David D Nowell PhD
www.DrNowell.com
www.DrNowell.com

DavidNowellSeminars
DavidNowell
Overview
• Perspectives
• Curious compassionate nonjudgmental evaluation
• ADHDetc
– SPD
– CAPD
– ADHD/ADD

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•
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•

Ask 2...
Overview
• Perspectives
• Curious compassionate nonjudgmental evaluation
• ADHDetc
– SPD
– CAPD
– ADHD/ADD

•
•
•
•

Ask 2...
www.slideshare.net/dnowell
PERSPECTIVES
Avoiding the most common
diagnostic error
What’s wrong with this brain model?
What’s wrong with this brain model?
What’s wrong with this brain model?
What are our data sources?
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Record review
Interview
Collateral interview
Checklists
Mental status examination
...
CURIOUS COMPASSIONATE
NONJUDGMENTAL EVALUATION
Curious Compassionate
Nonjudgmental Evaluation
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•
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Skillfully eliciting the chief complaint
HËDŸDT?
Forming a diagnos...
Skillfully eliciting the chief complaint
• Too much of what? Or too little of what?
• Invoking the Pediatric Fairy (or the...
HËDŸDT?
• How exactly did you do that?
– Everybody’s doing the best he/she can
– Every behavior problem is either
• Skills...
Forming a diagnostic impression
• Where do you see it the most? And where do
you see it the least?
• Two disorders = two s...
Documenting and communicating your
conclusions
• The footprints in the butter
• Defend your diagnosis
SPD, CAPD, ADD/ADHD, SCT

ADHDETC
ADHDetc

SENSORY PROCESSING DISORDER
Sensory Processing Terminology
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Sensory detection
Sensory discrimination
Sensory modulation
Sensory integration
– ...
Who doesn’t love a wedding?
Who doesn’t love a sensory
deprivation tank?
Sensory Processing Disorder
• Persistent atypical over-responsivity or
underresponsivity to sensation
SENSORY PROCESSING DISORDER

Sensory
modulation
disorder

Sensory
discrimination
disorder

Sensory-based
motor disorder

P...
Interventions for Sensory
Processing Disorders
Interventions for Sensory
Processing Disorders
• Top down
– Normalizing
– Patient and family education
– Environmental int...
The Sensory Defensive Adult
Consider your own self-stim strategies
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Applying lotion
Clicking pen
Sewing machine leg
Gum
Whistling
Instant study carrel
Time “in”
Place the student with tactile
defensiveness at the edge of the group
Provide multiple cues for transitions
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Verbal “two minute warning”
Visual schedule
Changes in lighting
Nonverbal c...
Heavy work
ADHDetc

CENTRAL AUDITORY PROCESSING
DISORDER
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Central auditory processes
• Auditory discrimination (same/different)
• Auditory localization (locate source of sound)
• A...
Central Auditory Processing Disorder
• Difficulty processing auditory information
despite normal hearing
– With functional...
CAPD: what we notice
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Poor communicator (terse, telegraphic)
Hears better when watching the speaker
Problems whe...
CAPD: what we notice
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Often needs remarks repeated
Difficulty sounding out words while reading
Confuses similar-so...
CAPD
• the research challenge of “supramodal
influences”
CAPD or ADHD?
• Where do you see it the most? Where do you
see it the least?
Interventions for CAPD
• Bottom up
– Auditory integration training and similar programs
– Environmental modifications
• FM...
Interventions for CAPD
• Bottom up
– Auditory integration training and similar programs
– Environmental modifications
• FM...
Interventions for CAPD
• Bottom up
– Auditory integration training and similar programs
– Environmental modifications
• FM...
True or False?
• Sensory Processing Disorder will be included
in the DSM5
• Only individuals on the autistic spectrum
enga...
Interventions for CAPD
• Top down
– Metalinguistic strategies including schema
induction, context-derived vocabulary build...
Interventions for CAPD
• Top down
– Metalinguistic strategies including schema
induction, context-derived vocabulary build...
Skillfully eliciting the chief complaint
• Too much of what? Or too little of what?
• Invoking the Pediatric Fairy (or the...
HËDŸDT?
• How exactly did you do that?
– Everybody’s doing the best he/she can
– Every behavior problem is either
• Skills...
Forming a diagnostic impression
• Where do you see it the most? And where do
you see it the least?
• Two disorders = two s...
Documenting and communicating your
conclusions
• The footprints in the butter
• Defend your diagnosis
Adults with Auditory Processing
Challenge
Strengths and Weaknesses Checklist
(Sensory Processing Problems)
Appendix A
ADHDetc

ATTENTION DEFICIT HYPERACTIVITY
DISORDER
The Executive Functions
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Nonverbal working memory
Verbal working memory
Self-regulation of affect/motivation/arous...
The Executive Functions
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Sensing to the self
Speech to the self
Emotion to the self
Play to the self

Barkley, RA,...
The Executive Functions
• Making movies in your head
• Talking to yourself

• Being your own boss
• Thinking and creating ...
Arenas of Involvement
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•
•
•

Intrapersonal
Interpersonal
Environmental
Academic / symbol system

(McCloskey & Perkins, 2...
Preschool
1. 1-step errands

2. Chores with cues
3. Basic inhibition

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Kindergarten 2nd Grade
1. 2-3 step directions
2. 20-30 minute assignments
3. Follow rules/inhibit/no grabbing

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©...
3rd-5th Grade
1. Simple shopping list
2. Keep track of variable daily schedule

3. Inhibit and regulate even without teach...
6th – 8th Grade
1. Complex chores
2. Organizing system
3. Time management
4. Self soothe
5. Manage conflict

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© 2...
Teenage-mid 20’s
1. Independent with assignments
2. Make adjustments based on feedback

3. Inhibit reckless behavior
4. Sa...
Knock 3 years off his age
Lending Your Brain

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Model and discuss attending
• Broad versus narrow
• Internal versus external
• Passive and active
ADHD and Brain Development
ADHD

Inattentive

Hyperactive

Combined
Appendix B
DSM-V Changes
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Age of onset (12 years rather than 7)
Adult criteria (5 symptoms rather than 6)
Additional symptom ...
ADHD and Brain Imaging
Environmental Influences
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Screens
Second-hand smoke
Toxic exposure
Sleep deprivation
Environmental Influences
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Screens
Second-hand smoke
Toxic exposure
Sleep deprivation
Functional impact
of core symptoms
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Arousal / alertness
Mental effort
Determination of saliency
Focal maintenance
Sleep hygiene
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Strict bedtime
Use bed only for sleep
No caffeine after mid-afternoon
No activating media after 7pm
Establish bedtime routine
Fidget supports
Functional impact
of core symptoms
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Arousal / alertness
Mental effort
Determination of saliency
Focal maintenance
Premack Principle
Reward small units of effort
Functional impact
of core symptoms
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Arousal / alertness
Mental effort
Determination of saliency (what’s in it for ...
There’s no such thing as
procrastination
• “There’s just choosing….and choosing
again…”
procrastinators-anonymous.org
Functional impact
of core symptoms
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•
•
•

Arousal / alertness
Mental effort
Determination of saliency
Focal maintenance
EZ-C Reader
Functional impact
of core symptoms
• Satisfaction control (“post-synaptic dopamine
insensitivity”)
• Inhibition
• Tempo co...
DRO
Differential Reinforcement of Other
Fail-proof desk activities

Appendix C
Daily report card

Appendix D / E
Meet with your ADHD employee for
regular ongoing feedback
Functional impact
of core symptoms
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Satisfaction control
Inhibition
Tempo control
Self-monitoring and correcting
There’s no such thing
as “disinhibited”
The “talking stick”
Functional impact
of core symptoms
• Satisfaction control
• Inhibition/Self-Regulation
– Arousal
– Motivation
– Mood
• ADH...
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•

ADHD is not
FRED-PG13
Flight of ideas
Racing thoughts
Euphoria
Decreased need for sleep
Periodicity
Grandio...
Functional impact
of core symptoms
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•
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Satisfaction control
Inhibition
Tempo control
Self-monitoring and correcting
Time Horizon

1 hour 1 day

1 week

1 month

1 year
Functional impact
of core symptoms
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Satisfaction control
Inhibition
Tempo control
Self-monitoring and correcting
Distraction delay training
COMPREHENSIVE ADHD
EVALUATION
Curious Compassionate
Nonjudgmental Evaluation
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Skillfully eliciting the chief complaint
HËDŸDT?
Forming a diagnos...
What are our data sources?
•
•
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•
•

Record review
Interview
Collateral interview
Checklists
Mental status examination
...
COMPREHENSIVE ADHD
TREATMENT
Comprehensive ADHD Treatment
• Medication
• Behavioral Support
• Working Memory
Training
• Movement
• Vestibular and
Cereb...
Comprehensive ADHD Treatment
• Medication
– Stimulant
– Non-stimulant
– “Off-label” treatment
Image: wikimedia commons
Cortico-striatal loop
Increase salience
Two weeks from now, how will you
know whether it’s working?
Appendix F / G
Daily report card

Appendix D
Comprehensive ADHD Treatment
• Behavioral Support
A

B

C

ANTECEDENTS

BEHAVIOR

CONSEQUENCES

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A

B

C

ANTECEDENT

BEHAVIOR

CONSEQUENCES

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A

C

ANTECEDENTS

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B
BEHAVIOR

CONSEQUENCES

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Set them up for
success
A
ANTECEDENTS

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Identify exceptions
A

Where do you see
it the most?

ANTECEDENTS

Where do you see
it the least?
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Rules
A
ANTECEDENTS

•Waking up
•Bedtime
•Chores
•Homework
•TV / internet
Launching Pad
Expectations
A
ANTECEDENTS

•Specific
•Behavioral
•In advance
Communication

A
ANTECEDENTS

•Get eye contact
•Speak clearly
•Provide behavioral info
•Check for understanding
Ask for What You Want
• Talk like a behaviorist
• Tell your partner what you want
• Post classroom expectations visibly
(for the non-ADD partner)
Ask for what you want
A

Provide prosthetic
cues at the “pointof-performance”
(Barkley)

ANTECEDENTS

• Staff mentor
• “Fall-back” peer
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A

Provide prosthetic
cues at the “pointof-performance”
(Barkley)

ANTECEDENTS

Appendix H
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Behavioral Support

A

B

C

ANTECEDENT

BEHAVIOR

CONSEQUENCES

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“A healthy highfunctioning 26
year old”
B
BEHAVIOR

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More
B
BEHAVIOR

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• Behavioral control
• Choices and options
• Self-regulation
• Arousal
• Motivation
• Mood
• At...
A

B

C

ANTECEDENT

BEHAVIOR

CONSEQUENCES

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Don’t reward them with stuff
Rotate rewards frequently
Determine what basic provisions are
unconditional…
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Love
Respect
Safety
3 meals
Essential clothing
Temperatu...
…and which are contingent
• Special foods
• Expensive or trendy clothing
• Extra video game time
Appendix I
Clip and share horrible articles about
teens falling out of the back of pickup
trucks
• Review cause and effect
• Discuss ...
Working Memory Training
• CogMed
• Lumosity
Movement Techniques
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•
•
•
•

Exercise
Rhythm and timing and cognition
Integrated movement
Yoga
Martial arts
Turn 30 minutes into 45
Balance screen time and “green time”
Balance screen time and “green time”
Movement Techniques
•
•
•
•

Exercise
Rhythm and timing and cognition
Yoga
Martial arts
Bal-A-Vis-X
Vestibular and Cerebellar Exercises
• Dyslexia Dyspraxia Attention Treatment
• Interactive metronome
Managing our Cave(wo)man
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•
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•

Meditation
Creative visualization
Mindfulness
Neurofeedback
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Managing our Cave(wo)man
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•
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Meditation
Creative visualization
Mindfulness
Neurofeedback
Mindfulness
Mindfulness
Managing our Cave(wo)man
•
•
•
•

Meditation
Creative visualization
Mindfulness
Neurofeedback
Bodywork
•
•
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•

Massage
Chiropractic
Acupuncture
Transcranial magnetic stimulation
Supplements and Diet
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•
•

Omegas
Food additives
Food allergies
Pesticides
Dietary recommendations
Supplements and Diet
• Omegas
– Zinc

•
•
•
•

Food additives
Food allergies
Pesticides
Dietary recommendations
Nutrition essentials
•
•
•
•

Emphasize protein at every snack and meal
Eat fewer processed foods
Choose local
Pay close a...
Hypnosis
ADD Coaching
Comprehensive ADHD Treatment
– May be expensive
Consider online peer support

www.reddit.com/r/ADHD/
Counseling Goals with the ADHD Client
Basic Brain Supports (without these the rest may
not matter)
• Sleep
• Nutrition
• E...
Rules,
Expecations, and
Communication
A

C

ANTECEDENTS

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B
BEHAVIOR

CONSEQUENCES

© 2011 David D. Nowell, Ph.D....
The
Self-esteem
Abacus
Counseling Goals with the ADHD Client
Therapeutic Interventions (traditional counseling tasks)
• Self-esteem
• Self-effica...
The “Big Five”
•
•
•
•
•

Daily focus time
Nutrition
Movement
Sleep
Connection
10-Minute
Morning Review
…the most
important 10
minutes of the
day….

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The “Big Five”
•
•
•
•
•

Daily focus time
Nutrition
Movement
Sleep
Connection
Barter Social/Practical Support
• Food prep for optimal nutrition
• Domestic organization
• Pre-tax paperwork
The “Big Five”
•
•
•
•
•

Daily focus time
Nutrition
Movement
Sleep
Connection
“Exercise for focus” is different from
"exercise for fitness”
The “Big Five”
•
•
•
•
•

Daily focus time
Nutrition
Movement
Sleep
Connection
The “Big Five”
•
•
•
•
•

Daily focus time
Nutrition
Movement
Sleep
Connection
Marry well and get a crackerjack
assistant at work
The ADHD Couple
The ADHD Couple: The Problems
The ADD Partner May Have:
• High need for stimulation
• Poorer impulse control
• Inattention...
The ADHD Couple: Counseling Goals
•
•
•
•
•

Remembering what drew you to your partner
Getting to “fair”
Outsourcing / pro...
Positive characteristics of many people
with attentional / executive challenges
Appendix J
The ADHD Couple: Counseling Goals
•
•
•
•
•

Remembering what drew you to your partner
Getting to “fair”
Outsourcing / pro...
Allow your non-ADHD partner or
roommate to tackle longer-term
projects: You take on more of the
easy/quick tasks.
Don’t do anything for your ADHD
partner or teenager which could just
as easily be managed by a machine or
an app
Shower Coach
“Walk Me Up” app
MORE STRATEGIES THAT JUST
MIGHT CHANGE YOUR LIFE
Tickler System
Why Don’t Nuns
Worry about What to Wear?
Strategy to rule to habit
• Let’s spend 30 seconds right now determining
where you’ll put your keys from now on upon
enter...
Strategy to rule to habit
3. habit

2. rule
1. strategy
Upstairs downstairs box
60-Second
Bathroom Cleaning Routine
Clear (see-through) storage
Model and practice self-talk
• “I’m checking email then returning phone
calls”
• “When do I need to be ready?”
• “How long...
Reck, S.G. et al (2013)
Self-talk proficiency

ASK TWO QUESTIONS
Am I having fun now?
Is this important?

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What does dopamine feeeel like?
Am I having fun now?
Is this important?
Yes
Yes
Yes
No

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No
Yes
No
No

© 2011 David D. Nowell, Ph.D. All rights
r...
Am I having fun now?
Is this important?

3/5/2014

Yes
Yes

No
Yes

Yes
No

I’m having fun.
I’m on task.

No
No

© 2011 Da...
Am I having fun now?
Is this important?

Yes
Yes

I’m having fun.
I’m not on task.

3/5/2014

No
Yes

Yes
No

No
No

© 201...
Beware dopamine tricksters!
•
•
•
•
•

Facebook
Gambling
Shopping
Video games
Free online Aramaic course
StayOnTask app
The best defense against the
manipulation of our attention is
to determine for ourselves – in
advance - how we want to
inv...
Key features of a great planner system
Key features of a great planner system
• 2 pages per day
• Master to-do list
• With the client at all times
Yoga / read
Phone calls
Staff meeting
Planning
session

billing
Vh: jeff w/ puritan oil
Vc: kate re: brimfield
TC umass dermatology.
Spoke w/ cindy 508 8564000
Key features of a great planner system
• 2 pages per day
• Master to-do list
• With the client at all times
What’s a To-Do list for anyway?
Key features of a great planner system
• 2 pages per day
• Master to-do list
• With the client at all times
Key features of a great planner system

• The “technology”
• The “practice”
Key features of a great planner system
• The “technology”

• The “practice”
Weekly Overview
10-Minute Morning Review
Where will I most likely feel
distracted today?
What will you do today that you'll
still remember one year from now??
Am I having fun now?
Is this important?

Yes
Yes

No
Yes

Yes
No

No
No

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I’m not having fun.
I’m on task.

© 201...
Increase salience
Use extrinsic reward
creatively

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Emphasize the sensory details of your
desired outcome
If It’s Harder than a “3” Find Some
Way to Make It Easier

easy

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hard

© 2011 David D. Nowell, Ph.D. All rights
...
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Assign separate due dates for smaller
parts of big projects
Barter Social/Practical Support
• Food prep for optimal nutrition
• Domestic organization
• Pre-tax paperwork
Am I having fun now?
Is this important?

Yes
Yes

Yes
No

3/5/2014

No
Yes

No
No

I’m not having fun.
I’m not on task.

©...
MORE STRATEGIES THAT JUST
MIGHT CHANGE YOUR LIFE
Celebrate Boxing Day
•
•
•
•

Valentine’s Day
Memorial Day
Arbor Day
Diwali
Celebrate Boxing Day
• Valentine’s Day
• Earth Day
• Diwali
Using your phone’s navigator as a
time-management tool
STRATEGIC BEHAVIORAL INQUIRY
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Objectives of SBI
• Specific behavioral strategy
• What was the feeling-goal?
• Motivational level on a scale from 1-10
Benefits of SBI
• Affirms the value of clients’ unique internal
experience
• Emphasizes the culture of self-regulation
• E...
Assumptions of SBI
• Everybody’s doing the best they can
• Behavior is not incomprehensible or random
• Behavior follows p...
How to do SBI
“How exactly did you do that?”
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Personal Application
…and How Exactly
Did You Do That?
…and How Exactly
Did You Do That?
Personal Application
• What bad habit persists? And How Exactly Do
You Do That?
ADHD and Insight
Fall in Love with the Truth
• Self-monitor and collect data:
– How long does your morning routine take,
exactly?
– How muc...
Learn from your To-Do list
• Which things are not getting completed?
• How – exactly – are these not getting
completed? Ho...
Clinical Application
• Who in your clinic or classroom is
demonstrating remarkable “resilience” –
persistence despite sign...
Clinical Application
• Who in your clinic or classroom is
demonstrating remarkable “resilience” –
persistence despite sign...
Clinical Application
• Who in your clinic or classroom is
demonstrating remarkable “resilience” –
persistence despite sign...
Living in The Gap
• Compassion
• Self-compassion
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Notes
•
•
•
•
•
•
•
•

Add barkley 2012 to references
Add mccloskey to references
Upload to slideshare
Pack 2 paddles or m...
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
Very best treatment for adhd and the processing disorders tatra 2014
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Very best treatment for adhd and the processing disorders tatra 2014

  1. 1. David D Nowell PhD www.DrNowell.com
  2. 2. www.DrNowell.com DavidNowellSeminars DavidNowell
  3. 3. Overview • Perspectives • Curious compassionate nonjudgmental evaluation • ADHDetc – SPD – CAPD – ADHD/ADD • • • • Ask 2 questions Strategic behavioral inquiry (HËDŸDT) Tools you can use now 75 strategies that just might change your life
  4. 4. Overview • Perspectives • Curious compassionate nonjudgmental evaluation • ADHDetc – SPD – CAPD – ADHD/ADD • • • • Ask 2 questions Strategic behavioral inquiry (HËDŸDT)` Tools you can use now 75 strategies that just might change your life
  5. 5. www.slideshare.net/dnowell
  6. 6. PERSPECTIVES
  7. 7. Avoiding the most common diagnostic error
  8. 8. What’s wrong with this brain model?
  9. 9. What’s wrong with this brain model?
  10. 10. What’s wrong with this brain model?
  11. 11. What are our data sources? • • • • • • Record review Interview Collateral interview Checklists Mental status examination Test scores
  12. 12. CURIOUS COMPASSIONATE NONJUDGMENTAL EVALUATION
  13. 13. Curious Compassionate Nonjudgmental Evaluation • • • • Skillfully eliciting the chief complaint HËDŸDT? Forming a diagnostic impression Defending your diagnosis / impression
  14. 14. Skillfully eliciting the chief complaint • Too much of what? Or too little of what? • Invoking the Pediatric Fairy (or the Psychiatric Genie)
  15. 15. HËDŸDT? • How exactly did you do that? – Everybody’s doing the best he/she can – Every behavior problem is either • Skills deficit • Contingency problem
  16. 16. Forming a diagnostic impression • Where do you see it the most? And where do you see it the least? • Two disorders = two stories
  17. 17. Documenting and communicating your conclusions • The footprints in the butter • Defend your diagnosis
  18. 18. SPD, CAPD, ADD/ADHD, SCT ADHDETC
  19. 19. ADHDetc SENSORY PROCESSING DISORDER
  20. 20. Sensory Processing Terminology • • • • Sensory detection Sensory discrimination Sensory modulation Sensory integration – Performing a developmentally appropriate task in a multi-sensory environment
  21. 21. Who doesn’t love a wedding?
  22. 22. Who doesn’t love a sensory deprivation tank?
  23. 23. Sensory Processing Disorder • Persistent atypical over-responsivity or underresponsivity to sensation
  24. 24. SENSORY PROCESSING DISORDER Sensory modulation disorder Sensory discrimination disorder Sensory-based motor disorder Postural disorder Overresponsive Underresponsive Sensation seeking Dyspraxia
  25. 25. Interventions for Sensory Processing Disorders
  26. 26. Interventions for Sensory Processing Disorders • Top down – Normalizing – Patient and family education – Environmental interventions – Self-esteem / success experiences – Treating comorbidities
  27. 27. The Sensory Defensive Adult
  28. 28. Consider your own self-stim strategies • • • • • Applying lotion Clicking pen Sewing machine leg Gum Whistling
  29. 29. Instant study carrel
  30. 30. Time “in”
  31. 31. Place the student with tactile defensiveness at the edge of the group
  32. 32. Provide multiple cues for transitions • • • • Verbal “two minute warning” Visual schedule Changes in lighting Nonverbal cues
  33. 33. Heavy work
  34. 34. ADHDetc CENTRAL AUDITORY PROCESSING DISORDER
  35. 35. 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 58
  36. 36. 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 59
  37. 37. 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 60
  38. 38. 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 61
  39. 39. 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 62
  40. 40. 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 63
  41. 41. 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 64
  42. 42. 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 65
  43. 43. Central auditory processes • Auditory discrimination (same/different) • Auditory localization (locate source of sound) • Auditory performance with degraded acoustic signal • Auditory figure-ground (perceiving sounds in background noise)
  44. 44. Central Auditory Processing Disorder • Difficulty processing auditory information despite normal hearing – With functional impact – Observable by SLPs, teachers, and parents
  45. 45. CAPD: what we notice • • • • • Poor communicator (terse, telegraphic) Hears better when watching the speaker Problems when I speak to rapidly to him She interprets words too literally Memorizes poorly
  46. 46. CAPD: what we notice • • • • Often needs remarks repeated Difficulty sounding out words while reading Confuses similar-sounding words Difficulty following directions in a series
  47. 47. CAPD • the research challenge of “supramodal influences”
  48. 48. CAPD or ADHD? • Where do you see it the most? Where do you see it the least?
  49. 49. Interventions for CAPD • Bottom up – Auditory integration training and similar programs – Environmental modifications • FM transmission • Train the speaker to face her listener, and check for understanding • Preferential seating • Untimed testing • …..and…..
  50. 50. Interventions for CAPD • Bottom up – Auditory integration training and similar programs – Environmental modifications • FM transmission • Train the speaker to face her listener, and check for understanding • Preferential seating • Untimed testing • Increased use of visual cues
  51. 51. Interventions for CAPD • Bottom up – Auditory integration training and similar programs – Environmental modifications • FM transmission • Train the speaker to face her listener, and check for understanding • Preferential seating • Untimed testing • Increased use of visual cues
  52. 52. True or False? • Sensory Processing Disorder will be included in the DSM5 • Only individuals on the autistic spectrum engage in self-stimulating behaviors • Speech Language Pathologists formally diagnose CAPD by way of screening tests • CAPD and ADHD can be co-occurring conditions in some clients
  53. 53. Interventions for CAPD • Top down – Metalinguistic strategies including schema induction, context-derived vocabulary building, phonological awareness, and semantic network expansion
  54. 54. Interventions for CAPD • Top down – Metalinguistic strategies including schema induction, context-derived vocabulary building, phonological awareness, and semantic network expansion – Metacognitive strategies including self-instruction, cognitive problem solving, and assertiveness training
  55. 55. Skillfully eliciting the chief complaint • Too much of what? Or too little of what? • Invoking the Pediatric Fairy (or the Psychiatric Genie)
  56. 56. HËDŸDT? • How exactly did you do that? – Everybody’s doing the best he/she can – Every behavior problem is either • Skills deficit • Contingency problem
  57. 57. Forming a diagnostic impression • Where do you see it the most? And where do you see it the least? • Two disorders = two stories
  58. 58. Documenting and communicating your conclusions • The footprints in the butter • Defend your diagnosis
  59. 59. Adults with Auditory Processing Challenge
  60. 60. Strengths and Weaknesses Checklist (Sensory Processing Problems) Appendix A
  61. 61. ADHDetc ATTENTION DEFICIT HYPERACTIVITY DISORDER
  62. 62. The Executive Functions • • • • Nonverbal working memory Verbal working memory Self-regulation of affect/motivation/arousal Reconstitution Barkley, RA, Murphy, KR., Fischer, M (2008). ADHD in Adults: What the Science Says . New York, Guilford Press.
  63. 63. The Executive Functions • • • • Sensing to the self Speech to the self Emotion to the self Play to the self Barkley, RA, (2012)
  64. 64. The Executive Functions • Making movies in your head • Talking to yourself • Being your own boss • Thinking and creating “what could be”
  65. 65. Arenas of Involvement • • • • Intrapersonal Interpersonal Environmental Academic / symbol system (McCloskey & Perkins, 2013)
  66. 66. Preschool 1. 1-step errands 2. Chores with cues 3. Basic inhibition 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 99
  67. 67. Kindergarten 2nd Grade 1. 2-3 step directions 2. 20-30 minute assignments 3. Follow rules/inhibit/no grabbing 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 100
  68. 68. 3rd-5th Grade 1. Simple shopping list 2. Keep track of variable daily schedule 3. Inhibit and regulate even without teacher present 4. Simple delayed gratification (phone) 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 101
  69. 69. 6th – 8th Grade 1. Complex chores 2. Organizing system 3. Time management 4. Self soothe 5. Manage conflict 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 102
  70. 70. Teenage-mid 20’s 1. Independent with assignments 2. Make adjustments based on feedback 3. Inhibit reckless behavior 4. Say “no” to fun activity if other plans already made 5. Take others’ perspective 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 103
  71. 71. Knock 3 years off his age
  72. 72. Lending Your Brain 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 105
  73. 73. Model and discuss attending • Broad versus narrow • Internal versus external • Passive and active
  74. 74. ADHD and Brain Development
  75. 75. ADHD Inattentive Hyperactive Combined
  76. 76. Appendix B
  77. 77. DSM-V Changes • • • • Age of onset (12 years rather than 7) Adult criteria (5 symptoms rather than 6) Additional symptom examples provided Strengthening of cross-situational requirement • Provision of comorbidity with autism
  78. 78. ADHD and Brain Imaging
  79. 79. Environmental Influences • • • • Screens Second-hand smoke Toxic exposure Sleep deprivation
  80. 80. Environmental Influences • • • • Screens Second-hand smoke Toxic exposure Sleep deprivation
  81. 81. Functional impact of core symptoms • • • • Arousal / alertness Mental effort Determination of saliency Focal maintenance
  82. 82. Sleep hygiene • • • • Strict bedtime Use bed only for sleep No caffeine after mid-afternoon No activating media after 7pm
  83. 83. Establish bedtime routine
  84. 84. Fidget supports
  85. 85. Functional impact of core symptoms • • • • Arousal / alertness Mental effort Determination of saliency Focal maintenance
  86. 86. Premack Principle
  87. 87. Reward small units of effort
  88. 88. Functional impact of core symptoms • • • • Arousal / alertness Mental effort Determination of saliency (what’s in it for me?) Focal maintenance
  89. 89. There’s no such thing as procrastination • “There’s just choosing….and choosing again…”
  90. 90. procrastinators-anonymous.org
  91. 91. Functional impact of core symptoms • • • • Arousal / alertness Mental effort Determination of saliency Focal maintenance
  92. 92. EZ-C Reader
  93. 93. Functional impact of core symptoms • Satisfaction control (“post-synaptic dopamine insensitivity”) • Inhibition • Tempo control • Self-monitoring and correcting
  94. 94. DRO Differential Reinforcement of Other
  95. 95. Fail-proof desk activities Appendix C
  96. 96. Daily report card Appendix D / E
  97. 97. Meet with your ADHD employee for regular ongoing feedback
  98. 98. Functional impact of core symptoms • • • • Satisfaction control Inhibition Tempo control Self-monitoring and correcting
  99. 99. There’s no such thing as “disinhibited”
  100. 100. The “talking stick”
  101. 101. Functional impact of core symptoms • Satisfaction control • Inhibition/Self-Regulation – Arousal – Motivation – Mood • ADHD or Bipolar Disorder? • Too much “push” or too little “pull”? • Tempo control • Self-monitoring and correcting
  102. 102. • • • • • • • ADHD is not FRED-PG13 Flight of ideas Racing thoughts Euphoria Decreased need for sleep Periodicity Grandiosity Age of onset
  103. 103. Functional impact of core symptoms • • • • Satisfaction control Inhibition Tempo control Self-monitoring and correcting
  104. 104. Time Horizon 1 hour 1 day 1 week 1 month 1 year
  105. 105. Functional impact of core symptoms • • • • Satisfaction control Inhibition Tempo control Self-monitoring and correcting
  106. 106. Distraction delay training
  107. 107. COMPREHENSIVE ADHD EVALUATION
  108. 108. Curious Compassionate Nonjudgmental Evaluation • • • • Skillfully eliciting the chief complaint HËDŸDT? Forming a diagnostic impression Defending your diagnosis / impression
  109. 109. What are our data sources? • • • • • • Record review Interview Collateral interview Checklists Mental status examination Test scores
  110. 110. COMPREHENSIVE ADHD TREATMENT
  111. 111. Comprehensive ADHD Treatment • Medication • Behavioral Support • Working Memory Training • Movement • Vestibular and Cerebellar Interventions • Neurofeedback • Breathwork / meditation • Creative visualization • Mindfulness • Bodywork • Supplements / diet • Hypnosis • Coaching • Counseling
  112. 112. Comprehensive ADHD Treatment • Medication – Stimulant – Non-stimulant – “Off-label” treatment
  113. 113. Image: wikimedia commons
  114. 114. Cortico-striatal loop
  115. 115. Increase salience
  116. 116. Two weeks from now, how will you know whether it’s working? Appendix F / G
  117. 117. Daily report card Appendix D
  118. 118. Comprehensive ADHD Treatment • Behavioral Support
  119. 119. A B C ANTECEDENTS BEHAVIOR CONSEQUENCES 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 183
  120. 120. A B C ANTECEDENT BEHAVIOR CONSEQUENCES 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 184
  121. 121. A C ANTECEDENTS 3/5/2014 B BEHAVIOR CONSEQUENCES © 2011 David D. Nowell, Ph.D. All rights reserved. 185
  122. 122. Set them up for success A ANTECEDENTS 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 186
  123. 123. Identify exceptions A Where do you see it the most? ANTECEDENTS Where do you see it the least? 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 187
  124. 124. Rules A ANTECEDENTS •Waking up •Bedtime •Chores •Homework •TV / internet
  125. 125. Launching Pad
  126. 126. Expectations A ANTECEDENTS •Specific •Behavioral •In advance
  127. 127. Communication A ANTECEDENTS •Get eye contact •Speak clearly •Provide behavioral info •Check for understanding
  128. 128. Ask for What You Want • Talk like a behaviorist • Tell your partner what you want • Post classroom expectations visibly
  129. 129. (for the non-ADD partner) Ask for what you want
  130. 130. A Provide prosthetic cues at the “pointof-performance” (Barkley) ANTECEDENTS • Staff mentor • “Fall-back” peer 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 196
  131. 131. A Provide prosthetic cues at the “pointof-performance” (Barkley) ANTECEDENTS Appendix H 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 197
  132. 132. Behavioral Support A B C ANTECEDENT BEHAVIOR CONSEQUENCES 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 200
  133. 133. “A healthy highfunctioning 26 year old” B BEHAVIOR 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 201
  134. 134. More B BEHAVIOR 3/5/2014 • Behavioral control • Choices and options • Self-regulation • Arousal • Motivation • Mood • Attention © 2011 David D. Nowell, Ph.D. All rights reserved. 202
  135. 135. A B C ANTECEDENT BEHAVIOR CONSEQUENCES 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 204
  136. 136. Don’t reward them with stuff
  137. 137. Rotate rewards frequently
  138. 138. Determine what basic provisions are unconditional… • • • • • • • Love Respect Safety 3 meals Essential clothing Temperature-controlled environment 30 minutes of video games
  139. 139. …and which are contingent • Special foods • Expensive or trendy clothing • Extra video game time
  140. 140. Appendix I
  141. 141. Clip and share horrible articles about teens falling out of the back of pickup trucks • Review cause and effect • Discuss consequences • Emphasize behavioral agency
  142. 142. Working Memory Training • CogMed • Lumosity
  143. 143. Movement Techniques • • • • • Exercise Rhythm and timing and cognition Integrated movement Yoga Martial arts
  144. 144. Turn 30 minutes into 45
  145. 145. Balance screen time and “green time”
  146. 146. Balance screen time and “green time”
  147. 147. Movement Techniques • • • • Exercise Rhythm and timing and cognition Yoga Martial arts
  148. 148. Bal-A-Vis-X
  149. 149. Vestibular and Cerebellar Exercises • Dyslexia Dyspraxia Attention Treatment • Interactive metronome
  150. 150. Managing our Cave(wo)man • • • • Meditation Creative visualization Mindfulness Neurofeedback
  151. 151. 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 238
  152. 152. © 2011 David D. Nowell, Ph.D. All rights reserved. 3/5/2014 239
  153. 153. © 2011 David D. Nowell, Ph.D. All rights reserved. 3/5/2014 240
  154. 154. © 2011 David D. Nowell, Ph.D. All rights reserved. 3/5/2014 241
  155. 155. Managing our Cave(wo)man • • • • Meditation Creative visualization Mindfulness Neurofeedback
  156. 156. Mindfulness
  157. 157. Mindfulness
  158. 158. Managing our Cave(wo)man • • • • Meditation Creative visualization Mindfulness Neurofeedback
  159. 159. Bodywork • • • • Massage Chiropractic Acupuncture Transcranial magnetic stimulation
  160. 160. Supplements and Diet • • • • • Omegas Food additives Food allergies Pesticides Dietary recommendations
  161. 161. Supplements and Diet • Omegas – Zinc • • • • Food additives Food allergies Pesticides Dietary recommendations
  162. 162. Nutrition essentials • • • • Emphasize protein at every snack and meal Eat fewer processed foods Choose local Pay close attention to patterns between food and focus/mood
  163. 163. Hypnosis
  164. 164. ADD Coaching
  165. 165. Comprehensive ADHD Treatment – May be expensive
  166. 166. Consider online peer support www.reddit.com/r/ADHD/
  167. 167. Counseling Goals with the ADHD Client Basic Brain Supports (without these the rest may not matter) • Sleep • Nutrition • Exercise Family Supports (any ADHD treatment should include support for the spouse or parents) • Rules • Expectations • Communication
  168. 168. Rules, Expecations, and Communication A C ANTECEDENTS 3/5/2014 B BEHAVIOR CONSEQUENCES © 2011 David D. Nowell, Ph.D. All rights reserved. 262
  169. 169. The Self-esteem Abacus
  170. 170. Counseling Goals with the ADHD Client Therapeutic Interventions (traditional counseling tasks) • Self-esteem • Self-efficacy Lend-Me-Your-Brain Interventions (executive function support) • Reading skills • Study skills • Time/goal management – Calendar – To-do list
  171. 171. The “Big Five” • • • • • Daily focus time Nutrition Movement Sleep Connection
  172. 172. 10-Minute Morning Review
  173. 173. …the most important 10 minutes of the day…. 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 267
  174. 174. The “Big Five” • • • • • Daily focus time Nutrition Movement Sleep Connection
  175. 175. Barter Social/Practical Support • Food prep for optimal nutrition • Domestic organization • Pre-tax paperwork
  176. 176. The “Big Five” • • • • • Daily focus time Nutrition Movement Sleep Connection
  177. 177. “Exercise for focus” is different from "exercise for fitness”
  178. 178. The “Big Five” • • • • • Daily focus time Nutrition Movement Sleep Connection
  179. 179. The “Big Five” • • • • • Daily focus time Nutrition Movement Sleep Connection
  180. 180. Marry well and get a crackerjack assistant at work
  181. 181. The ADHD Couple
  182. 182. The ADHD Couple: The Problems The ADD Partner May Have: • High need for stimulation • Poorer impulse control • Inattention to detail The Non-ADD Partner May Have: • Rigid style • Mild anxiety • Unrealistic expectations
  183. 183. The ADHD Couple: Counseling Goals • • • • • Remembering what drew you to your partner Getting to “fair” Outsourcing / professional supports Feeling your contributions are valued Communication skills training
  184. 184. Positive characteristics of many people with attentional / executive challenges Appendix J
  185. 185. The ADHD Couple: Counseling Goals • • • • • Remembering what drew you to your partner Getting to “fair” Outsourcing / professional supports Feeling your contributions are valued Communication skills training
  186. 186. Allow your non-ADHD partner or roommate to tackle longer-term projects: You take on more of the easy/quick tasks.
  187. 187. Don’t do anything for your ADHD partner or teenager which could just as easily be managed by a machine or an app
  188. 188. Shower Coach
  189. 189. “Walk Me Up” app
  190. 190. MORE STRATEGIES THAT JUST MIGHT CHANGE YOUR LIFE
  191. 191. Tickler System
  192. 192. Why Don’t Nuns Worry about What to Wear?
  193. 193. Strategy to rule to habit • Let’s spend 30 seconds right now determining where you’ll put your keys from now on upon entering your home.
  194. 194. Strategy to rule to habit 3. habit 2. rule 1. strategy
  195. 195. Upstairs downstairs box
  196. 196. 60-Second Bathroom Cleaning Routine
  197. 197. Clear (see-through) storage
  198. 198. Model and practice self-talk • “I’m checking email then returning phone calls” • “When do I need to be ready?” • “How long will this take?”
  199. 199. Reck, S.G. et al (2013)
  200. 200. Self-talk proficiency ASK TWO QUESTIONS
  201. 201. Am I having fun now? Is this important? 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 305
  202. 202. 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 306
  203. 203. 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 308
  204. 204. What does dopamine feeeel like?
  205. 205. Am I having fun now? Is this important? Yes Yes Yes No 3/5/2014 No Yes No No © 2011 David D. Nowell, Ph.D. All rights reserved. 318
  206. 206. Am I having fun now? Is this important? 3/5/2014 Yes Yes No Yes Yes No I’m having fun. I’m on task. No No © 2011 David D. Nowell, Ph.D. All rights reserved. 319
  207. 207. Am I having fun now? Is this important? Yes Yes I’m having fun. I’m not on task. 3/5/2014 No Yes Yes No No No © 2011 David D. Nowell, Ph.D. All rights reserved. 321
  208. 208. Beware dopamine tricksters! • • • • • Facebook Gambling Shopping Video games Free online Aramaic course
  209. 209. StayOnTask app
  210. 210. The best defense against the manipulation of our attention is to determine for ourselves – in advance - how we want to invest it. - E. Goldberg
  211. 211. Key features of a great planner system
  212. 212. Key features of a great planner system • 2 pages per day • Master to-do list • With the client at all times
  213. 213. Yoga / read Phone calls Staff meeting Planning session billing
  214. 214. Vh: jeff w/ puritan oil Vc: kate re: brimfield TC umass dermatology. Spoke w/ cindy 508 8564000
  215. 215. Key features of a great planner system • 2 pages per day • Master to-do list • With the client at all times
  216. 216. What’s a To-Do list for anyway?
  217. 217. Key features of a great planner system • 2 pages per day • Master to-do list • With the client at all times
  218. 218. Key features of a great planner system • The “technology” • The “practice”
  219. 219. Key features of a great planner system • The “technology” • The “practice”
  220. 220. Weekly Overview
  221. 221. 10-Minute Morning Review
  222. 222. Where will I most likely feel distracted today?
  223. 223. What will you do today that you'll still remember one year from now??
  224. 224. Am I having fun now? Is this important? Yes Yes No Yes Yes No No No 3/5/2014 I’m not having fun. I’m on task. © 2011 David D. Nowell, Ph.D. All rights reserved. 352
  225. 225. Increase salience
  226. 226. Use extrinsic reward creatively 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 355
  227. 227. Emphasize the sensory details of your desired outcome
  228. 228. If It’s Harder than a “3” Find Some Way to Make It Easier easy 3/5/2014 hard © 2011 David D. Nowell, Ph.D. All rights reserved. 357
  229. 229. 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 359
  230. 230. Assign separate due dates for smaller parts of big projects
  231. 231. Barter Social/Practical Support • Food prep for optimal nutrition • Domestic organization • Pre-tax paperwork
  232. 232. Am I having fun now? Is this important? Yes Yes Yes No 3/5/2014 No Yes No No I’m not having fun. I’m not on task. © 2011 David D. Nowell, Ph.D. All rights reserved. 362
  233. 233. MORE STRATEGIES THAT JUST MIGHT CHANGE YOUR LIFE
  234. 234. Celebrate Boxing Day • • • • Valentine’s Day Memorial Day Arbor Day Diwali
  235. 235. Celebrate Boxing Day • Valentine’s Day • Earth Day • Diwali
  236. 236. Using your phone’s navigator as a time-management tool
  237. 237. STRATEGIC BEHAVIORAL INQUIRY
  238. 238. 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 384
  239. 239. 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 385
  240. 240. Objectives of SBI • Specific behavioral strategy • What was the feeling-goal? • Motivational level on a scale from 1-10
  241. 241. Benefits of SBI • Affirms the value of clients’ unique internal experience • Emphasizes the culture of self-regulation • Encourages metacognition
  242. 242. Assumptions of SBI • Everybody’s doing the best they can • Behavior is not incomprehensible or random • Behavior follows patterns which reveal themselves to the curious observer free of prejudice or blame or theory
  243. 243. How to do SBI “How exactly did you do that?”
  244. 244. 3/5/2014 © 2011 David D. Nowell, Ph.D. All rights reserved. 394
  245. 245. Personal Application
  246. 246. …and How Exactly Did You Do That?
  247. 247. …and How Exactly Did You Do That?
  248. 248. Personal Application • What bad habit persists? And How Exactly Do You Do That?
  249. 249. ADHD and Insight
  250. 250. Fall in Love with the Truth • Self-monitor and collect data: – How long does your morning routine take, exactly? – How much time – exactly – do you need to complete expense forms? – How, exactly, do you follow through on commitments to others and not to yourself?
  251. 251. Learn from your To-Do list • Which things are not getting completed? • How – exactly – are these not getting completed? How do you do that?
  252. 252. Clinical Application • Who in your clinic or classroom is demonstrating remarkable “resilience” – persistence despite significant obstacles? And how, exactly, does he/she do that?
  253. 253. Clinical Application • Who in your clinic or classroom is demonstrating remarkable “resilience” – persistence despite significant obstacles? And how, exactly, does he/she do that? • What recurring behavioral problem is showing up in your clinic or classroom?
  254. 254. Clinical Application • Who in your clinic or classroom is demonstrating remarkable “resilience” – persistence despite significant obstacles? And how, exactly, does he/she do that? • What recurring behavioral problem is showing up in your clinic or classroom? • Note: we aren’t asking “why did you do that,” but rather “how exactly did you do that.”
  255. 255. Living in The Gap • Compassion • Self-compassion
  256. 256. www.slideshare.net/dnowell
  257. 257. David D Nowell PhD Let’s stay in touch!  Join my e-newsletter list:  Fill out a card today and drop it in the box.  Sign up on my web site or Facebook page  Visit on the web: www.DrNowell.com @davidnowell David Nowell Seminars
  258. 258. Notes • • • • • • • • Add barkley 2012 to references Add mccloskey to references Upload to slideshare Pack 2 paddles or marker Pack talk points Add moonwalking bear video to stick Insert slide with pushpin in dictionary Check “appendx” references in slides

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