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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 />
“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 />
This Dense Pudding<br /> <br />What Does Dopamine Feel Like?<br /> <br />Why You Aren’t Getting Exactly What  Want All the...
This Dense Pudding<br />Normal and Abnormal Sensory Processing and Attentional Functioning<br />
Sensory Processing Disorder<br />
Sensory Integration Terminology<br />Sensory Processing<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 />
Regulatory-Sensory Processing Disorders<br />Treatment<br />“top down”<br />“bottom up”<br />
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 />
Self-assessment<br />
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 />
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 />
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 />consequences<br />X<br />
A<br />B<br />C<br />behavior<br />
Metacognition<br />Metacognitiveknowledge<br />Metacognitivestrategies<br />
“Lend Me Your Brain”<br />
What Does Dopamine Feel Like?<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 />
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 />
Broaden and Build<br />
“NeuroMalleability”<br />
Why You Aren’t Getting Exactly What You Want All the Time<br />The Brain’s Reward and Planning System  - And How It Breaks...
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...
Lend Me Your Brain<br />Supporting Clients with Executive Dysfunction<br />
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 />
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 />
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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BRS ADHD Workshop

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Bureau of Rehabilitation Services ADHD Workshop

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BRS ADHD Workshop

  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. “Top – down” dysfunction<br />ADHD<br />Executive dysfunction<br />
  6. 6. “Bottom - up” dysfunction<br />Central auditory processing problems<br />Sensory processing problems<br />
  7. 7.
  8. 8. What’s the kid’s deal?<br />
  9. 9. This Dense Pudding<br /> <br />What Does Dopamine Feel Like?<br /> <br />Why You Aren’t Getting Exactly What Want All the Time<br /> <br />Lend Me Your Brain<br />Overview<br />
  10. 10. This Dense Pudding<br />Normal and Abnormal Sensory Processing and Attentional Functioning<br />
  11. 11. Sensory Processing Disorder<br />
  12. 12.
  13. 13. Sensory Integration Terminology<br />Sensory Processing<br />
  14. 14. Developmental considerations<br />Auditory .<br />Visual<br />Tactile<br />Proprioceptive<br />Vestibular<br />Motor<br />
  15. 15. Sensory Processing/Integration Disorder and DSM-V<br />
  16. 16. What’s the kid’s deal?<br />
  17. 17.
  18. 18. What’s the kid’s deal?<br />
  19. 19.
  20. 20. Strategies<br />
  21. 21. Regulatory-Sensory Processing Disorders<br />Treatment<br />“top down”<br />“bottom up”<br />
  22. 22.
  23. 23.
  24. 24. Regulatory-Sensory Processing Disorders<br />Treatment<br />“top down”<br />“bottom up”<br />
  25. 25.
  26. 26. Central Auditory Processing Disorder<br />
  27. 27.
  28. 28.
  29. 29. Central Auditory Processing Disorder<br /><ul><li> Auditory discrimination (same/different)
  30. 30. Auditory closure (fill in missing bits)
  31. 31. Auditory localisation(locate source of sound)
  32. 32. Auditory performance with degraded acoustic</li></ul>signal<br /><ul><li> Auditory figure-ground (perceiving sounds in</li></ul>background noise)<br />
  33. 33. 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 />
  34. 34. 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 />
  35. 35. 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 />
  36. 36. CAPD or ADHD?<br />
  37. 37. What’s the kid’s deal?<br />
  38. 38.
  39. 39. Strategies<br />
  40. 40. (C)APD<br />Treatment<br />“top down”<br />“bottom up”<br />X<br />
  41. 41. Treatment for CAPD<br /> Environmental modifications<br />
  42. 42. Treatment for CAPD<br />Compensatory Strategies<br />
  43. 43. Self-assessment<br />
  44. 44. Attention Deficit Hyperactivity Disorder<br />
  45. 45. Increase salience<br />
  46. 46. Attention Deficit Hyperactivity Disorder<br />
  47. 47. (85 – X) x 365<br />
  48. 48. “I’m gonna eat all the gum and candy I want!”<br />
  49. 49. Core symptoms<br />Inattention / distractibility<br />
  50. 50. Core symptoms<br />Hyperactivity / impulsivity<br />
  51. 51. ….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 />
  52. 52.
  53. 53. Functional impact of core symptoms<br />Arousal / alertness<br />Mental effort<br />Determination of saliency<br />Focal maintenance<br />
  54. 54. Functional impact of core symptoms<br />Arousal / alertness<br />Mental effort<br />Determination of saliency<br />Focal maintenance<br />
  55. 55. Functional impact of core symptoms<br />Arousal / alertness<br />Mental effort<br />Determination of saliency<br />Focal maintenance<br />
  56. 56.
  57. 57. Functional impact of core symptoms<br />Arousal / alertness<br />Mental effort<br />Determination of saliency<br />Focal maintenance<br />
  58. 58. Functional impact of core symptoms<br />Satisfaction control<br />Previewing<br />Inhibition<br />Tempo control<br />Self-monitoring and correcting<br />
  59. 59. Functional impact of core symptoms<br />Satisfaction control<br />Previewing .<br />Inhibition<br />Tempo control<br />Self-monitoring and correcting<br />
  60. 60. Functional impact of core symptoms<br />Satisfaction control<br />Previewing<br />Inhibition<br />Tempo control<br />Self-monitoring and correcting<br />
  61. 61. Functional impact of core symptoms<br />Satisfaction control<br />Previewing<br />Inhibition<br />Tempo control<br />Self-monitoring and correcting<br />
  62. 62. Functional impact of core symptoms<br />Satisfaction control<br />Previewing<br />Inhibition<br />Tempo control<br />Self-monitoring and correcting<br />
  63. 63. Subtypes of ADHD<br />ADHD, predominantly inattentive type<br />ADHD, predominantly hyperactive type<br />ADHD, combined type<br />ADHD, Not Otherwise Specifed<br />
  64. 64. Subtypes of ADHD<br />ADHD, predominantly inattentive type<br />ADHD, predominantly hyperactive type<br />ADHD, combined type<br />ADHD, Not Otherwise Specifed<br />
  65. 65. 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 />
  66. 66.
  67. 67. 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 />
  68. 68. ADHD and girls<br />
  69. 69.
  70. 70.
  71. 71. ADHD and women<br />
  72. 72.
  73. 73. 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 />
  74. 74. Executive Functioning:An Overarching Theme<br />Sensory Processing Disorder<br />Central Auditory Processing Disorder<br />ADHD and Executive Dysfunction<br />
  75. 75. The Executive Functions<br />Internalizing speech<br />Previewing<br />Prioritizing<br />Tempo control<br />Inhibition<br />
  76. 76. 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 />
  77. 77.
  78. 78.
  79. 79. Appropriate expectations<br />
  80. 80. Age-appropriate expectations<br />Preschool<br />1-step errands<br />Chores with cues<br />Basic inhibition<br />
  81. 81. 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 />
  82. 82. 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 />
  83. 83. 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 />
  84. 84. 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 />
  85. 85. “what is” vs. “what could be”<br />
  86. 86. “what is” vs. “what could be”<br />
  87. 87. Inter-connectedness of systems<br />Cortico-striatal system, for example<br />
  88. 88.
  89. 89. Strategies<br />
  90. 90. Pharmacotherapy<br />X<br />
  91. 91. Behavioral Supports<br />
  92. 92. A<br />B<br />C<br />
  93. 93. A<br />B<br />C<br />behavior<br />
  94. 94. A<br />B<br />C<br />consequences<br />
  95. 95. A<br />B<br />C<br />antecedent<br />
  96. 96. A<br />B<br />C<br />
  97. 97. A<br />B<br />C<br />antecedent<br />
  98. 98.
  99. 99. A<br />B<br />C<br />antecedent<br />
  100. 100.
  101. 101.
  102. 102.
  103. 103. easy<br />hard<br />
  104. 104.
  105. 105.
  106. 106.
  107. 107.
  108. 108.
  109. 109.
  110. 110. A<br />B<br />C<br />consequences<br />
  111. 111.
  112. 112.
  113. 113.
  114. 114. 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 />
  115. 115. 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 />
  116. 116.
  117. 117.
  118. 118.
  119. 119. Intrinsic motivation<br />
  120. 120.
  121. 121. A<br />B<br />C<br />consequences<br />X<br />
  122. 122. A<br />B<br />C<br />behavior<br />
  123. 123. Metacognition<br />Metacognitiveknowledge<br />Metacognitivestrategies<br />
  124. 124. “Lend Me Your Brain”<br />
  125. 125. What Does Dopamine Feel Like?<br />The Physiology of Motivation and Reward<br />
  126. 126. Preferred States: What Does Dopamine Feel Like?<br />Great experience<br />Kodak moment<br />The feeeeling<br />
  127. 127. 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 />
  128. 128. 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 />
  129. 129. 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 />
  130. 130. PREFERRED STATES <br />INVENTORY<br />
  131. 131.
  132. 132.
  133. 133. Broaden and Build<br />
  134. 134. “NeuroMalleability”<br />
  135. 135. Why You Aren’t Getting Exactly What You Want All the Time<br />The Brain’s Reward and Planning System - And How It Breaks Down<br />
  136. 136. The reward-and-planning system<br />Anticipate goal<br />Identify tasks<br />Sequence / problem-solve<br />Block out distractions<br />Get the reward<br />
  137. 137. “what is” vs. “what could be”<br />
  138. 138. “what is” vs. “what could be”<br />
  139. 139. The reward-and-planning system<br />Anticipate goal<br />Identify tasks<br />Sequence / problem-solve<br />Block out distractions<br />Get the reward<br />
  140. 140. 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 />
  141. 141. 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 />
  142. 142. 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 />
  143. 143. 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 />
  144. 144.
  145. 145. Lend Me Your Brain<br />Supporting Clients with Executive Dysfunction<br />
  146. 146. 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 />
  147. 147. 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 />
  148. 148. 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 />
  149. 149.
  150. 150. 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 />
  151. 151. 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 />
  152. 152.
  153. 153. 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 />
  154. 154. Ways the reward-and-planning system can go wrong<br />Sequence / problem-solve<br />
  155. 155.
  156. 156. Ways the reward-and-planning system can go wrong<br />Sequence / problem-solve<br />Verbal working memory<br />Nonverbal working memory<br />
  157. 157.
  158. 158. 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 />
  159. 159. Ways the reward-and-planning system can go wrong<br />Block out distractions<br />
  160. 160.
  161. 161. 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 />
  162. 162.
  163. 163. 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 />
  164. 164. Ways the reward-and-planning system can go wrong<br />Get the reward<br />
  165. 165.
  166. 166. 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 />
  167. 167.
  168. 168. Instant gratification vs. executive gratification<br />
  169. 169.
  170. 170.
  171. 171.
  172. 172.
  173. 173. A<br />B<br />C<br />behavior<br />x<br />
  174. 174. Self-Talk Proficiency<br />
  175. 175. 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 />
  176. 176. 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 />
  177. 177. 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 />
  178. 178. Match the Picture<br />
  179. 179.
  180. 180.
  181. 181. Distraction Delay Training<br />
  182. 182.
  183. 183.
  184. 184. Executive Estimates Training<br />X<br />
  185. 185. Learning Time:<br />What is the “felt” experience of time?<br />What is the “frontal” aspect of time?<br />
  186. 186. Learning Time:<br />
  187. 187. Learning Time:<br />
  188. 188.
  189. 189.
  190. 190. Learning Time:<br />Theres no such thing as procrastination….there’s just choosing. And choosing again.<br />
  191. 191. Asking two questions…<br />Am I having fun now?<br />And is this what I set out to do?<br />
  192. 192. Am I having fun now?<br />Is this what I set out to do?<br />
  193. 193. Am I having fun now?<br />Is this what I set out to do?<br />
  194. 194. 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 />
  195. 195. 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 />
  196. 196. Methylphenidate Enhances the Saliency of a Mathematical Task by Increasing Dopamine in the Human BrainVolkow, et al. 2004<br />
  197. 197. Increase salience<br />
  198. 198.
  199. 199.
  200. 200.
  201. 201.
  202. 202. Increase salience<br />
  203. 203.
  204. 204.
  205. 205. Quarterly QI review<br />
  206. 206. The post-mortem<br />
  207. 207.
  208. 208.
  209. 209. Your #1 Organizational Tool<br />
  210. 210. Your #1 Organizational Tool<br />Yoga / read<br />Phone calls<br />Staff meeting<br />Planning<br />session<br />billing<br />
  211. 211. 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 />
  212. 212. Your #1 Organizational Tool<br />
  213. 213. Learn French<br />Be a better spouse<br />Stop smoking<br />
  214. 214. The “Big Five” <br />Daily focus time<br />Values/motivational clarity<br />Nutrition<br />Movement<br />Connection<br />
  215. 215.
  216. 216.
  217. 217. The “Big Five” <br />Daily focus time<br />Values/motivational clarity<br />Nutrition<br />Movement<br />Connection<br />
  218. 218.
  219. 219.
  220. 220.
  221. 221. The “Big Five” <br />Daily focus time<br />Values/motivational clarity<br />Nutrition<br />Movement<br />Connection<br />
  222. 222. The “Big Five” <br />Daily focus time<br />Values/motivational clarity<br />Nutrition<br />Movement<br />Connection<br />
  223. 223. The “Big Five” <br />Daily focus time<br />Values/motivational clarity<br />Nutrition<br />Movement<br />Connection<br />
  224. 224. A challenge….<br />
  225. 225. 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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