Treating ADHD, Predominantly Inattentive Type with Integrated Psychosocial Treatment - PowerPoint PPT Presentation

1 / 84
About This Presentation

Treating ADHD, Predominantly Inattentive Type with Integrated Psychosocial Treatment


Treating ADHD, Predominantly Inattentive Type with Integrated Psychosocial Treatment – PowerPoint PPT presentation

Number of Views:1065
Avg rating:3.0/5.0
Slides: 85
Provided by: sand61


Transcript and Presenter's Notes

Title: Treating ADHD, Predominantly Inattentive Type with Integrated Psychosocial Treatment

Treating ADHD, Predominantly Inattentive Type
with Integrated Psychosocial Treatment
Linda Pfiffner, Ph.D. Childrens Center at
Langley Porter University of California, San
What is ADHD-I?
  • Case Description Kayla
  • 8 y/o girl, 3rd grade, private school
  • Referred due to concerns about attention mind
    floats, lives in fantasy world, organizational
    problems, needs to be redirected. Also concerns
    about social interaction problems.
  • Family background lives with her biological
    mother and sister parents are divorced. History
    of ADHD, behavior problems, depression in family.
    Mother works full-time.
  • Birth, medical and developmental history
    normal, but slightly late in some fine and
    gross motor skills.

  • School History
  • Problems with attention, focus and completing
    tasks began during first grade and have worsened
    each year.
  • Teacher comments
  • Capable, but works slowly
  • Doesnt use class time well, mostly in her own
  • Concentration problems worse as day progresses or
    if activity is lengthy
  • Lack of attention leads to missing directions
  • Needs 11 or small group to stay on task and
  • Work is often sloppy, messy, incomplete, not
    turned in
  • Academic ability on grade level
  • Very imaginative, artistic
  • Few behavior problems

  • Peer Relations
  • Immature, fits in better with younger children
  • Has a few friends but does not seek new friends
  • Makes up stories
  • Can be bossy
  • Some teasing by peers
  • Teacher describes as eccentric
  • Home Behavior
  • Daily routine activities and homework are an
  • Takes forever to get things done
  • Lots of frustration and conflict over need for
    reminders and not completing tasks
  • Needs constant supervision
  • Affects getting ready in am, homework, chores,
  • High levels of mother-daughter conflict, but
    evidence of loving relationship

Teacher Ratings
  • Teacher CSI ADHD IA 8/9 often or very often,
    H/I 0/9
  • SCT 11/15 often or very often
  • APRS 50 work completed, often completes work
    in careless fashion, often requires assistance
    to complete work, quality of work is more
    successful than poor
  • Peer Relations Scale often chosen late, never
    sought after by peers, none would like for a best
    friend, none would wish she was not in class
  • School Situations Q moderate-severe in 4/8
  • SSRS SS Scale 79, AC88, PB130

Parent Interview and Ratings
  • Parent KSADS and CSI IA 9/9, H/I2/9, past sep
    anx disorder.
  • Home Sit. Q. moderate in 10/13 areas
  • HPC very often 17/20 items
  • SSRS SS Scale 67, PB Scale134
  • PSI P-C Dys Interaction 99, Difficult Child
    97, Total Stress 97
  • ABAS Gen Adaptive Composite 72

Test Results
  • Behavioral Observations cheerful, rapport each
    to establish, somewhat slow to respond, compliant
    and friendly
  • WASI FSIQ108, Verb114, Perf102
  • WIAT II WR93, MR106, S96
  • MASC T65, elevated
  • CDI T47, normal range
  • DSM-IV Diagnosis ADHD-I

Life in families with ADHD-I
  • Homework vacillates between a struggle and a
  • Routine activities and chores are forgotten
  • Getting ready in the morning is a formidable
  • Dawdling and procrastination means things are
    done at the last minute
  • Bedrooms and play areas usually messy and
    disorganizedclothes laying in the same spot they
    were dropped toys, papers, books, and magazines
    in disarray.
  • Lots of time spent looking for lost things
  • Off in own world," not listening and not
    following through

School (cont.)
  • Academic underachievement, learning disabilities
    (McBurnett et al., 1999 Carlson Mann, 2000)
  • These problems may be less extreme in early
    elementary years, but as demands for independence
    increase with each grade, these problems can be
    quite severe by middle and high school.

Peer Relations in ADHD-ICarlson Mann, 2000
Maedgen Carlson, 2000 Blachman Hinshaw, 2002
  • Tend to be passive and withdrawn
  • Often play by themselves play with others for
    only short periods of time.
  • Often shy, not tuned in to group conversation.
  • Poor tracking and processing of social cues,
  • Not well-accepted by peers teased, unpopular,
    neglected rather than openly rejected.
  • Deficits in knowing what to do when interacting
    with others, not just a performance problem.

DSM-IV ADHD-I Must occur OFTEN, cause
IMPAIRMENT, X 2 settings
  • Inattentive (6)
  • Fails to give attention to details/makes careless
  • Difficulty sustaining attention
  • Seems not to listen
  • Fails to finish tasks
  • Difficulty organizing
  • Avoids tasks requiring sustained attention
  • Loses things
  • Easily distracted
  • Forgetful
  • Hyper/Impulsive (5-)
  • Fidgets or squirms in seat
  • Difficulty remaining seated when asked to
  • Runs about or climbs on things when asked not to
  • Difficulty playing quietly
  • Acts on the go or driven by a motor
  • Talks excessively
  • Blurts out answers
  • Difficulty awaiting turn in group activities
  • Interrupts people, butts into others activities

Sluggish Cognitive Tempo(McBurnett et al., 2001
Carlson et al., 2002
  • Daydreams
  • Sluggish or drowsy
  • Confused or in a fog
  • Absent-minded
  • Apathetic or unmotivated
  • Stares blankly
  • Underactive or unmotivated
  • Forgetful

Attention Problems in ADHD-I vs. ADHD-C
  • ADHD-I more severe alertness/orientation problems
    than ADHD-C (McBurnett et al., 2001).
  • ADHD-I more problems in focused or selective
    attention ADHD-C more problems with persistence,
    working memory and behavioral inhibition
    (Barkley, 1997).
  • Both types share deficits on tests of frontal
    lobe functions, but additional problems in
    perceptual-motor speed and slow processing
    specific to ADHD-I (e.g., Barkley et al., 1992)

Work Style in ADHD-I vs. ADHD-C (Booth et al.,
2001 Carlson et al., 2002)
  • ADHD-I and ADHD-C-
  • lower motivation for learning
  • less interest in challenging tasks
  • less persistent and more easily discouraged
  • ADHD-I prefer cooperative work setting ADHD-C
    prefer more competitive environment.
  • ADHD-I motivated to please teacher, make good
    grades more so than for own curiosity, interest
    or internal drive.
  • ADHD-C more likely to value being perceived as
    high performing and successful than those with

Comorbid DisordersCarlson Mann, 2000
  • Oppositional Defiant Disorder and Conduct
    Disorder less in ADHD-I than ADHD-C
  • Anxiety and Depression comparable or more in
    ADHD-I than ADHD-C
  • Learning Disorders comparable or more in ADHD-I
    than ADHD-C (esp. math achievement)

Tailoring psychosocial treatment to ADHD-I
  • Academic impairment -- necessitates close
    involvement with school direct intervention for
  • Work style issues use non-competitive external
    rewards for specific goals accommodations to
    tasks and assignments to address slow processing
  • Social difficulties-- teach and practice specific
    skills provide opportunities and reinforcement
    for approaching and interacting with peers.

Tailoring Tx (cont.)
  • Lack of independence in daily living tasks-- most
    efficiently increased with routines, parent
    monitoring and reinforcement.
  • Fewer disruptive behavior problems-- Limit
    setting strategies (time-out) less useful.
    Instead, positive reinforcement targeting
    specific goals and routines indicated.

Why psychosocial treatment?
  • Medication may be less helpful for ADHD-I than
    ADHD-C. (Barkley et al, 1991 Greenhill et al,
  • Social impairment in ADHD-I (social
    passivity/withdrawal, lack of social knowledge)
    likely to be more amenable to PST than ST
    (Pfiffner et al, 2000)
  • ST side effects of social withdrawal (Granger et
    al., 1996) may be less acceptable in children who
    already have social withdrawal problems
  • ST often does not normalize functioning the
    inclusion of PST may be necessary to produce
    excellent treatment response
  • Parents show a significant preference for
    behavioral treatments over pharmacological
    treatment alone (Pelham, 1999)
  • These factors suggest that psychosocial
    interventions may be even more important for this

Life Skills Training for ADHD-Inattentive Type
  • Exploratory/Developmental 3 year grant funded by
    NIMH (2002-2005)
  • Treatment incorporates rehabilitation approaches
    based on similarities between ADHD-I and mild
    brain injuries (e.g., sluggish cognitive tempo,
  • Emphasizes adaptive skills, functional
    competence, compensatory strategies
  • Uses cues, prompts, routines
  • Involves teachers and parents to provide
    necessary environmental supports at school and at

Child Life Skills Program
  • Study Screening and Assessment Process
  • Telephone screenings (parent, teacher)
  • Agreement from school to participate
  • Standardized rating scales completed by parent
    and teacher (symptoms, impairment)
  • Clinic visit for family
  • Clinical Interview
  • KSADS Diagnostic Interview
  • WASI and WIAT II screener
  • Child self-report MASC, CDI
  • Parent-completed PSI, APQ

Child Life Skills Program
  • Study design
  • 28 children (age 7-11) randomly assigned to
  • Life Skills Training program, or
  • Assessment only group (Treatment as usual)
  • DSM-IV Diagnoses
  • ADHD-I only 61
  • Comorbid ODD 32
  • Comorbid anxiety disorder 21
  • Comorbid depressive disorder 4
  • Parent and teacher ratings gathered at
    pre-treatment, post-treatment and follow-up

Participant Characteristics

Standard deviation (SD) in parentheses.
Child Life Skills Program
  • Treatment Components
  • Child
  • Weekly Child Group meetings (90 min.) for eight
    weeks, concurrent with Parent Group meetings.
  • Four family meetings with study therapists
  • Parent
  • Weekly Parent Group meetings (90 min.) for eight
    weeks, concurrent with Child Group meetings
  • Four family meetings with study therapists
  • Teacher
  • Five consultations with study therapists,
    families attend part of meetings

Child Component Skills Taught
  • Independence Modules
  • Homework/study skills
  • Self-care skills
  • Getting chores done
  • Routines, organization and time tools
  • Public Situations
  • Social Skills Modules
  • Friendship-making
  • Handling teasing
  • Assertion
  • Accepting
  • Being a good sport
  • Problem-solving

Structure of each Child Group
  • Review homework, previous skills taught, stars
    earned at home and school
  • Present skill of the week
  • Skill game
  • Role Plays
  • Independence Stations and/or free play to
    practice new skills
  • Reinforcement
  • Review and meet with parents

Parent Component Skills Taught
  • Positive communication (attending, praising,
    quality time)
  • Use of more powerful reinforcement programs to
    support daily living skills (e.g., star systems,
    home challenge)
  • Use of effective instructions and commands
  • Prudent discipline (planned ignoring, response

Parent Component (cont.)
  • Using routines and plans to promote success
  • Morning and evening routines
  • Homework
  • Playdate plan
  • Chores
  • Child skill of the week also reviewed with
    parents to promote generalization
  • Social skills
  • Independence Modules

Outline of session content
  • Week 1
  • Child Group Session 1
  • Friendship-making Skills
  • Good Sportsmanship
  • Parent Group Session 1
  • Overview of ADHD, Child Life Skills Program
  • Behavioral Model of Child Behavior
  • Attending and Quality Time
  • Positive Attention and Verbal Praise
  • Teacher Component (Orientation)
  • Overview of Child Life Skills Program, behavioral
    intervention, classroom accommodations
  • Classroom Challenge overview

  • Week 2
  • Child Group Session 2
  • Whats my job? Intro to routines
  • Morning routine planning
  • Accepting
  • Parent Group Session 2
  • Rewarding behavior with praise, activities and
  • Token Economy
  • Effective use of Positive Reinforcement (novelty,
    consistency, specificity)
  • Effective Communication with school and teacher
    (Classroom challenge)

  • Week 3
  • Individual Family Session 1
  • Review of home programs
  • Individualized feedback and assistance
  • Review classroom challenge
  • Parent/Teacher/Child Meeting 1
  • Discuss and develop classroom challenge
  • Review homework routine, modify as needed

  • Week 4
  • Child Group Session 3
  • Homework and study skills
  • Remembering important things
  • Parent Group Session 3
  • Strategies for Handling Homework Problems
  • Review Teacher Homework Expectations
  • Discuss a Script for Parent-Teacher Meetings
  • Plan Homework Program

  • Week 5
  • Child Group Session 4
  • Homework and study skills practice
  • Assertive Behavior
  • Parent Group Session 4
  • Effective vs. Ineffective Commands
  • How to Structure Antecedents to Improve Peer
  • Practice Homework Routine

  • Week 6
  • Individual Family Session 2
  • Review and Troubleshoot Home Programs
  • Individualized Feedback and Assistance
  • Practice Using Script for Parent-Teacher Meetings
  • Review classroom challenge
  • Parent/Teacher/Child Meeting 2
  • Review classroom challenge, modify as needed
  • Review homework routine, modify as needed
  • Review accommodations

  • Week 7
  • Child Group Session 5
  • Dealing with Teasing
  • Lets Make a Plan!
  • Parent Group Session 5
  • Reducing Problem Behavior by Planned Ignoring
  • Effective Strategies for Changing Antecedents
  • Applying Antecedents to Evening Routine or Other
  • Parent/Teacher/Child Meeting 3
  • Review classroom challenge, modify as needed
  • Review homework routine, modify as needed
  • Review accommodations, modify as needed

  • Week 8
  • Individual Family Session 3
  • Troubleshoot and Individualize Other Home
  • Review Parent-Teacher Meetings
  • Review classroom challenge
  • AND
  • Child Group Session 6
  • Study Skills and Homework Practice
  • Problem Solving and Organization
  • Parent Group Session 6
  • Response Cost (and Fines)
  • Using Punishment Effectively
  • Approaches to Problem Solving and Organization
    with my Child

  • Week 9
  • Child Group Session 7
  • Time Management Tools
  • Do it Now! Overcoming Procrastination
  • Parent Group Session 7
  • Improving My Childs Organization and Time
    Management Skills
  • Planning Activities in Advance
  • Promoting Independence in Public Places
  • Parent/Teacher/Child Meeting 4
  • Review classroom challenge, modify as needed
  • Review homework routine, modify as needed
  • Review accommodations, modify as needed
  • Individual Family Session 4 (if needed)

Week 10
  • Child Group Session 8
  • Review all skills taught
  • Select personal challenge
  • Parent Group Session 8
  • Review all skills taught
  • Discuss strategies for maintaining gains working
    with new teachers
  • Being prepared for future problems
  • Plus monthly family meetings until follow-up

Sample Home Challenge
Name Date
Sample home target behaviors
  • Complete morning routine (e.g., get up w/o
    complaining, get dressed-all items, put backpack
    by front door)
  • Complete H/W assignment independently (e.g.,
    start with one page, increase with success
    strategies for going on when stuck)
  • Complete chores
  • Complete evening routine independently (e.g.,
    bathe, dressed, clothes in hamper, brush teeth in
    x mins).

Name DateHome Challenge
Teacher Component
  • Orientation meeting with teacher and therapist
  • Overview of ADHD-I and the Child Life Skills
  • Overview of behavioral interventions and
    classroom-based accommodations for ADHD-I
  • Overview of Daily Report Card (Classroom
  • Four meetings between teacher, therapist and
    family focus on
  • Homework Plan
  • Classroom Challenge
  • Classroom-based accommodations

Homework Expectations
  • When, what and how is homework assigned?
  • Should parent help child with homework or correct
  • How important is neatness?
  • How long should it take?
  • Is homework meant for practicing skills or is
    there some other purpose?

Homework plan
  • Own desk
  • Organize space with paper sorter, etc.
  • Lighting
  • Prioritize, break down h/w
  • H/W sheet checked each day
  • Built in breaks
  • Closely supervised H/W, incidental teaching, not
    just giving answers

Sample Classroom Challenge
Name Date
Steps to set up Classroom Challenge
  • Select target behaviors
  • List target behaviors on the CC Card
  • Discuss logistics during school day
  • Discuss logistics when at home

Sample target behaviors
  • Academics/ Study habits
  • completes assigned work accurately
  • has materials necessary for task
  • completes and returns homework
  • keeps desk area organized/neat
  • starts work with X or fewer reminders
  • Peers
  • plays with other children
  • shows good sportsmanship
  • Rules/behavior
  • accepts consequences
  • follows rules/directions

Steps (cont.)
  • Identify reinforcers for the child to earn at
  • Discuss baseline ratings Match Game
  • Review plan do a walk-through of procedure
    with child
  • Schedule Follow-up meeting for 1-2 weeks after CC

Communication styles for working with attention
  • Giving directions
  • Praise
  • Corrective feedback

Give clear directions
Effective and Ineffective Praise You should
always keep your desk that clean!! Your desk is
spotless!! Finally you remembered your
homework. I like the way you remembered your
homework today. I hope you can put your things
away like this all the time. Its so helpful when
you have your things away on time. You ignored
Sallys teasing right now. I just hope you dont
get back at her when I leave. You made a super
effort at ignoring Sallys teasing. Why cant
your desk look like this all of the time? Your
desk looks very organized.
Prudent and Imprudent Feedback
Classroom Accommodations for Attentional Problems
  • For problems following instructions and
  • Keep instructions brief (one or two parts),
    specific, and step-by-step.
  • For problems completing assignments and tasks
  • Reduce length of assignment (break into smaller
  • Allot extra time for work completion.
  • Give assignments one at a time, rather than all
    at once.
  • Set time limits or challenges for completion of
  • Include some method of checking work.

Classroom Accommodations (cont.)
  • For problems with organization, planning, or
    beginning assignments or tasks
  • Encourage child to make to do lists and use
    organizer notebooks or folders. Monitor these
  • Teach child to organize assignments by
    completion notes according to chronological
    order, etc.
  • Teach outlining and note-taking skills (e.g., by
    providing outlines for child to complete).
  • Praise child for getting started on a task.

Classroom Accommodations (cont.)
  • For problems staying focused and on task
  • Seat child away from doors, windows, areas of
    frequent activity or noise, and disruptive
  • Place child near teachers desk to help teacher
    monitor more closely whether child is paying
    attention to oral instructions and completing
  • Provide quiet zone (e.g., desk with study
    carrel located in a corner) in which child can
    sit while taking tests, or at times when
    distracted or having trouble concentrating.

Classroom Accommodations (cont.)
  • Cue child when it is important to pay attention
    by putting important information on chalkboard or
    introducing it with verbal prompts (for example,
    This is important).
  • Cue child in advance about times or tasks where
    independence is needed, and encourage
    non-disruptive activities while waiting (for
    example, reading, journal writing, doodling, note
  • Instruct child to move on to another task when
    work finished early or to continue on easier
    parts of an assignment or task while waiting for

Classroom Accommodations (cont.)
  • For problems working independently
  • Reward child for finishing small portions of an
    assignment on his/her own gradually increase the
    requirement as s/he is successful.
  • Set time limits or challenges for completion of

Kayla Home program
  • H/W moved work station into bedroom too noisy
    in kitchen area due to remodeling. Made sure
    desk area stocked and clean/organized
  • To remember assignments and bring back, CC and
    prompting most helpful
  • AM routine added checklists and daily rewards
    get up earlier- reward with shower in am.
  • Commandsdistant commands decreased

  • Playdates
  • during playdates would withdraw into own activity
    and engage in parallel play. Parent monitored
    more often and found alternatives for interactive
  • Selected specific girls for playdates
  • Planned activities in advance

Kayla School program
  • Listening target implies social behavior of
    less chatting, more eye contact. Teacher took
    the time to define and troubleshoot. Used
  • H/W target implies remembering to get it home.
    Needed reminders/cues. Tried
  • Visual sticker in cubby
  • Hawaiian dress key chain on backpack
    (laminated)jingly noise helped the most
  • Self-monitoring whats the first thing I need
    to do when I get to the classroom
  • Teacher posted homework sign for all

Dennis, 9 years, 3rd grade
  • Getting started target due to spacing out,
    forgetting instructions. Teacher agrees to
    accommodate cross checking that he understood
  • Organization target mastered in 2 weeks
  • Completing work half of problems assigned to
    the rest of classskill development still
    accomplished with half the problems.
  • Child identified problems to work on, he helped
    set the goal which increased motivation

Tips for making a DRC work
  • Define target behaviors very specifically
  • Organized desk give examples of criteria
  • Vague targets (paying attention) hard to track
  • Include easy target behavior
  • Change target behaviors or requirements if not
    working take flexible approach

Tips (cont.)
  • Be encouraging and positive use praise
  • Integrate self-monitoring, Match Game
  • Make homework expectations clear
  • Maintain close communication between home and

Troubleshooting a program
  • Are target behaviors clear to the child (and
    teacher) and appropriate?
  • Does child understand the program?
  • Does child remember the target behaviors during
    the day?
  • Are the criteria realistic?
  • Is the child getting sufficient feedback during
    day about his/her progress?
  • Is child interested in the rewards? Are more
    immediate rewards at school needed?

Progress during Teacher/Family meetings, Sample
  • Meeting 1
  • Pxs distractibility and not completing work
  • When distracted go to secret spot
  • Complete all in-class assignment during class
  • Meeting 2
  • Modify in-class assignments to writing only
  • Decrease doodling on h/w (parent reluctant to set
    higher expectations)
  • Meeting 3
  • Good progress, mostly 2s on CC
  • Secret spot not used, add ignoring to CC
  • Add completion of h/w problem in homework clinic

  • Meeting 4
  • Mostly 2s on CC for writing assignments
  • Ignoring a px, modify to before lunch, using sign
    (could use response cost)
  • Not doing h/w problem in h/w clinic teacher had
    not communicated with homework clinic staff

Progress during family meetingsSample case
  • Meeting 1
  • Px with am routine, hard to get out of bed
  • Dad doing h/w for her pessimistic
  • Set up HC targeting h/w and am program, use
    stickers for daily reward and weekly video
  • Meeting 2
  • Not much improvement in h/w
  • Modify after school routine dad picks up 30 min
    early, small snack, start h/w earlier, make sure
    rewards given (parent did not believe in

  • Meeting 3
  • Program is working Dad goes through h/w
    instructions, but she does it without Dads help.
  • Earning daily and weekly rewards
  • Dad says still distractible. Get a desk and put
    in her room.
  • Meeting 4
  • Desk has greatly helped decrease distractions
  • Routine and rewards working, earning free time
  • Using incidental teaching (not giving the
  • For am, using alarm clock and stars
  • Parents did not think much could change, but
    small modification made a big difference. She is
    happy on playground, increased confidence, doing
    better with social entry, less snippy with peers,
    and has playdates for first time.

Mean scores for Child Life Skills and Assessment
Only groups at baseline and post-treatment,
Parent Report
Mean scores for Child Life Skills and
Assessment-Only groups at baseline and
post-treatment, Parent Report
Mean scores for Child Life Skills and Assessment
Only groups at baseline and post-treatment,
Teacher Report
Parent Consumer Satisfaction Ratings
  • Attention Difficulties 90 improved or much
  • Change in Target Behaviors
  • 88 improved or much improved
  • Morning routine
  • Social Skills
  • Homework
  • Classroom
  • Home and School Challenge 100 helpful or very
  • Usefulness of Skills Taught 95 useful or
    extremely useful
  • Satisfaction With Treatment 100 satisfied or
    very satisfied

Teacher Consumer Satisfaction Ratings
  • Classroom Challenge 100 helpful or
    very helpful
  • Effort required to participate 88 not too much
  • Continued use of Classroom Challenge
  • 80 likely or very likely
  • Recommendation of the program to other parents
    and teachers
  • 93 recommend or strongly recommend
  • Use of program to treat attentional/academic/socia
    l skills problems
    100 appropriate or very appropriate

Child Consumer Satisfaction Ratings
  • (Ratings on 5- point scale not at all, a little,
    somewhat, pretty much, a lot)
  • How much did you like the group? 90 pretty much
    or a lot
  • How much did you learn in group? 90 pretty much
    or a lot
  • How much did the Home Challenge help you do
    better at home?
  • 85 pretty much or a lot
  • How much did the School Challenge help you do
    better at school?
  • 80 pretty much or a lot
  • How much would you like to continue in the group?
  • 80 pretty much or a lot
  • Note for all questions, one child rated

Common Issues
  • Family fails to do homework
  • Does not understand
  • Too angry
  • Disagrees with need
  • Too much effort
  • No time (and didnt get needed supplies)
  • Forgot
  • Kitchen-sinking, hard to stay on topic
  • Child tests the system
  • Siblings
  • Teacher/school not supportive or parents and
    teacher fail to communicate

Common Issues (cont.)
  • Resistance to using rewards re-name, hear about
    success from other parents, use small, practical
  • Managing parent affect and emotion increase
    awareness, coping strategies
  • Anxiety and perfectionism in implementing
    program lower the threshold for success, step
    back, be more supportive and catch them being

What was most helpful?
  • Using consequences rather than repeating
    directions over and over.
  • Attending and praising
  • Setting time limits, using a timer
  • Ignoring outbursts
  • Using varying levels of rewards cuddle time,
    computer time, having friend over, dessert
    choice, movie, lunch date with mom, bike to park
  • Using job jar for infractions (home tasks)
  • Applying the program consistently

  • Giving immediate commands (e.g., do xyz, rather
    than when this is over can you do this?)
  • Playdates
  • Plans importantactivity, length, practice
    setting up, use telephone, coaching before child
    came, rewarding afterwards
  • Using a chart
  • Having a defined program allowed for more
    couples time without constant discussion of

What did parents like about the program?
  • Groups
  • Children in own peer group made it fun
  • Relating to other parents
  • Feeling supported, individualized advice,
    sharing info
  • Group size great
  • Therapists addressed concerns well, responsive
    to feedback
  • Educating parents (informative), increased
    awareness of parenting
  • Program
  • Separate family and teacher components, holistic
  • Positive reinforcement and praise for target
    behs, home and classroom challenges
  • Rewards program for children
  • Organized (structured), common sense approach
    that values the child
  • Parenting Help
  • Parenting tips, ABC, social skills for children
  • Immediate change in childs beh
  • Learning that children need limits

What did teachers like about the program?
  • Effort
  • Quick and efficient, meetings were short and
  • Easy target behaviors to work on
  • Minimal effort
  • Teacher-Child Relationship
  • Daily feedback, classroom challenge helped
    student and teacher focus on behaviors
  • One-on-one work
  • Hands-on nature
  • Seeing child pleased with ratings
  • Made teacher pay close attention to child
  • Gets student involved in own decision-making
  • School/Family Relations
  • Educating, involving both teachers and parents

Barriers to treatment
  • Parent psychopathology
  • Low SES (transportation, childcare px, no job/
    neighborhood factors)
  • No coverage for mental health services
  • Marital conflict (and inconsistent parenting)
  • School not willing or able to participate
  • Insular family, lack of social support
  • Language and/or learning px in parent

Methods for tailoring behavioral intervention
  • Parenting skills Group vs. family format
  • Child skills Group vs. individual, need to
    teach basics to parents/teachers
  • School List accommodations, request 504 or IEP
    (if comorbidities present) to formalize. Daily
    report card almost always helpful during
    school-age years.

Reference for Child Life Skills Program
  • Pfiffner, L.J. (2003). Psychosocial treatment
    for ADHD-Inattentive Type. The ADHD Report, 11,
Write a Comment
User Comments (0)