ADHD Co-existing Problems Interventions

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ADHD Co-existing Problems Interventions

• Presented by
• Dianne Zaccheo MSW FTC
• Medical Family Therapy Consultant
• The Coaching Centre, London England

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This Presentation Will

• Explain
• ADHD Characteristics
• Comorbidity Related Problems
• Children with ADHD Experiences
• Academic underachievement failure
• What is Best Treatment
• The Zaccheo Coach model
• A Call for Increased Recognition

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What is ADHD?

• A Neurobiological Disorder
• Brain Regions and Genetic Factors
• Twin Studies highly genetic in twins
• Cardinal Symptoms
• Inability to Sustain Attention
• Distractibility
• Hyperactivity
• Three Sub-Types
• DSM-IV vs. ICD-10

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Historical Overview

• Dr George F Still, British Paediatrician,
  Original Quotes Lancet, 1902
• A persistence in a degree unusual
• not corresponding to environment
• Abnormal incapacity for sustained attention,
  parents teachers notice these children are
• a danger to self others
• Below average degree of moral control
• Call for active recognition

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Research Findings
Research confirms Studies show the rate of brain
utilising glucose is lower in ADHD Significant
evidence of brain regions Prefrontal cortex
which regulates attention, distraction leading
towards self regulation B. Developmental delays
up to 3 years, Dr Shaw Chicago Exercise and its
enormous benefits Newer medications to fine tune
effects non stimulant types The uses of Coaching
approaches Boy to girl ratio increasing 4 to 1
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DSM-IV ADHD Subtypes

• Innattentive Type
• Hyperactive Impulsive Type
• Combined Type
• ADD highlighted by daydreaming forgetful
• under activity difficulty sustained effort
• ADHD highlighted by over-activity racing
• Impulsivity, excessive behaviours fidgety
• Combined Type both inattentive hyperactive
  impulsive usually adolescents

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Children, Adolescents Adultswith ADHD Have
Problems

• Hyperactivity, Inattention, Impulsiveness
• Trouble sustaining mental efforts
• Poor working memory forgetfulness
• Internal motivation goal directed self-talk
• Organisation losing things
• Making prioritising decisions
• Readiness towards responsibility
• Remaining on task
• Communication and articulation skills
• Social interaction skills

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Comorbidity Co-Existing Related Disorders

• Self development, Behaviour, Education, Social,
  Family Community
• Low Self Esteem Low Self Worth
• Faulty distorted self perception
• Oppositional Defiant Disorder/Conduct Disorder
• Tourettes, Autistic Spectrum Aspergers
• Language Communication disorders
• Development Delay
• Social and relationship problems
• Academic under performance and achievement
• Depression, Anxiety, OCD, Substance Abuse,
• Self Harming, Eating Disorders, Suicidal
• Criminality, Gambling

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Adolescents with ADHD at Risk
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AN IMPARED SENSE OF TIME

• Has no 'sense of time'
• Does not get ready on time
• Does not plan for future
• Does not estimate time correctly
• Crises may be frequent
• This affects
• Planning
• Prioritizing
• Scheduling
• Following a Plan

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We Know what ADHD is
We just dont agree about what to do about it
Hey Stupid
Treatments?
Vitamins
Psychotherapy
God Help us!
Ritalin????
Pray
Punishments?
Parent-Child Strategies
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Statistics

• Long term studies over 30 Years
• 70 -80 of Children with ADHD developed Conduct
  Disorder Oppositional Defiant Disorders
• Links between aggression in Boys to skill
  deficits especially Executive Functions poor
  planning,
• abstract reasoning, problem solving, attention
  span,
• concentration, inability to delay gratification,
• controlling short term behaviour to achieve long
  term goals

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Statistics

• 30 -50 of Adolescents with ADHD will exhibit
  pervasive conduct problems into adulthood
• 35- 55 Adolescents with ADHD show significantly
  higher arrest rates
• Conduct Disorder increases risk of criminality
  55
• 35 of Children with ADHD leave school with no
  qualifications

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Statistics taken from Prison

• Untreated ADHD and Co-existing Problem?
• Prisoners Personality disorders reading
  disorders cause problems of great magnitude
• 56 found positive for ADHD scores
• 48 exhibit neurological impairment
• 62. Positive for Dyslexia
• ADHD Conduct Disorder highly associated with
  Driving Offences

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What Evaluations can be done

• Medical Diagnosis Testing
• Medication for Symptom Relief
• Psychological Mental health for Comorbidity
• Intellectual Assessment
• Academic assessment, interventions support IEP
• Speech and Language Assessment
• Learning Disorders Assessment
• Neurological Assessment
• 12 to 37 may have Chromosome abnormalities,
  thyroid
• Neurofibromatosis, other neurological disorders

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What works Best? Treatments Interventions

• Gain as much information as possible
• Learn about individual uniqueness
• Be Consistent, patient flexible
• Structure environments at home school
• Teach appropriate behaviour
• Prompt and Reward appropriate behaviour
• Academic support

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Interventions and Treatments

• Interventions for Home Environment
• Skill Building for Developmental Delays
• Self Esteem building
• Coaching (versus Traditional Therapy)
• Exercise, Relaxation Techniques
• Social Skills Training
• Art Music Therapy, Support Groups
• Equine animal therapy Neurofeedback

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Forms of Therapeutic Help

• Direct planning instructions
• Role modelling situations
• Role play
• Positive reinforcement
• Therapist and Coach giving feedback
• Peer feedback
• Peer interaction
• Conversational, social, emotional skills training
• Frequent Coaching and maintenance

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Family Management

• Parents learning about ADHD
• Child management strategies
• Parental ADHD Under Control
• Juggling ADHD Sibling Issues
• Parent Teacher Child Relations
• Parent Advocacy Programmes
• ADHD Support Groups
• Consensus Continuing Education

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Designing Interventions

• Knowledge
• Trust Respect
• Clear Rules Routines
• Structure Boundaries
• Fair but Firm
• ADHD is an explanation not an excuse
• Accept Differences Uniqueness
• Learn About Medication
• Protection From Risk factors Potential Threats
• Consistency, Reliability, Responsibility
• Reframing ADHD builds hopes bridges

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Multi-Disciplinary Team Approach

• Reaching Consensus in Service delivery
• Education for professionals
• Advocacy for children families
• Appropriate Courses and Skill Building
• Community Outreach
• Local Support Groups
• Self education for sufferers

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Is it ADHD, ASD, Aspergers, HFA, Depression, ODD,
CD, OCD, PDD, LD, MR, RAD, Gifted, ???

• Statistics 70 will have 2nd or 3rd disorder
• Assessments must be multi-disciplinary
• Intellectual, psychological, language, social,
  behavioural, overshadowing symptoms
• There are more than 10 possible co-existing
  conditions to test for

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How to make comparisons

• Make complete lists of all behaviours
• Check off the similarities to other disorders
• Understand stages of childhood development
• Seek out Specialists Doctors, Psychologists, etc.
• http//www.childdevelopmentinfo.com/development/er
  ickson.shtmlt
• http//www.childdevelopmentinfo.com/disorders/depr
  ession_in_children_and_teens.htm
• http//www.childdevelopmentinfo.com/disorders/anxi
  ety_disorders_in_children.htm
• http//childdevelopmentinfo.com/disorders/tourette
  _syndrome.shtml
• http//childdevelopmentinfo.com/disorders/child_OC
  D.htm

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Compared to ADHDProblems in Communication
Here follows a list for Aspergers
Syndrome Monopolises discussion Of topic with
own agenda Unable to read non-verbal cues Monotone
Advanced vocabulary Limited facial gestures And
facial expressions Trouble joining in with
conversations Bland emotional expressions Limited
range of topics
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AS Problems with Play Social Friendship

• Little
• Imaginative play
• Poor cooperative play
• Dominates play
• Insists other play same
• Way as them
• Trouble with play group
• Invades personal space
• Plays along side not w-peers
• Uses playmates as objects
• Difficulty sharing things
• Poor sportsmanship
• Wants complete control
• over whatever is happening

• Poor eye contact
• Little interest in others
• Lacks empathy
• Egocentric bubble
• May prefer to be alone
• Fails to compliment peers, friends, others
• Cannot function in groups
• Lacks social sense
• Unable to read social cues/ feedback
• Better w-younger peers
• Better with adults
• Emotionally detached
• Lacks reciprocity in relationships

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AS Social Skill Deficits

• Repetitive organising of toys Does
  not repair conflicts
• May prefer to play alone Does
  not accept views others
• Limited pretend or thematic play Cannot
  tolerate criticism
• Lacks flexibility in play
  Does not initiate contact
• Ritualistic forms of play
  Does not express joy easily
• Rigidity in rules /everything
  Limited shared enjoyment
• Limited play interests
• Accepting suggestions 4 play Accepting
  others mistakes
• Apologising
• Voice volume may be loud Accepting
  losing at games

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Tips to help you calm upset

• Remain calm regardless of how out of control
• Prompt to use cool down methods- breathing
• Intervene before the upset know the patterns
• Attempt to redirect with pleasurable tasks
• Praise attempts at cooling down/successfully
• Find persons he/she can talk to when upset
• Provide safe calm spaces to go when upset
• Stay out of power struggles Be a soothing
  presence
• Reduce your language lower the tone of your voice
• Find the root of the problem No demands except
  for safety
• Dont try to talk during full blown upset
• Use a problem wheel to look at what patterns exist

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123 Problem Wheel shows what the pattern is
Every pattern has a trigger
When same repeats Same happens
Honeymoon time
There is a point of no return
There is manipulation
There is a pay-off
There are habits that drive Behaviours wanted or
other
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A Call For Urgent Recognition

• Uniformity among all professionals
• Awareness Education re ADHD
• Early Recognition of children in Schools
• Parents Training Programmes
• Awareness in the community
• Police, Dept SS all Service Delivery
• Appropriate Provisions in Health Care
• Mental Health Care Doctors
• Police, Prisons,