run simple errands (e.g., “Get your shoes from thebedroom”). Tidy bedroom or playroom with assistance. Perform simple chores and self-help tasks withreminders (e.g., clear dishes from table, brush teeth,get dressed). Inhibit behaviors: don’t touch a hot stove; don’t runinto the street; don’t grab a toy from another child;don’t hit, bite, push, etc.
  • FIGHTING NUN IN MYSTERY BOX: WHY IS THIS FUNNY? WE HAVE EXPECTATIONS BASED ON AGE, STATUS, ETC.Preschool Run simple errands (e.g., “Get your shoes from thebedroom”). Tidy bedroom or playroom with assistance. Perform simple chores and self-help tasks withreminders (e.g., clear dishes from table, brush teeth,get dressed). Inhibit behaviors: don’t touch a hot stove; don’t runinto the street; don’t grab a toy from another child;don’t hit, bite, push, etc.
  • Run errands (two to three step directions).Grade 2 Tidy bedroom or playroom. Perform simple chores, self-help tasks; may needreminders (e.g., make bed). Bring papers to and from school. Complete homework assignments (20-minutemaximum). Decide how to spend money (allowance). Inhibit behaviors: follow safety rules, don’t swear,raise hand before speaking in class, keep hands to self.Look both ways before x streetShare toys w/o grabbing
  • Run errands (may involve time delay or greater distance, such as going toa nearby store or remembering to do something after school). Tidy bedroom or playroom (may include vacuuming, dusting, etc.). Perform chores that take 15—30 minutes (e.g., clean up after dinner, rakeleaves). Bring books, papers, assignments to and from school. Keep track of belongings when away from home. Complete homework assignments (1 hour maximum). Plan simple school project such as book reports (select book, read book,‘write report). Keep track of changing daily schedule (i.e., different activities afterschool). Save money for desired objects, plan how to earn money. Inhibit/self-regulate: behave when teacher is out of the classroom;refrain from rude comments, temper tantrums, bad manners.f/u simple classroom rulesWaits till m,f off tc before telling something
  • Help out with chores around the home, including both dailyresponsibilities and occasional tasks (e.g., emptying dishwasher, rakingleaves, shoveling snow); tasks may take 60—90 minutes to complete. Baby-sit younger siblings or for pay. Use system for organizing schoolwork, including assignment book,notebooks, etc. Follow complex school schedule involving changing teachers andchanging schedules. Plan and carmy out long-term projects, including tasks to beaccomplished and reasonable timeline to follow; may require planningmultiple large projects simultaneously. Plan time, including after school activities, homework, familyresponsibilities; estimate how long it takes to complete individual tasksand adjust schedule to fit. Inhibit rule breaking in the absence of visible authorityHandles conflcit w/o physical fightsCan calm down or self soothe
  • Manage schoolwork effectively on a day-to-day basis, including completing andhanding in assignments on time, studying for tests, creating and followingtimelines for long-term projects, and making adjustments in effort and quality ofwork in response to feedback from teachers and others (e.g., grades on tests,papers). Establish and refine a long-term goal and make plans for meeting that goal. If thegoal beyond high school is college, the youngster selects appropriate courses andmaintains grade point average (GPA) to ensure acceptance into college. Theyoungster also participates in extracurricular activities, signs up for and takesScholastic Aptitude Tests (SATs) or American College Tests (ACTs) at theappropriate time and carries out the college application process. If the youngsterdoes not plan to go to college, he or she pursues vocational courses and, ifapplicable, employment outside of school to ensure the training and experiencenecessary to obtain employment after graduation. Make good use of leisure time, including obtaining employment or pursuingrecreational activities during the summer. Inhibit reckless and dangerous behaviors (e.g., use of illegal substances, sexualacting out, shoplifting, or vandalism).Able to walk away from provocationCan say no to fun activitgy if other plans have already been madeResists saying hurtful things
  • APPENDIX L p.a13: LAST TXGIVING HOLIDAY: ON SCALE FROM 1-10 HOW GOOD WAS IT FOR U AND YR FAMILY? HOW COULD IT BE A (+1)?MAIN RELATIONSHIP…MOST IMP RELATIONSHIP: WHAT WOULD MAKE IT 10% BETTER? WHAT COULD I DO THIS WK’END TO MAKE THAT HAPPEN?
  • APPENDIX L p.a13: LAST TXGIVING HOLIDAY: ON SCALE FROM 1-10 HOW GOOD WAS IT FOR U AND YR FAMILY? HOW COULD IT BE A (+1)?MAIN RELATIONSHIP…MOST IMP RELATIONSHIP: WHAT WOULD MAKE IT 10% BETTER? WHAT COULD I DO THIS WK’END TO MAKE THAT HAPPEN?
  • NeuroanatomyNeurotransmittersPhenomenology of dopamine and serotonin
  • Parents’ goal: well adjusted 18 yo….or 21 yo
  • What questions do you have re: rx?
  • What questions do you have re: rx?
  • 147”
  • R+ inhibitionPremack principleBehav contractToken system
  • Dawson p 81Setting him up for success – think about the “box” and its capacity. Don’t overload it.Change physical or soc. Environment – add bariers, &lt;distractions, &gt;org. structure, change social mixChange nature of tasks – reduce complexity (if &gt; 3/10 on difficulty scale)Why do students shape up when tchr close by? &gt;insight, activate rules, clearly they “can” – performance deficit vs skills deficit.
  • Dawson p 81Setting him up for success – think about the “box” and its capacity. Don’t overload it.Change physical or soc. Environment – add bariers, &lt;distractions, &gt;org. structure, change social mixChange nature of tasks – reduce complexity (if &gt; 3/10 on difficulty scale)Why do students shape up when tchr close by? &gt;insight, activate rules, clearly they “can” – performance deficit vs skills deficit.
  • Dawson p 81Setting him up for success – think about the “box” and its capacity. Don’t overload it.Change physical or soc. Environment – add bariers, &lt;distractions, &gt;org. structure, change social mixChange nature of tasks – reduce complexity (if &gt; 3/10 on difficulty scale)Why do students shape up when tchr close by? &gt;insight, activate rules, clearly they “can” – performance deficit vs skills deficit.
  • Make task shorter, build in breaks, use salient r+ for afterwards, make steps more explicit, make task more appealing (beat the clock, write steps down on slips of paper, in jar)
  • 2:00
  • 242”
  • R+ inhibitionPremack principleBehav contractToken system
  • 242”
  • He should just do it!
  • Victoriah’s F re: u sh just do it, tense/frustrated
  • 147”
  • Lady Gaga and 4 word list
  • What questions do you have re: rx?
  • PREP FOR TRANSITION
  • APPENDIX J: p. a11Where exactly do u feel that? E.g. my morning feeling after good nights sleep
  • Broaden+emo enlarge the cog context, ? d/t dopamine levelsFaster learning and improved cognitive performanceBuildEnduring personal resources – physical, intellectual, and social41”
  • Why aren’t we getting exactly what we want, all the time?
  • APPENDIX L p.a13: LAST TXGIVING HOLIDAY: ON SCALE FROM 1-10 HOW GOOD WAS IT FOR U AND YR FAMILY? HOW COULD IT BE A (+1)?MAIN RELATIONSHIP…MOST IMP RELATIONSHIP: WHAT WOULD MAKE IT 10% BETTER? WHAT COULD I DO THIS WK’END TO MAKE THAT HAPPEN?
  • APPENDIX L p.a13: LAST TXGIVING HOLIDAY: ON SCALE FROM 1-10 HOW GOOD WAS IT FOR U AND YR FAMILY? HOW COULD IT BE A (+1)?MAIN RELATIONSHIP…MOST IMP RELATIONSHIP: WHAT WOULD MAKE IT 10% BETTER? WHAT COULD I DO THIS WK’END TO MAKE THAT HAPPEN?
  • Why aren’t we getting exactly what we want, all the time?
  • Why aren’t we getting exactly what we want, all the time?
  • Why aren’t we getting exactly what we want, all the time?
  • Why aren’t we getting exactly what we want, all the time?
  • Why aren’t we getting exactly what we want, all the time?
  • Why aren’t we getting exactly what we want, all the time?
  • St’s going to happen today at 5:00
  • Insight re: match b/t activities and PSI
  • Insight re: match b/t activities and PSI
  • 77”How would you get to 495 if 290 were shut down from auburn to plantation street exit?
  • Attn is a precious commodity. Things and ppl will compete for itBest defense vs the manipulation of one’s attn is to determine for oneself how one wants to invest itSt’s going to happen today at 5:00
  • APPENDIX F p.a7: WRITE DOWN ?S YOU’VE HAD TO THIS POINT
  • 132
  • What’s the one thing I need to do…. APPENDIX O p. a16Challenge: move that item to To Do list, APPENDIX A p.a2
  • Which behavior (more or / less orf) would make the biggest difference?
  • What are non-impaired kids doing that this pt is NOT?You can say: “If I keep doing this it islikely my teacher/friend will……”Ask to hear what the inner voice wassaying: “Tell me what you like bestabout that!”“Tell me what you were thinking whenyou came up with that idea!”“That must have been a challenge…whatdid you tell yourself to get past it?”• -“How are you going to know when to be ready?”• -“How are you going to stop yourself from…?”• -“What is your goal?”• -“What do you want it to look like?”• -“How long do you think it will take?”• -“How much did time did it take last time?”• -“How are you going decide where to set that up?”• -“How are you going to know what you need?”• -“How are you going to know what is most important?”• -“How are you going to decide what to do first?”• -“How will you know when you are done?”• -“How will you continue when you are tired?”• -“How did that work out?”• -“How long do you think that took?”• -“How did you manage/know how to do it?”• -“Would you do anything differently?”• -“Have you done anything like this before?”• -“Was that harder or easier than….”
  • What are non-impaired kids doing that this pt is NOT?You can say: “If I keep doing this it islikely my teacher/friend will……”Ask to hear what the inner voice wassaying: “Tell me what you like bestabout that!”“Tell me what you were thinking whenyou came up with that idea!”“That must have been a challenge…whatdid you tell yourself to get past it?”• -“How are you going to know when to be ready?”• -“How are you going to stop yourself from…?”• -“What is your goal?”• -“What do you want it to look like?”• -“How long do you think it will take?”• -“How much did time did it take last time?”• -“How are you going decide where to set that up?”• -“How are you going to know what you need?”• -“How are you going to know what is most important?”• -“How are you going to decide what to do first?”• -“How will you know when you are done?”• -“How will you continue when you are tired?”• -“How did that work out?”• -“How long do you think that took?”• -“How did you manage/know how to do it?”• -“Would you do anything differently?”• -“Have you done anything like this before?”• -“Was that harder or easier than….”
  • What are non-impaired kids doing that this pt is NOT?You can say: “If I keep doing this it islikely my teacher/friend will……”Ask to hear what the inner voice wassaying: “Tell me what you like bestabout that!”“Tell me what you were thinking whenyou came up with that idea!”“That must have been a challenge…whatdid you tell yourself to get past it?”• -“How are you going to know when to be ready?”• -“How are you going to stop yourself from…?”• -“What is your goal?”• -“What do you want it to look like?”• -“How long do you think it will take?”• -“How much did time did it take last time?”• -“How are you going decide where to set that up?”• -“How are you going to know what you need?”• -“How are you going to know what is most important?”• -“How are you going to decide what to do first?”• -“How will you know when you are done?”• -“How will you continue when you are tired?”• -“How did that work out?”• -“How long do you think that took?”• -“How did you manage/know how to do it?”• -“Would you do anything differently?”• -“Have you done anything like this before?”• -“Was that harder or easier than….”
  • What are non-impaired kids doing that this pt is NOT?You can say: “If I keep doing this it islikely my teacher/friend will……”Ask to hear what the inner voice wassaying: “Tell me what you like bestabout that!”“Tell me what you were thinking whenyou came up with that idea!”“That must have been a challenge…whatdid you tell yourself to get past it?”• -“How are you going to know when to be ready?”• -“How are you going to stop yourself from…?”• -“What is your goal?”• -“What do you want it to look like?”• -“How long do you think it will take?”• -“How much did time did it take last time?”• -“How are you going decide where to set that up?”• -“How are you going to know what you need?”• -“How are you going to know what is most important?”• -“How are you going to decide what to do first?”• -“How will you know when you are done?”• -“How will you continue when you are tired?”• -“How did that work out?”• -“How long do you think that took?”• -“How did you manage/know how to do it?”• -“Would you do anything differently?”• -“Have you done anything like this before?”• -“Was that harder or easier than….”
  • 154”Sarah ward, slpExecutivefunctiontherapy.com
  • GUESS HOW OLD?
  • HOW LONG HAVE WE BEEN HERE SINCE THE BREAK? HOW MUCH TIME DO WE HAVE LEFT? WHICH FEELS LONGER, THE TIME WE’VE BEEN HERE OR THE TIME WE HAVE LEFT?
  • 122”
  • EXPLAIN WKSHOP’S PURPOSE, INCREASE SALIENCE, RELATE TO PRIOR K’LEDGE
  • STUDY BOX
  • If only I could be as org. as I am the day before vacation
  • EXPLAIN WKSHOP’S PURPOSE, INCREASE SALIENCE, RELATE TO PRIOR K’LEDGE
  • Token economy or response costChunking larger work into manageable units; beat the clock game; make post-homework time salientSet a clear when and whereMove towards independence; fade supervision“forgetting” homework is not a memory problem, but an organization problem
  • Reif 207218Token economy or response costChunking larger work into manageable units; beat the clock game; make post-homework time salientSet a clear when and whereMove towards independence; fade supervision“forgetting” homework is not a memory problem, but an organization problem
  • Reif 207218Token economy or response costChunking larger work into manageable units; beat the clock game; make post-homework time salientSet a clear when and whereMove towards independence; fade supervision“forgetting” homework is not a memory problem, but an organization problem
  • Self-assessment or parent ass’mentAttitude of curiosityIf I was off task, why? Answer is never b/c I’m bad stupid lazy etc
  • BIG 5 QUESTIONNAIRESuccess isn&apos;t a result of spontaneous combustion.  You must set yourself on fire.  ~Arnold H. Glasow
  • BIG 5 QUESTIONNAIRESuccess isn&apos;t a result of spontaneous combustion.  You must set yourself on fire.  ~Arnold H. Glasow
  • BIG 5 QUESTIONNAIRESuccess isn&apos;t a result of spontaneous combustion.  You must set yourself on fire.  ~Arnold H. Glasow
  • BIG 5 QUESTIONNAIRESuccess isn&apos;t a result of spontaneous combustion.  You must set yourself on fire.  ~Arnold H. Glasow
  • BIG 5 QUESTIONNAIRESuccess isn&apos;t a result of spontaneous combustion.  You must set yourself on fire.  ~Arnold H. Glasow
  • MYSTERY BOXHAVE ST / VP PUT NAMES OF ATTENDEES IN HATAPPENDIX A p. a2: TO DO
  • Transcript of "Lend me your brain easter seals"

    1. 1. www.DrNowell.com<br />Lend Me Your Brain:<br />Practical Strategies for Managing ADD/ADHD,<br />Executive Dysfunction, and Processing Disorders<br />DavidNowellSeminars<br />DavidNowell<br />
    2. 2. ….a challenge<br />
    3. 3.
    4. 4. Perspective of this workshop…..<br />
    5. 5. “Making distinctions”<br />
    6. 6.
    7. 7. 301.13, rule out 296.89<br />
    8. 8. “Top – down” dysfunction<br />ADHD<br />Executive dysfunction<br />
    9. 9. “Bottom - up” dysfunction<br />Central auditory processing problems<br />Sensory processing problems<br />
    10. 10.
    11. 11.
    12. 12.
    13. 13. What’s the kid’s deal?<br />
    14. 14. Normal and Abnormal Sensory Processing and Attentional Functioning<br /> <br />The Physiology of Motivation and Reward<br /> <br />The Brain’s Reward and Planning System – and How that System Breaks Down<br /> <br />A Practical Toolbox of Strategies<br />Overview<br />
    15. 15. Normal and Abnormal Sensory Processing and Attentional Functioning<br />
    16. 16. Sensory Processing Disorder<br />
    17. 17.
    18. 18. Jean Ayres<br />
    19. 19.
    20. 20. Sensory Integration Terminology<br />Sensory Processing<br />
    21. 21. Hard signs and soft signs<br />
    22. 22. Developmental soft signs<br />
    23. 23. Developmental considerations<br />Auditory .<br />Visual<br />Tactile<br />Proprioceptive<br />Vestibular<br />Motor<br />
    24. 24. Sensory Processing/Integration Disorder and DSM-V<br />
    25. 25.
    26. 26. What’s the kid’s deal?<br />
    27. 27.
    28. 28. What’s the kid’s deal?<br />
    29. 29.
    30. 30. Strategies<br />
    31. 31. Regulatory-Sensory Processing Disorders<br />Treatment<br />“top down”<br />“bottom up”<br />
    32. 32.
    33. 33. X<br />
    34. 34.
    35. 35. Regulatory-Sensory Processing Disorders<br />Treatment<br />“top down”<br />“bottom up”<br />
    36. 36. Monitoring<br />Percepts<br />Top – down <br />factors<br />Emotion and Motivation<br />Sensory input<br />RAS<br />Aleman and Laroi, 2008<br />
    37. 37.
    38. 38. Monitoring<br />Percepts<br />Top – down <br />factors<br />Emotion and Motivation<br />Sensory input<br />RAS<br />Aleman and Laroi, 2008<br />
    39. 39. Role of the Mental Health Clinician in SPD<br />Primarily “top down”<br />Normalizing<br />Patient and family education<br />Environmental interventions<br />
    40. 40. Role of the Mental Health Clinician in SPD<br />Compensatory strategies<br />Self-esteem<br />Planning for success experiences<br />Treating comorbidities<br />
    41. 41. Central Auditory Processing Disorder<br />
    42. 42.
    43. 43.
    44. 44. Central Auditory Processing Disorder<br /><ul><li> Auditory discrimination (same/different)
    45. 45. Auditory closure (fill in missing bits)
    46. 46. Auditory localisation(locate source of sound)
    47. 47. Auditory performance with degraded acoustic</li></ul>signal<br /><ul><li> Auditory figure-ground (perceiving sounds in</li></ul>background noise)<br />
    48. 48. Central Auditory Processing Disorder<br />CAPD refers to a deficit observed in one or more of the central auditory processes responsible for generating the auditory evoked potentials and the following behaviors: <br />sound localization and lateralization<br />auditory discrimination<br />auditory pattern recognition<br />
    49. 49. Central Auditory Processing Disorder<br />- Poor "communicator" (terse, telegraphic). - Memorizes poorly.- Hears better when watching the speaker. - Problems with rapid speech. <br /> - Interprets words too literally.<br />
    50. 50. Central Auditory Processing Disorder<br /> - Often needs remarks repeated. - Difficulty sounding out words.- Confuses similar-sounding words.- Difficulty following directions in a series. - Speech developed late or unclearly.<br />
    51. 51. CAPD or ADHD?<br />
    52. 52. What’s the kid’s deal?<br />
    53. 53.
    54. 54. Strategies<br />
    55. 55. (C)APD<br />Treatment<br />“top down”<br />“bottom up”<br />X<br />
    56. 56.
    57. 57.
    58. 58. Treatment for CAPD<br /> Environmental modifications<br />
    59. 59. Treatment for CAPD<br />Compensatory Strategies<br />strengthening higher order central resources (language, memory, attention)<br />
    60. 60. Treatment for CAPD<br />Compensatory Strategies<br />Metalinguistic strategies include: schema induction, context-derived vocabulary building, phonological awareness, and semantic network expansion <br />
    61. 61. Treatment for CAPD<br />Compensatory Strategies<br />Metacognitive strategies include self-instruction, cognitive problem solving, and assertiveness training <br />x<br />
    62. 62. Attention Deficit Hyperactivity Disorder<br />
    63. 63. Increase salience<br />
    64. 64. Attention Deficit Hyperactivity Disorder<br />
    65. 65. (85 – X) x 365<br />
    66. 66. “I’m gonna eat all the gum and candy I want!”<br />
    67. 67. Core symptoms<br />Inattention / distractibility<br />
    68. 68. Core symptoms<br />Hyperactivity / impulsivity<br />
    69. 69. ….and the rest of the criteria<br />Onset before age 7<br />Impairment in 2 or more settings<br />Significant functional impairment<br />Not better accounted for by another mental disorder<br />
    70. 70.
    71. 71. Functional impact of core symptoms<br />Arousal / alertness<br />Mental effort<br />Determination of saliency<br />Focal maintenance<br />
    72. 72. Functional impact of core symptoms<br />Arousal / alertness<br />Mental effort<br />Determination of saliency<br />Focal maintenance<br />
    73. 73. Functional impact of core symptoms<br />Arousal / alertness<br />Mental effort<br />Determination of saliency<br />Focal maintenance<br />
    74. 74.
    75. 75. Functional impact of core symptoms<br />Arousal / alertness<br />Mental effort<br />Determination of saliency<br />Focal maintenance<br />
    76. 76. Functional impact of core symptoms<br />Satisfaction control<br />Previewing<br />Inhibition<br />Tempo control<br />Self-monitoring and correcting<br />
    77. 77. Functional impact of core symptoms<br />Satisfaction control<br />Previewing .<br />Inhibition<br />Tempo control<br />Self-monitoring and correcting<br />
    78. 78. Functional impact of core symptoms<br />Satisfaction control<br />Previewing<br />Inhibition<br />Tempo control<br />Self-monitoring and correcting<br />
    79. 79. Functional impact of core symptoms<br />Satisfaction control<br />Previewing<br />Inhibition<br />Tempo control<br />Self-monitoring and correcting<br />
    80. 80. Functional impact of core symptoms<br />Satisfaction control<br />Previewing<br />Inhibition<br />Tempo control<br />Self-monitoring and correcting<br />
    81. 81. Subtypes of ADHD<br />ADHD, predominantly inattentive type<br />ADHD, predominantly hyperactive type<br />ADHD, combined type<br />ADHD, Not Otherwise Specifed<br />
    82. 82. Subtypes of ADHD<br />ADHD, predominantly inattentive type<br />ADHD, predominantly hyperactive type<br />ADHD, combined type<br />ADHD, Not Otherwise Specifed<br />
    83. 83. Common comorbidities with ADHD<br />Learning disorder<br />Behavioral disorder<br />Anxiety<br />Depression<br />Substance abuse<br />Sensory processing and auditory processing challenges<br />
    84. 84.
    85. 85. Common comorbidities with ADHD<br />Learning disorder<br />Behavioral disorder<br />Anxiety<br />Depression<br />Substance abuse<br />Sensory processing and auditory processing challenges<br />
    86. 86. ADHD and girls<br />
    87. 87.
    88. 88.
    89. 89. ADHD and women<br />
    90. 90.
    91. 91. ADHD and women<br />More tasks<br />More diffuse<br />More parental responsibility<br />Less likely to have an “executive” partner<br />Less likely to have assistants at work<br />Less likely to focus on a narrow area<br />More likely to feel shame about disorganization<br />
    92. 92. Executive Functioning:An Overarching Theme<br />Sensory Processing Disorder<br />Central Auditory Processing Disorder<br />ADHD and Executive Dysfunction<br />
    93. 93. The Executive Functions<br />Internalizing speech<br />Previewing<br />Prioritizing<br />Tempo control<br />Inhibition<br />
    94. 94. The Executive Functions<br />Determining salience (what’s in it for me?)<br />Blocking out distractions<br />Self-monitoring and correcting<br />Certain aspects of memory / learning<br />
    95. 95.
    96. 96.
    97. 97. Appropriate expectations<br />
    98. 98. Age-appropriate expectations<br />Preschool<br />1-step errands<br />Chores with cues<br />Basic inhibition<br />
    99. 99. Age-appropriate expectations<br />K – 2nd grade<br />2-3 step directions<br />Bring papers home<br />20-30 minute assignments<br />Simple spending decisions<br />Follow rules / inhibit / no grabbing<br />
    100. 100. 3rd – 5th<br />Simple shopping list<br />Keep track of personal items<br />Longer homework assignments<br />Simple project planing<br />Keep track of variable daily schedule<br />Save money<br />Inhibit and regulate even w/o teacher present<br />Manners<br />Simple delayed gratification (phone)<br />Age-appropriate expectations<br />
    101. 101. 6th – 8th<br />complex chores<br />Babysitting<br />Organizing system<br />Complex schedule<br />Longer term projects<br />Time management<br />Self soothe<br />Manage conflict<br />Age-appropriate expectations<br />
    102. 102. Teenage – mid 20s<br />Independent with assignments<br />Make adjustments based on feedback<br />Longer term goal setting<br />Managing leisure time<br />Inhibit reckless behavior<br />Easily walk away from provocation<br />Say “no” to fun activity if other plans already made<br />Take others’ perspective<br />Age-appropriate expectations<br />
    103. 103. “what is” vs. “what could be”<br />
    104. 104. “what is” vs. “what could be”<br />
    105. 105. Introduction to Neuroanatomy<br />Inter-connectedness of systems<br />Cortico-striatal system, for example<br />
    106. 106.
    107. 107. Strategies<br />
    108. 108. Pharmacotherapy<br />X<br />
    109. 109. Behavioral Supports<br />
    110. 110. A<br />B<br />C<br />
    111. 111. A<br />B<br />C<br />behavior<br />
    112. 112. A<br />B<br />C<br />consequences<br />
    113. 113. A<br />B<br />C<br />antecedent<br />
    114. 114.
    115. 115. A<br />B<br />C<br />antecedent<br />
    116. 116.
    117. 117. A<br />B<br />C<br />antecedent<br />
    118. 118. easy<br />hard<br />
    119. 119.
    120. 120.
    121. 121.
    122. 122.
    123. 123. A<br />B<br />C<br />consequences<br />
    124. 124.
    125. 125.
    126. 126.
    127. 127. Time Out<br />Select target behavior<br />Set place<br />Determine how much time<br />Dress rehearsal<br />Measure the time<br />Withdraw attention<br />Establish the cause and effect<br />
    128. 128. Token economy<br />Good balance<br />Precursor to adult reinforcement system<br />Lots of work to do well<br />Even more work to set up well<br />
    129. 129.
    130. 130.
    131. 131.
    132. 132. Intrinsic motivation<br />
    133. 133.
    134. 134. A<br />B<br />C<br />behavior<br />
    135. 135. Metacognition<br />Metacognitiveknowledge<br />Metacognitivestrategies<br />
    136. 136. “Lend Me Your Brain”<br />
    137. 137. The Physiology of Motivation and Reward<br />
    138. 138. Preferred States: What Does Dopamine Feel Like?<br />Great experience<br />Kodak moment<br />The feeeeling<br />
    139. 139.
    140. 140.
    141. 141. Broaden and Build<br />
    142. 142. “NeuroMalleability”<br />
    143. 143. The Brain’s Reward and Planning System<br />
    144. 144. The reward-and-planning system<br />Anticipate goal<br />Identify tasks<br />Sequence / problem-solve<br />Block out distractions<br />Get the reward<br />
    145. 145. “what is” vs. “what could be”<br />
    146. 146. “what is” vs. “what could be”<br />
    147. 147. The reward-and-planning system<br />Anticipate goal<br />Identify tasks<br />Sequence / problem-solve<br />Block out distractions<br />Get the reward<br />
    148. 148. Ways the reward-and-planning system can go wrong<br />Alicia R. Ruelaz, M.D.: “the biggest issue for me, and others I've seen, has been maintaining motivation between the excitement of setting a goal and not losing interest before it is completed.”<br />
    149. 149. Ways the reward-and-planning system can go wrong<br />Jacy, a freelance artist from Connecticut,: I get so excited about a new idea, I forget the zeal that I had once felt for an old one. Thus creating my inevitable "idea graveyard.“<br />
    150. 150. Ways the reward-and-planning system can go wrong<br />Juzer :“my biggest problem is that I want to do everything all at once!”<br />
    151. 151. Ways the reward-and-planning system can go wrong<br />Inna: “I just get blank. I usually start sitting more slouched, hold my head with my left hand, ….you freeze and instead of being able to think of alternatives, you start thinking to yourself that you cannot find a logical answer and you are tempted to avoid it as if it poses a threat somehow to you.”<br />
    152. 152.
    153. 153. Ways the reward-and-planning system can go wrong<br />Hank: “I have things I need to do to improve my marriage, my health and my financial situation, but I honestly believe that I have zero chance of actually making any of those three things actually get better. ”<br />
    154. 154. Ways the reward-and-planning system can go wrong<br />Alice, a oach from Long Island: The difference between a dream and a goal is a plan. It is the myriad of steps BETWEEN point A and point B that fail to happen. That is why a coach can be so important to folks with ADHD. A coach can help the person develop a step-by-step plan and help the person decide which steps they can & will complete (the exciting ones) and which steps they are best off hiring or asking someone else to do (the boring ones).<br />
    155. 155. Ways the reward-and-planning system can go wrong<br />Anticipate goal (state)<br />Identify tasks<br />Sequence / problem-solve<br />Block out distractions<br />Get the reward<br />
    156. 156.
    157. 157. Ways the reward-and-planning system can go wrong<br />Anticipate goal (state)<br />Working memory<br />Insight<br />Alexithymia / emotional intelligence<br />Disconnect from values<br />Diminished options<br />Overly influenced by externals<br />Too busy with current activity<br />Field dependent<br />
    158. 158. Ways the reward-and-planning system can go wrong<br />Identify tasks<br />Working memory<br />Intelligence / development<br />Overly conventional thinking<br />Insight<br />Emotional intelligence<br />
    159. 159.
    160. 160. Ways the reward-and-planning system can go wrong<br />Identify tasks<br />Working memory<br />Intelligence / development<br />Overly conventional thinking<br />Insight<br />Emotional intelligence<br />
    161. 161. Ways the reward-and-planning system can go wrong<br />Sequence / problem-solve<br />
    162. 162.
    163. 163. Ways the reward-and-planning system can go wrong<br />Sequence / problem-solve<br />Verbal working memory<br />Nonverbal working memory<br />
    164. 164.
    165. 165. Ways the reward-and-planning system can go wrong<br />Sequence / problem-solve<br />Verbal working memory<br />Nonverbal working memory<br />Reconstitution<br />Understanding of causality<br />Self-efficacy<br />Coping<br />Learned helplessness<br />
    166. 166. Ways the reward-and-planning system can go wrong<br />Block out distractions<br />
    167. 167.
    168. 168. The best defense against the manipulation of our attention is to determine for ourselves – in advance - how we want to invest it.<br /> - E. Goldberg<br />
    169. 169.
    170. 170. Ways the reward-and-planning system can go wrong<br />Block out distractions<br />Field dependent (sensitive to novelty)<br />Saliency<br />Working memory<br />Easily discouraged<br />
    171. 171. Ways the reward-and-planning system can go wrong<br />Get the reward<br />
    172. 172.
    173. 173. Ways the reward-and-planning system can go wrong<br />Get the reward<br />Satisfaction control<br />Picked wrong task<br />Picked wrong goal (“state”)<br />Sociopathy<br />
    174. 174.
    175. 175. Instant gratification vs. executive gratification<br />
    176. 176.
    177. 177.
    178. 178.
    179. 179. PREFERRED STATES <br />INVENTORY<br />David D. Nowell, Ph.D.<br />189 May Street<br />Worcester, Mass. 01602<br />DrNowell.com<br />www.Lulu.com<br />
    180. 180. Identify 20 peak experiences.<br />For each peak experience, identify the highlight moment – the snapshot.<br />Go to the visceral…what was the feeling of that moment? Name it.<br />Check the 20 peak moment-feelings for clusters, groupings. There will probably be 4 or 5.<br />PREFERRED STATES <br />INVENTORY<br />
    181. 181. Find a word, a label, for each of the groupings.<br />Check for accuracy (“gut” check).<br />Those are your preferred states, your “values,” ways that you really like to feel. <br />Now you know your motivation…use this knowledge to review your daily activities and planning.<br />PREFERRED STATES <br />INVENTORY<br />
    182. 182. PREFERRED STATES <br />INVENTORY<br />
    183. 183.
    184. 184. A<br />B<br />C<br />behavior<br />x<br />
    185. 185. Self-Talk Proficiency<br />
    186. 186. Self-Talk Proficiency<br />• -“How are you going to know when to be ready?”<br />• -“How are you going to stop yourself from…?”<br />• -“What is your goal?”<br />• -“What do you want it to look like?”<br />• -“How long do you think it will take?””<br />
    187. 187. Self-Talk Proficiency<br />• -“How are you going to know what you need?”<br />• -“How are you going to know what is most important?”<br />• -“How are you going to decide what to do first?”<br />• -“How will you know when you are done?”<br />
    188. 188. Self-Talk Proficiency<br />• -“How will you continue when you are tired?”<br />• -“How did that work out?”<br />• -“How long do you think that took?”<br /> • -“Would you do anything differently?”<br />“Who will be the first person to notice that….”<br />
    189. 189. Match the Picture<br />
    190. 190.
    191. 191.
    192. 192. Distraction Delay Training<br />
    193. 193.
    194. 194.
    195. 195. Executive Estimates Training<br />X<br />
    196. 196. Learning Time:<br />What is the “felt” experience of time?<br />What is the “frontal” aspect of time?<br />
    197. 197. Learning Time:<br />
    198. 198. Learning Time:<br />
    199. 199.
    200. 200.
    201. 201. Learning Time:<br />Theres no such thing as procrastination….there’s just choosing. And choosing again.<br />
    202. 202. Asking two questions…<br />Am I having fun now?<br />And is this what I set out to do?<br />
    203. 203. Am I having fun now?<br />Is this what I set out to do?<br />
    204. 204. Am I having fun now?<br />Is this what I set out to do?<br />
    205. 205. Key Features of Video Games<br />Clear expectations<br />Behavioral specificity<br />Build on small changes in behavior<br />Irrelevant behaviors ignored<br />Reward appropriate behavior and punish inappropriate behavior – never reverse this<br />
    206. 206. Key Features of Video Games<br />Always follow up on rules, no exceptions<br />Consequences are immediate<br />Punishment is mild<br />Stimuli are exciting and multi-sensory<br />Conduct expensive and time-consuming focus groups to determine what really “grabs ‘em”<br />
    207. 207. Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human BrainVolkow, et al. 2004<br />
    208. 208. Increase salience<br />
    209. 209.
    210. 210.
    211. 211.
    212. 212.
    213. 213. Increase salience<br />
    214. 214.
    215. 215. Quarterly QI review<br />
    216. 216. Homework problems<br />Fails to write down assignments<br />Forgets the assignment book<br />Forgets necessary materials<br />Takes hours to do minutes of homework<br />Hassles about when and where to do homework<br />Lies about having done homework<br />Needs constant supervision with homework<br />Forgets to bring homework back to school<br />
    217. 217. Homework challenges<br />School / parent communication<br />Routine<br />Limit distractions<br />Chunking<br />Support the “getting started”<br />Praise, reward, incentives<br />
    218. 218. Homework challenges<br />School / parent communication<br />Routine<br />Limit distractions<br />Chunking<br />Support the “getting started”<br />Praise, reward, incentives<br />
    219. 219.
    220. 220.
    221. 221. The post-mortem<br />
    222. 222.
    223. 223.
    224. 224. Your #1 Organizational Tool<br />
    225. 225. Your #1 Organizational Tool<br />Yoga / read<br />Phone calls<br />Staff meeting<br />Planning<br />session<br />billing<br />
    226. 226. Your #1 Organizational Tool<br />Vh: jeff w/ puritan oil<br />Vc: kate re: brimfield<br />TC umass dermatology. Spoke w/ cindy 508 8564000<br />
    227. 227. Your #1 Organizational Tool<br />
    228. 228. Learn French<br />Be a better spouse<br />Stop smoking<br />
    229. 229. The “Big Five” <br />Daily focus time<br />Values/motivational clarity<br />Nutrition<br />Movement<br />Connection<br />
    230. 230.
    231. 231.
    232. 232. The “Big Five” <br />Daily focus time<br />Values/motivational clarity<br />Nutrition<br />Movement<br />Connection<br />
    233. 233.
    234. 234.
    235. 235.
    236. 236. The “Big Five” <br />Daily focus time<br />Values/motivational clarity<br />Nutrition<br />Movement<br />Connection<br />
    237. 237. The “Big Five” <br />Daily focus time<br />Values/motivational clarity<br />Nutrition<br />Movement<br />Connection<br />
    238. 238. The “Big Five” <br />Daily focus time<br />Values/motivational clarity<br />Nutrition<br />Movement<br />Connection<br />
    239. 239. A challenge….<br />
    240. 240. www.DrNowell.com<br />Lend Me Your Brain:<br />Practical Strategies for Managing ADD/ADHD,<br />Executive Dysfunction, and Processing Disorders<br />DavidNowellSeminars<br />DavidNowell<br />

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