Very Best                       Treatments For                       ADHD                       And the processing disorde...
Attributions & #gratitude  Dr.   David Nowell  Dr.   Laurie Dietzel  Dr.   Raun Melmed  Dr.   Ron Fischler  Dr.   Sus...
What we will explore todayDiagnosis and Treatment of ADHDThe Role of Executive DysfunctionSensory Processing DisorderCAPDB...
What we will learn  Differential diagnosis of ADHD  Common pitfalls in diagnosis  Identifying EF dysfunction and it’s  ...
What’s in a diagnosis?  Executive Dysfunction  Sensory Processing Disconnections  Neuropsychological Model of Executive...
What does executive dysfunction“look like”  Child completes work but “forgets” to hand it in  Child has difficulty trans...
What is Executive Functioning(EF)?  An umbrella term covering related yet   distinct skills  Refers to cognitive control...
McCloskey 23 Self-RegulationExecutive Functions                          Organize         Perceive         Foresee        ...
EF Domains    Attention, focus, distractibility    Cognitive control, shift and flexibility    Memory, input, manipulat...
I. Executive Functions includethe ability to:  Survey and preview  Plan, organize, sequence, initiate and   execute task...
II. Executive Functions includethe ability to:  Conduct visual-spatial mental operations  Track information and activiti...
Neuropsych & EF ~ I 1. Processing speed The speed at which you perceive, analyze and respond 2. Selective Attention Choosi...
Neuropsych & EF ~ II 7. Working Memory Ability to keep information stored in active memory in order to complete an action ...
Don’t All People have someExecutive Dysfunction?  EF follows a developmental course as   do all cognitive and social-emot...
ADHD and EF    Working memory and recall (holding facts in mind while     manipulating information; accessing facts store...
What does ADHD + EF LookLike?  Practically speaking, executive function deficits may   cause problems for students with A...
Types of Attention  Focused attention: This is the ability to respond discretely to specific    visual, auditory or tactil...
ADHD childhood v adulthood    The symptoms change as someone with ADD/ADHD develops     from a child into a teenager and ...
What skills do we wish toteach?    Goal                           Execute    Plan                           Complete ...
Good Books on EF
DSM V ~ What can weimagine?  We may see the age of onset raised   to age 12  We may see a collapse of the Dx w   focus o...
Twitter ~ The ResearchPlayground BRAIN DEVELOPMENT    @davidnowell    @drbethkids    @all4mychild    @braininsights  ...
Enhancing Executive Functionwith skill set developmentWhere we are heading: Improving Neuronal Connections Knowing the d...
Your Brain is Like A Placemat Insulted?  Don’t be. A placemat is  a good thing. Connect the  dots.
How do Neurons Connect?The electrical signals (nerve impulses) carried by neuronsare passed on to other neurons at junctio...
What is The Synapse?  When a nerve impulse reaches the synapse at   the end of a neuron, it cannot pass directly to   the...
Neurotransmitters  Your brain uses over 50 different   neurotransmitter chemicals. Although electrical   signaling betwee...
Connections  Neurons can connect with up   to a hundred thousand other   cells. This number of   connections is a truly  ...
How Do We Build BrainConnections?  Exposure  Experience  Doing, thinking,   mirroring  Practice ~ and a   lot of it   ...
Pruning  In a human fetus, almost a trillion   neurons are produced. During the last   month, they are produced at the   ...
Executive Function andEducation  EF and intelligence  Twice Gifted  Disorganized students  Homework interventions  Ta...
EF and Intelligence  Intelligence and executive functioning   are different sets of skills (Barkley,   1997a)  Modest co...
Gifted/Talented Children  Many children who are highly gifted   show uneven skill development;   executive skills may lag...
Twice Gifted ~ 2 E    Gifted individuals are those who demonstrate outstanding levels of aptitude     (defined as an exce...
Bi-Polar    BPD is characterized by alternating periods of emotional highs     and lows.    Ranges from mild to severe....
Disorganized Students
Organizing The DisorganizedPerson  Determine “Help Me” domain  listening attending, focus, note taking, impulse  control,...
Calendars and Planners  Calendars (must build a habit for   checking on a regular basis)  Request assignments in advance...
EF Management  Calendars, planners and schedules  Routines and daily activities  Task Lists  Project Management  SYST...
Planning/Time Management  Use timers (auditory, visual)  Use alarms  Estimate amount of time needed for a   task and th...
What every person needs toknow ~ How to…  Plan  Initiate  Execute  Review  Revise
Manage The Work Space  What does your space look like?   How functional is it?      How organized is your study space?  ...
Skill Set Tracking
Go Multi-Sensory  Encourage transfer skills  Use video, audio and tactile strategies  Use marker boards  Use quad bull...
Habit Development I  A rule of thumb      (for kids and adults without ADHD  or other neurodevelopmental conditions) is t...
Habit Development II  Develop habits that interfere with   impulsive behavior (e.g., everyone put their   hands on the ta...
Talking with Students about theirStudy Styles  Emphasize strengths  Keep it short and simple!  Use visuals  Discuss we...
There are no BUT’s here  Help the student feel valued  Let the student have some control in   the discussion and plan  ...
Prioritization The modified Sullivan  technique for prioritizing,  planning and execution A B C 48 hrs
Communication and ADHD  Go to your child and make direct eye contact before   giving an instruction.  Check for understa...
Diagnostic Considerations
Cognitive Flexibility +Classroom/Work Previewing  Review upcoming changes to   schedule or environment  Preview what is ...
Building Cognitive Flexibility  Social stories (relaxkids.com,   mindfulness, meditation,   stressfreekids.com)  Social ...
Even the Playing Field  This is the goal of a 504 Plan and IEP   accommodations/modifications –   accommodations and modi...
Interaction with Cultural andEnvironmental Factors  Some kids with typically developing   executive skills have trouble b...
Sensory Processing DisordersSensory Modulation   Sensory          Sensory-Based Motor                     Discrimination  ...
SPD ~ Modulation I  Sensory modulation refers to a complex central   nervous system process by which neural   messages th...
SPD – Modulation II  Sensory registration problems - This refers to the   process by which the central nervous system att...
The Brain Process  We   perceive  We   think  We   feel  We   respond (behave)
CAPD    Complex problem affecting about 5% of school-aged children.    Children cant process the information they hear i...
CAPD Phenotypically                                         activity if other sounds are    hearing in noisy situations  ...
Non-Verbal Learning Disability  NLD is a neurological syndrome characterized   by the impairment of nonverbal or   perfor...
NVLD Manifestations  Developmental disorder with   manifestations in the following   domains:    a) somatosensory and mo...
Interventions  Proper diagnosis  Behavioral skill building  Academic/social support  Medication  Brain Training  An ...
HOW TO HELP Accommodations                  Strategies Skill Building
At Home ~ The Family CoachMethod & ADHD  Stay out of The Discipline Trap  Establish routines and rhythm  Clarify the fa...
Intervention Pyramid  Medication  Neurotransmitters  Food/Nutrition Developmental,  Behavioral,  Learning  Interventions
Brain Training  Some programs include Luminosity, Captain’s Log,   COGMED, MC2, Brain Gym and Brain Builder. If the child...
Let’s Start Moving  Suzy Koontz suzykoontz.com  Jean Blaydes Madigan abllab.com  SparkPE  Eric Jensen www.jensenlearni...
You are what you assimilate  Get back to real whole food  Consider amino acids   neurogistics.com
5 Food Rules1. 1 oz water per pound per day2. If it does not rot or sprout do without3. Consider 1-2 oz protein/fats every...
Twitter ~ The ResearchPlayground NUTRITION  @NutritionBlogs  @MelissaMcCreey  @childobesity (nourish interactive)    @...
Skill Deficits vs Willful Non-compliance  The 80/20 rule  A skill deficit is when the task   demands exceed the skill le...
Is this a skill deficit?Can he do it?If yes, expect itIf no, teach it
EF and Behavioral Change  Visualizing and verbalizing  Role Play  Social Stories  The Beginning, Middle & End  Going ...
Cognitive Skills     Attention              Organization     Distraction            One step at a time     Focus     ...
Breaking Down Skill Sets I                       Listening    I   chose not to speak    I   established eye contact    ...
Breaking Down Skill Sets II                       Listening    I   chose not to speak    I   established eye contact   ...
Breaking Down Skill Sets IIIFor The Parent    I   defined an expected behavior    I   named the expected behavior    I ...
Impulsivity     Waiting one’s turn     Refraining from touching others     Keeping one’s hands to self     Not grabbin...
Helping children “do as expected”takes previewing and planning  1. Tell the children what is about to   happen. “We are g...
Self-Regulation   Recognizing             Maintaining calm    escalation              Using calming skills   Asking fo...
Anger Mountain
Polyspot Stories
The Caveman and The Thinker          Your Child’s Two-Part          Brain          The Defensive Brain          Collaborat...
We Calm Down To Think  Teach relaxation breathing and self-talk  Allow for a break (including a physical   place to calm...
EF ~ Social Skills I  1. Perspective-taking - The ability to see   a situation from another person’s   perspective  2. I...
EF ~ Social Skills II  4. Conflict Resolution – The ability to solve an   interpersonal problem satisfactorily to both   ...
Twitter ~ The ResearchPlayground INTERVENTION  @Inclusive_Class  @marianne_russo  @‫‏‬special-ism  @movingsmartnow  @...
5 Things About The Teen BrainYou were afraid to ask, but need to know  Teen brain growth (neuronal connections) is in spu...
Teens and Tweenies  Teenage as a second language ~   Barbara R. Greenberg, & Jennifer A.   Powell-Lunder  Get out of my ...
Freedomland
Field Trip!
 Play Math is a cortico-  cerebellar math program  that alternates fine and  gross motor movement to  teach children ages...
The Method  Mirror or Skip Count (Balls)  Slide and Glide (Blocks)  Over and Up (Blocks)  How do numbers fit together?...
Three things children taught meabout how they learn math.  1. We build to learn: Exploring fact   families in “arrays” (w...
Three things children taught me about how they learn math.  We need to touch the blocks for   better encoding: With base ...
Three things children taught meabout how they learn math. We build brain connections  with:a. Rhythmb. Fine and Gross Mot...
Audition and Rhythm  For younger kids who have trouble getting   started with the morning or evening routine at   home, u...
The Importance of Play
Gill Connell ~ Play  PLAY: How it Shapes the Brain, Opens the Imagination,   and Invigorates the Soul by Stuart Brown, M....
The Power of Hopscotch  HOPPING = MIDLINE DEVELOPMENT For children,     hopping signals sophisticated advances in both ph...
We Teach EF Through Play  Decision making  Inhibition  Cognitive Flexibility  Attention  Focus  Shift  Creativity/I...
Prescribe Love and Caring
Kenney ADHD EF NC March 2013
Kenney ADHD EF NC March 2013
Kenney ADHD EF NC March 2013
Kenney ADHD EF NC March 2013
Kenney ADHD EF NC March 2013
Kenney ADHD EF NC March 2013
Kenney ADHD EF NC March 2013
Kenney ADHD EF NC March 2013
Kenney ADHD EF NC March 2013
Kenney ADHD EF NC March 2013
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Kenney ADHD EF NC March 2013

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This the 6 hr talk I gave for CMI/PESI in North Carolina March 2013. Some of the slides were prepared by the original authors Dr. David Nowell & Dr. Susan Fralick-Bell.The full page printables for this talk can be found on my site www.lynnekenney.com as well as on pinterest http://pinterest.com/lynnekenney/. To schedule a talk at your school, PTO or company simply email me. If you download to share with colleagues, teachers or parents, please credit the authors.

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Kenney ADHD EF NC March 2013

  1. 1. Very Best Treatments For ADHD And the processing disorders Lynne Kenney, PsyD www.lynnekenney.com @drlynnekenneyPrintables can be found at http://pinterest.com/lynnekenney/
  2. 2. Attributions & #gratitude  Dr. David Nowell  Dr. Laurie Dietzel  Dr. Raun Melmed  Dr. Ron Fischler  Dr. Susan Fralick-Ball  Dr. Ron Schouten  Dr. Karen Saywitz
  3. 3. What we will explore todayDiagnosis and Treatment of ADHDThe Role of Executive DysfunctionSensory Processing DisorderCAPDBehavioral and Learning Interventions25+ Strategies you can use today
  4. 4. What we will learn  Differential diagnosis of ADHD  Common pitfalls in diagnosis  Identifying EF dysfunction and it’s correlates  The role of EF in social and academic functioning  Targeting interventions for ADHD, EF, SPD and CAPD (and more…)
  5. 5. What’s in a diagnosis?  Executive Dysfunction  Sensory Processing Disconnections  Neuropsychological Model of Executive Functioning (EF)  ADHD  Central Auditory Processing Disorder  Non-Verbal Learning Disorder  Mood Dysregulation across disorders  How are child and adult ADHD the same and different (Original Source: Sarah Ward)
  6. 6. What does executive dysfunction“look like”  Child completes work but “forgets” to hand it in  Child has difficulty transitioning from one situation or task to another  Child doesn’t seem to catch “careless” errors  Child needs more external support and reminders than peers  Child can’t seem to keep track of directions, possessions, and assignments  Child is very inconsistent in her performance   Original source Dr. Laurie Dietzel
  7. 7. What is Executive Functioning(EF)?  An umbrella term covering related yet distinct skills  Refers to cognitive control/self- regulatory processes  Can be understood as Cognitive and Limbic
  8. 8. McCloskey 23 Self-RegulationExecutive Functions Organize Perceive Foresee Initiate Generate Modulate Associate Gauge Balance Focus/Select Store Sustain Retrieve Stop/Interrupt Pace Flexible/Shift Time Inhibit Execute Hold Monitor Manipulate Correct
  9. 9. EF Domains  Attention, focus, distractibility  Cognitive control, shift and flexibility  Memory, input, manipulation, output  Emotional regulation and modulation  Problem solving, decision making  Impulse control and management  Organization, planning, and time management  Motor management planning, pacing, initiation, maintaining, stopping Kenney 2012
  10. 10. I. Executive Functions includethe ability to:  Survey and preview  Plan, organize, sequence, initiate and execute tasks  Hold, manipulate and retrieve memory  Shift focus, sustain attention, tolerate and adapt to changes in expectations  Stop, think, decide, respond
  11. 11. II. Executive Functions includethe ability to:  Conduct visual-spatial mental operations  Track information and activities in working memory  Perceive, read, interpret and respond to social situations  Regulate and manage emotions  Evaluate, plan and manage time  Use language to facilitate communication within relationships  Reason, evaluate choices and make decisions
  12. 12. Neuropsych & EF ~ I 1. Processing speed The speed at which you perceive, analyze and respond 2. Selective Attention Choosing relevant stimuli or data (target selection) 3. Hand-Eye Coordination The ability to produce specific hand movements based on visual cues with motor planning and accuracy 4. Visual Scanning Ability to search for information in the visual field 5. Inhibition Suppression of inappropriate responses or distracting stimuli 6. Cognitive Control/flexibility/shift Adjustment of behavior according to context
  13. 13. Neuropsych & EF ~ II 7. Working Memory Ability to keep information stored in active memory in order to complete an action 8. Episodic Memory Memory of personal events and related context 9. Temporal Order Memory Ability to remember the order in which items appear 10. Visuo-spatial skills Ability to analyze and understand space in two or three dimensions 11. Temporal Perception Ability to determine the duration of events 12. Word naming Ability to produce language and maintain conversation 13. Semantic Categorization Creation of groups based on similarity of concepts Modified from original source: Brain Center America & Quebec
  14. 14. Don’t All People have someExecutive Dysfunction?  EF follows a developmental course as do all cognitive and social-emotional skills  We all have domains in which we could improve, but that doesn’t add up to EFD  EFD interferes with daily adaptive living skills
  15. 15. ADHD and EF  Working memory and recall (holding facts in mind while manipulating information; accessing facts stored in long-term memory.)  Activation, arousal, and effort (getting started; paying attention; finishing work)  Controlling emotions (ability to tolerate frustration; thinking before acting or speaking)  Internalizing language (using "self-talk" to control ones behavior and direct future actions)  Taking an issue apart, analyzing the pieces, reconstituting and organizing it into new ideas (complex problem solving).
  16. 16. What does ADHD + EF LookLike?  Practically speaking, executive function deficits may cause problems for students with ADHD in several important areas:   getting started and finishing work   remembering homework   memorizing facts   writing essays or reports   working through math problems   being on time   controlling emotions   completing long-term projects   planning for the future
  17. 17. Types of Attention Focused attention: This is the ability to respond discretely to specific visual, auditory or tactile stimuli. Sustained attention: This refers to the ability to maintain a consistent behavioral response during continuous and repetitive activity. Selective attention: This level of attention refers to the capacity to maintain a behavioral or cognitive set in the face of distracting or competing stimuli. Therefore it incorporates the notion of "freedom from distractibility" Alternating attention: It refers to the capacity for mental flexibility that allows individuals to shift their focus of attention and move between tasks having different cognitive requirements. Divided attention: This is the highest level of attention and it refers to the ability to respond simultaneously to multiple tasks or multiple task demands. Source: Dr. Fralick-Ball SFBPsychMedEd 2010-2013
  18. 18. ADHD childhood v adulthood  The symptoms change as someone with ADD/ADHD develops from a child into a teenager and then into an adult. While the core problems of hyperactivity, impulsiveness, and inattentiveness remain the same, the specific symptoms manifest differently.   DSM-5 is looking to further refine the adult Dx to include more inattentiveness & impulsive decision making  The impairment is hallmarked with impairment of executive functions and emotional control.  Typically, the symptoms of hyperactivity decrease and become more subtle, while problems related to concentration and dysorganization become more dominant.  Female adult ADHD clients are often underdiagnosed and undertreated.
  19. 19. What skills do we wish toteach?  Goal   Execute  Plan   Complete  Pace   Inhibit  Observe time-frames   Resist  Observe the passage of   Delay time   Shift  Sequence   Self-monitor  Prioritize   Emotional control  Organize  Hold and manipulate info in memory  Initiate
  20. 20. Good Books on EF
  21. 21. DSM V ~ What can weimagine?  We may see the age of onset raised to age 12  We may see a collapse of the Dx w focus on axes  We may see a separation of of ADHD restrictive (no H); we hope for  sluggish cognitive tempo  Co-morbidity and cross-over
  22. 22. Twitter ~ The ResearchPlayground BRAIN DEVELOPMENT  @davidnowell  @drbethkids  @all4mychild  @braininsights  @viviensabel  @drmarty01  @DrEscotet  @TheTeenDoc  @NutritionistJan
  23. 23. Enhancing Executive Functionwith skill set developmentWhere we are heading: Improving Neuronal Connections Knowing the difference between askill deficit and willful non-compliance Strategies to build brain connections
  24. 24. Your Brain is Like A Placemat Insulted? Don’t be. A placemat is a good thing. Connect the dots.
  25. 25. How do Neurons Connect?The electrical signals (nerve impulses) carried by neuronsare passed on to other neurons at junctions calledsynapses. The signal may be directly transferred atelectrical synapses or, if there is no physical link betweenadjacent neurons, the signal is carried across the gap bychemicals called neurotransmitters. By usingneurotransmitters, the nervous system can alter the waya message is passed on. Each neuron communicateswith many others and this contributes to the amazingcomplexity of the brain. www.sciencemuseum.org.uk
  26. 26. What is The Synapse?  When a nerve impulse reaches the synapse at the end of a neuron, it cannot pass directly to the next one. Instead, it triggers the neuron to release a chemical neurotransmitter. The neurotransmitter drifts across the gap between the two neurons. On reaching the other side, it fits into a tailor-made receptor on the surface of the target neuron, like a key in a lock. This docking process converts the chemical signal back into an electrical nerve impulse. www.sciencemuseum.org.uk
  27. 27. Neurotransmitters  Your brain uses over 50 different neurotransmitter chemicals. Although electrical signaling between neurons is quicker and more energy efficient, chemical signaling is far more versatile. The signals carried by some neurotransmitters excite the target cell while others dampen down their activity, depending on the type of neurotransmitter released at the synapse and the receptors they reach. This is what sharpens the contrast between light and dark in the eye, for example. www.sciencemuseum.org.uk
  28. 28. Connections  Neurons can connect with up to a hundred thousand other cells. This number of connections is a truly enormous number: 10 thousand trillion.  One neuron can have as many as 100,000 dendrites.  In a human, there are more than 125 trillion synapses just in the cerebral cortex alone
  29. 29. How Do We Build BrainConnections?  Exposure  Experience  Doing, thinking, mirroring  Practice ~ and a lot of it www.unc.edu
  30. 30. Pruning  In a human fetus, almost a trillion neurons are produced. During the last month, they are produced at the unbelievable rate of 250,000 per second. Eighty-to-hundred billion of these neurons will be utilized by experience and become permanent, while the other 900 billion will be pruned – that is, carefully dismantled with the material recycled by the brain’s unique immune system. jonlieffmd.com
  31. 31. Executive Function andEducation  EF and intelligence  Twice Gifted  Disorganized students  Homework interventions  Task Analysis  Skill-set development  Multi-sensory interventions (MIT)
  32. 32. EF and Intelligence  Intelligence and executive functioning are different sets of skills (Barkley, 1997a)  Modest correlations are seen between scores on IQ tests and measures of “higher-order” EF such as cognitive flexibility in problem-solving  UNITY AND DIVERSITY OF EXECUTIVE FUNCTIONS Miyake et al. (2000) Cognitive Psychology41,49–100 (2000)
  33. 33. Gifted/Talented Children  Many children who are highly gifted show uneven skill development; executive skills may lag behind the development of abstract thinking abilities  There is no reason to think that a child with accelerated academic skills will also have advanced EF
  34. 34. Twice Gifted ~ 2 E  Gifted individuals are those who demonstrate outstanding levels of aptitude (defined as an exceptional ability to reason and learn) or competence (documented performance or achievement in top 10% or rarer) in one or more domains. Domains include any structured area of activity with its own symbol system (e.g., mathematics, music, language) and/or set of sensorimotor skills (e.g., painting, dance, sports). NAGT  2 E’s “…are identified as gifted and talented in one or more areas of exceptionality (specific academics, general intellectual ability, creativity, leadership, visual, or performing arts); {and have a} disability defined by Federal/State eligibility criteria: specific learning disability, significant identifiable emotional disability, physical disabilities, sensory disabilities, autism, or ADHD.” (Colorado Dept. of Education 2009)  Misdiagnosis and dual diagnosis of gifted children and adults ~ Webb et al.
  35. 35. Bi-Polar  BPD is characterized by alternating periods of emotional highs and lows.  Ranges from mild to severe.  Mood swings have long intervals to rapidly cycling.  The emotional ‘highs’ include:   Feelings of euphoria, optimism   Rapid speech, racing thoughts, agitation,↑  activity   Poor judgment   Recklessness   Difficulty sleeping   Tendency to be distracted   Inability to concentrate   Extreme irritability
  36. 36. Disorganized Students
  37. 37. Organizing The DisorganizedPerson  Determine “Help Me” domain listening attending, focus, note taking, impulse control, transferring data, input, output, audition, vision, organization, previewing, planning, execution, time-management  Identify needed skill-set  Make a plan  Execute, monitor, review plan
  38. 38. Calendars and Planners  Calendars (must build a habit for checking on a regular basis)  Request assignments in advance to allow for planning homework and studying (many students would benefit from a semester syllabus)
  39. 39. EF Management  Calendars, planners and schedules  Routines and daily activities  Task Lists  Project Management  SYSTEMS: Digital, paper, post-it notes, planners, mobiles tools Cozi.com, myjobchart.com, famzoo.com
  40. 40. Planning/Time Management  Use timers (auditory, visual)  Use alarms  Estimate amount of time needed for a task and then write down actual time  Sarah Ward ~ cognitiveconnectionstherapy.com
  41. 41. What every person needs toknow ~ How to…  Plan  Initiate  Execute  Review  Revise
  42. 42. Manage The Work Space  What does your space look like? How functional is it?   How organized is your study space?   Does your student have all the items he needs?   Does your student have the ability to use multi-sensory transfer skills?   Describe the study space setting, could you work there?   Is there an adult near-by?   Do you have a time set aside?   Are you working in 15 min increments or those suitable to your child?   Do you have prompts or cues?   Is your workspace portable or stationary?
  43. 43. Skill Set Tracking
  44. 44. Go Multi-Sensory  Encourage transfer skills  Use video, audio and tactile strategies  Use marker boards  Use quad bulletin board  Draw and doodle  Vary the types of paper available  Plain, graph, wide ruled, narrow ruled
  45. 45. Habit Development I  A rule of thumb (for kids and adults without ADHD or other neurodevelopmental conditions) is that it takes at least 30 days to build a new habit (make a behavior automatic)  Use sound behavioral principles including tying adequate impulse control to positive reinforcers (must make sure that the interval is appropriate-some kids will need to have chance to earn reinforcer after just a few minutes)  Use visual cues (e.g., big stop sign on door)
  46. 46. Habit Development II  Develop habits that interfere with impulsive behavior (e.g., everyone put their hands on the table, hands in pockets or holding sides of pants/skirts while walking)  Use of a fidget toy (if you are holding a squishy ball, you cannot grab someone else’s belongings) – this only works if kid doesn’t throw the fidget object www.abilitations.com www.kidscompanions.com  The Outliers ~ Malcolm Gladwell
  47. 47. Talking with Students about theirStudy Styles  Emphasize strengths  Keep it short and simple!  Use visuals  Discuss weaknesses as hypotheses (it seems that you lose track of your ideas when you are writing...is that true?)  Instill hope as you describe interventions  Collaborate, collaborate more…
  48. 48. There are no BUT’s here  Help the student feel valued  Let the student have some control in the discussion and plan  Ask questions without making assumptions  The relationship is the agent of change
  49. 49. Prioritization The modified Sullivan technique for prioritizing, planning and execution A B C 48 hrs
  50. 50. Communication and ADHD  Go to your child and make direct eye contact before giving an instruction.  Check for understanding: “Tell me what I want you to do.”  Give verbal directions one at a time, not in a long list.  Physical contact can help the child focus.  Encourage your child to talk through a situation rather than just plunging in (Walk and Talk).  Go over steps in a procedure before and during activities, including those you and your child do together.  Express expectations in written or visual form as well as verbal, such as a chore chart or a checklist.
  51. 51. Diagnostic Considerations
  52. 52. Cognitive Flexibility +Classroom/Work Previewing  Review upcoming changes to schedule or environment  Preview what is upcoming  Who, what, when, where, how  Use multi-sensory strategies  Cornell Method for note-taking  Quad boards
  53. 53. Building Cognitive Flexibility  Social stories (relaxkids.com, mindfulness, meditation, stressfreekids.com)  Social skills training (individual, dyad, group)  Positive reinforcement for managing a change or generating a new way of responding
  54. 54. Even the Playing Field  This is the goal of a 504 Plan and IEP accommodations/modifications – accommodations and modifications do not directly build skills- they buffer the negative effects of the disability  Remember that the educational impact of executive dysfunction may not always be apparent from grades and test scores
  55. 55. Interaction with Cultural andEnvironmental Factors  Some kids with typically developing executive skills have trouble because the expectations at school or home are unrealistically high  Expectations for planning, organization, time management, and autonomy vary widely depending upon a person’s cultural/ethnic context  Families may not be well functioning
  56. 56. Sensory Processing DisordersSensory Modulation Sensory Sensory-Based Motor Discrimination DisorderSensory Over- Visual Postural DisordersResponsivitySensory Under- Auditory DyspraxiaResponsivitySensory Seeking/ TactileCraving Vestibular Proprioceptive Gustatory Olfactory Source: Lucy Jane Miller
  57. 57. SPD ~ Modulation I  Sensory modulation refers to a complex central nervous system process by which neural messages that convey information about the intensity, frequency, duration, complexity, and novelty of sensory stimuli are adjusted.  Behaviorally, this is manifested in the tendency to generate responses that are appropriately graded in relation to incoming sensations, neither under-reacting nor overreacting to them.
  58. 58. SPD – Modulation II  Sensory registration problems - This refers to the process by which the central nervous system attends to stimuli. This usually involves an orienting response. Sensory registration problems are characterized by failure to notice stimuli that ordinarily are salient to most people.  Sensory defensiveness - A condition characterized by over-responsivity in one or more systems.  Gravitational insecurity - A sensory modulation condition in which there is a tendency to react negatively and fearfully to movement experiences, particularly those involving a change in head position and movement backward or upward through space. (Jane Case-Smith, 2005)
  59. 59. The Brain Process  We perceive  We think  We feel  We respond (behave)
  60. 60. CAPD  Complex problem affecting about 5% of school-aged children.  Children cant process the information they hear in the same way as others because their ears and brain dont fully coordinate.  The way the brain recognizes and interprets sounds, most notably the sounds composing speech is altered.  Often do not recognize subtle differences between sounds in words, even when the sounds are loud and clear enough to be heard.  These kinds of problems typically occur in background noise, which is a natural listening environment.  Basic difficulty of understanding any speech signal presented under less than optimal conditions.
  61. 61. CAPD Phenotypically activity if other sounds are  hearing in noisy situations present child is easily distracted by other sounds in  following long conversations the environment  hearing conversations on the telephone   with organizational skills   following multi-step  learning a foreign language directions or challenging vocabulary words   in directing, sustaining, or  remembering spoken dividing attention information (i.e., auditory   with reading and/or spelling memory deficits)   processing nonverbal  taking notes information (e.g., lack of  maintaining focus on an music appreciation)
  62. 62. Non-Verbal Learning Disability  NLD is a neurological syndrome characterized by the impairment of nonverbal or performance-based information controlled by the right hemisphere of the brain. Performance-based information governed by the R hemisphere is impaired in varying degrees, including problems with visual-spatial, intuitive, organizational, evaluative, and holistic processing functions.
  63. 63. NVLD Manifestations  Developmental disorder with manifestations in the following domains:   a) somatosensory and motor functions   b) visuospatial and visuoconstructive functions   c) arithmetic   d) social cognition   E) inferential reasoning
  64. 64. Interventions  Proper diagnosis  Behavioral skill building  Academic/social support  Medication  Brain Training  An organized home environment  Access to competent mentors  Nourishment
  65. 65. HOW TO HELP Accommodations Strategies Skill Building
  66. 66. At Home ~ The Family CoachMethod & ADHD  Stay out of The Discipline Trap  Establish routines and rhythm  Clarify the family culture  Collaborate on behavioral expectations  Build a pond for better behavior  Focus on what works
  67. 67. Intervention Pyramid  Medication  Neurotransmitters  Food/Nutrition Developmental, Behavioral, Learning Interventions
  68. 68. Brain Training  Some programs include Luminosity, Captain’s Log, COGMED, MC2, Brain Gym and Brain Builder. If the child or adult has not had a neuropsychological or executive function evaluation that may be a first step.  Exercise is brain training. Activities that involve motor control and thinking at the same time build brain connections. Some activities to consider include: XBox Dance Dance Revolution, karate, double dutch jump rope, yoga, hacky sac, swimming and tennis. Getting up, out and moving in any way possible is good for everyone.  Preventing brain loss: Cognitive-motor exercises, working memory, nutrition, exercise
  69. 69. Let’s Start Moving  Suzy Koontz suzykoontz.com  Jean Blaydes Madigan abllab.com  SparkPE  Eric Jensen www.jensenlearning.com  Gil Connell @movingsmart now
  70. 70. You are what you assimilate  Get back to real whole food  Consider amino acids neurogistics.com
  71. 71. 5 Food Rules1. 1 oz water per pound per day2. If it does not rot or sprout do without3. Consider 1-2 oz protein/fats every four hours forchildren4. Consider 8-10 servings of color per day (1/2 cupper serving)5. Consider pharm grade or whole food multi-vitamins, Omega 3’s, probiotics and antioxidantsPlease consult with your physician regardingyour specific needs.
  72. 72. Twitter ~ The ResearchPlayground NUTRITION  @NutritionBlogs  @MelissaMcCreey  @childobesity (nourish interactive)  @ RMNutrition  @nutritionistjan  @eatingarainbow  www.KidKritics.com  www.pathways4health.org
  73. 73. Skill Deficits vs Willful Non-compliance  The 80/20 rule  A skill deficit is when the task demands exceed the skill level  Are the expectation clearly understood?  Chunk  Be detailed  Model role play, practice
  74. 74. Is this a skill deficit?Can he do it?If yes, expect itIf no, teach it
  75. 75. EF and Behavioral Change  Visualizing and verbalizing  Role Play  Social Stories  The Beginning, Middle & End  Going Full Circle  See, say, play, touch, build  Mentoring others  Motor movement
  76. 76. Cognitive Skills   Attention   Organization   Distraction   One step at a time   Focus   Previewing   Shift   Planning   Rumination   Completing a task   Perseveration   Hopeful thinking   Negativity   Resistance
  77. 77. Breaking Down Skill Sets I Listening  I chose not to speak  I established eye contact  I listened to someone speaking  I nodded my head to show I was listening  I repeated back what I heard, when asked  I asked a question when I did not understand  I remembered instructions  I followed the instructions
  78. 78. Breaking Down Skill Sets II Listening  I chose not to speak  I established eye contact  I listened to someone speaking  I nodded my head to show I was listening  I repeated back what I heard, when asked  I asked a question when I did not understand  I remembered instructions  I followed the instructions
  79. 79. Breaking Down Skill Sets IIIFor The Parent  I defined an expected behavior  I named the expected behavior  I chose my behavior, thinking it through  I practiced ready, steady, act  I practiced “I have a choice”  I thought about the next step  I spoke the sequence of my actions  I wrote the sequence of my actions
  80. 80. Impulsivity   Waiting one’s turn   Refraining from touching others   Keeping one’s hands to self   Not grabbing without permission   Keeping one’s body still   Thinking before you act   Managing oral-motor movements   Verbalization, waiting one’s turn   Speaking in turn
  81. 81. Helping children “do as expected”takes previewing and planning  1. Tell the children what is about to happen. “We are going outside to play. We will quietly get in line, stand helicopter distance from one another and keep our voices quiet.”  2. Tell them what they can do with their hands and their bodies. “While you are on the playground, keep your hands to yourself as you run, jump and play.”  3. Tell them how they will know the activity is over. “When you hear our ‘secret signal’, you will line up at the red door and we will slowly walk back inside.”
  82. 82. Self-Regulation   Recognizing   Maintaining calm escalation   Using calming skills   Asking for help (I (breathing, music, feel revved up, motor movement, angry, annoyed) yoga, meditation   Stopping escalation   Using energy   Making a choice to release skills (jump use a calming skill ropes, trampoline,   De-escalating jumping jacks)   Initiating calm
  83. 83. Anger Mountain
  84. 84. Polyspot Stories
  85. 85. The Caveman and The Thinker Your Child’s Two-Part Brain The Defensive Brain Collaboration Works Calm the caveman to engage the thinker
  86. 86. We Calm Down To Think  Teach relaxation breathing and self-talk  Allow for a break (including a physical place to calm down) when child encounters a change  Provide warnings (signals) prior to transitions – they can be visual, touch, or verbal  @stressfreekids Lori Lite
  87. 87. EF ~ Social Skills I  1. Perspective-taking - The ability to see a situation from another person’s perspective  2. Impulse Control - The ability to control initial impulses (thoughts, desires) without acting on them  3. Delaying gratification - The ability to delay gratification of needs and desires
  88. 88. EF ~ Social Skills II  4. Conflict Resolution – The ability to solve an interpersonal problem satisfactorily to both parties, without resorting to aggression (verbal or physical)  5. Reading social cues – The ability to decode facial expressions, actions and words  6. Mood modulation – Managing the ups and downs of feelings in the moment, employing calming skills, using one’s thoughts to manage one’s feelings
  89. 89. Twitter ~ The ResearchPlayground INTERVENTION  @Inclusive_Class  @marianne_russo  @‫‏‬special-ism  @movingsmartnow  @micheleborba  @talkingteenage  @Kiboomu  @kidlutions
  90. 90. 5 Things About The Teen BrainYou were afraid to ask, but need to know  Teen brain growth (neuronal connections) is in spurts and starts The Teen Years Explained: A Guide to Healthy Adolescent Development (Johns Hopkins University, 2009) by Clea McNeely and Jayne Blanchard  Go away! Wait, where are you going? (Separation and Independence)  Why do moody? The limbic interference relates to neuronal growth, hormonal changes and brain re- organization  Why so cliquey? Teens are herd animals…  What? Your brakes aren’t working? (Impulsivity and risk taking and the teenage brain)
  91. 91. Teens and Tweenies  Teenage as a second language ~ Barbara R. Greenberg, & Jennifer A. Powell-Lunder  Get out of my life! But first will you take me and Cheryl to the mall ~ Anthony Wolf  Why do they act that way? ~ David Walsh
  92. 92. Freedomland
  93. 93. Field Trip!
  94. 94.  Play Math is a cortico- cerebellar math program that alternates fine and gross motor movement to teach children ages 6-12 fact families, factors and fractions(Kenney 2012)
  95. 95. The Method  Mirror or Skip Count (Balls)  Slide and Glide (Blocks)  Over and Up (Blocks)  How do numbers fit together?  What makes a family?  Advanced techniques
  96. 96. Three things children taught meabout how they learn math.  1. We build to learn: Exploring fact families in “arrays” (we call them squares and rectangles) we have 7 year olds learning order of operations, distributive property and fact families all through play.
  97. 97. Three things children taught me about how they learn math.  We need to touch the blocks for better encoding: With base ten blocks, when children start to see with their own eyes or feel with their own hands/feet/ rhythm or say with their own voices, that 6 fits into 12 and you can make 12 several different ways 3+9=12 9+3 =12; 6+6=12 11+1 = 12, the children love it. They make patterns and do grouping naturally. This enhances memory encoding.
  98. 98. Three things children taught meabout how they learn math. We build brain connections with:a. Rhythmb. Fine and Gross Motor Movementc. Mentoring
  99. 99. Audition and Rhythm  For younger kids who have trouble getting started with the morning or evening routine at home, use a song they like to guide them through  Before starting a seated task, engage in some gross motor activity (quick walk, throw a koosh ball, etc.)  Alex Doman ~ Healing At The Speed of Sound  @Kiboomu
  100. 100. The Importance of Play
  101. 101. Gill Connell ~ Play  PLAY: How it Shapes the Brain, Opens the Imagination, and Invigorates the Soul by Stuart Brown, M.D.  THE POWER OF PLAY: Learning What Comes Naturally by David Elkind, Ph.D.  PLAYFUL PARENTING by Lawrence J. Cohen, Ph.D.  A CHILDS WORK – The Importance of Fantasy Play by Vivien Gussen Paley  THE ART OF ROUGHHOUSING by Anthony T. DeBenedet, M.D. and Lawrence J. Cohen, Ph.D.
  102. 102. The Power of Hopscotch  HOPPING = MIDLINE DEVELOPMENT For children, hopping signals sophisticated advances in both physical coordination, balance, AND cognitive development. You see, as your child refines her physical coordination, she is also building essential neural pathways in the brain. Its those exact same pathways which will one day become the conduits for left/right brain thinking tasks such as creativity, reasoning, and self- regulation.  DONT STEP ON THE LINE = BODY CONTROL  STOP & START = BODY RHYTHM  LEAPING = MUSCLE STRENGTH  SPACES = SPATIAL AWARENESS movingsmartblog.blogspot.com
  103. 103. We Teach EF Through Play  Decision making  Inhibition  Cognitive Flexibility  Attention  Focus  Shift  Creativity/Imagination
  104. 104. Prescribe Love and Caring

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