An ADHD Primer: Treatment for Educators

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An ADHD PrimerTreatment for Educators

• Jill Zaruba, OT
• Columbus Community Hospital
• Tawnya Meadows, Ph.D.
• Munroe-Meyer Institute, UNMC

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Not recommended!
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What we know works

• Drug Therapy
• Behavior Therapy
• Combined Behavioral/Drug Treatments
• APA Task Force on Evidence-Based Treatments,
  JCCAP, Pelham, Wheeler, Chronis, 1998
• American Academic of Pediatrics

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AAP Guidelines

• 1. Establish a management program that
  recognizes ADHD as a chronic condition (strength
  of evidence good strength of recommendation
  strong).

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AAP Guidelines

• 2. Clinician, parents, and child, in
  collaboration with school should specify
  appropriate target outcomes to guide management
  (strength of evidence good strength of
  recommendation strong).

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AAP Guidelines

• 3. Recommend stimulant medication and/or
  behavior therapy as appropriate (strength of
  evidence strong).

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AAP Guidelines

• 4. When management has not met target,
  clinicians should evaluate the original
  diagnosis, treatments, adherence and coexisting
  conditions (evidence weak recommendation
  strong).

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AAP Guidelines

• 5. Periodically provide systematic follow-up to
  monitor targets and adverse effects by gaining
  information from child, parents, and teachers
  (evidence fair recommendation strong).

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What we know DOESNT work

• Play therapy
• Individual or family counseling (without altering
  the environment)
• Social skills/self-monitoring/organizational
  planning
• Dietary management
• Megavitamin therapy
• Sensory integration therapy/chiropractics
• EEG Biofeedback

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• Optometric vision training
• Anti-motion-sickness medication
• Treatment for candida yeast infection
• Applied kinesiology (realigning bones in the
  skull)

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What we know works

• CNS Stimulant Medications
• 250 studies (N gt 5000)
• Behavior Therapy
• 48 classroom studies (N gt 900)
• 80 parent/home studies (N gt 5,000)
• Combined Behavioral/Drug Treatments
• 25 studies (N gt 800)

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Behavior Therapy for ADHD

• Components
• Highly structured

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Behavior Therapy for ADHD

• Components
• Highly structured
• Immediate feedback
• reinforcer or reward for appropriate behavior
• consequence for inappropriate behavior

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Behavior Therapy for ADHD

• Components
• Highly structured
• Immediate feedback
• reinforcer or reward for appropriate behavior
• consequence for inappropriate behavior
• Salient/meaningful feedback

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Behavior Therapy for ADHD

• Components
• Highly structured
• Immediate feedback
• reinforcer or reward for appropriate behavior
• consequence for inappropriate behavior
• Salient/meaningful feedback
• Programming at home and school

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School Behavior Intervention

• Examples
• 1. The Attention Training System (ATS)
• Home School Note
• Self-monitoring
• Accommodations

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School Behavior InterventionThe Attention
Training System (ATS)

• 1. Technology
• Teacher Module
• Student Module

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School Behavior InterventionThe Attention
Training System (ATS)

• 1. Technology
• Teacher Module
• Student Module
• 2. Immediate feedback

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School Behavior InterventionThe Attention
Training System (ATS)

• 1. Technology
• Teacher Module
• Student Module
• 2. Immediate feedback
• 3. Meaningful consequences

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School Behavior InterventionThe Attention
Training System (ATS)

• 1. Technology
• Teacher Module
• Student Module
• 2. Immediate feedback
• 3. Meaningful consequences
• 4. Structured time

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School Behavior InterventionThe ATS Lisa
No ATS
ATS
No ATS
ATS
Time Off Task
Days
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School Behavior InterventionThe ATS Troy
No ATS
No ATS
No ATS
ATS
ATS
Meds Only
Time Off Task
Days
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School Behavior InterventionHome School Notes

• Address Problems With
• Academic effort
• In-class behaviors
• Assignment completion

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School Behavior InterventionHome School Notes

• Procedures
• Identify target behaviors

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School Behavior InterventionHome School Notes

• Academic Behaviors
• Working on assignments
• Completing homework
• Handing in assignments
• All work up to date
• On time for class

• Social Behaviors
• Out of seat
• Talking without permission
• Disrespectful behavior
• Bothering peers
• Following instructions
• Hands to self

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School Behavior InterventionHome School Notes

• Procedures
• Identify target behaviors
• Design school note form

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School Behavior InterventionHome School Notes
GOAL 8 of 12 YES Desk neat and organized Homework written neatly, accurately in book by class bell Class assignment neat and 80 accurate or better Math L. Arts History Science
GOAL 8 of 12 YES Desk neat and organized Homework written neatly, accurately in book by class bell Class assignment neat and 80 accurate or better Yes No Yes No Yes No Yes No
GOAL 8 of 12 YES Desk neat and organized Homework written neatly, accurately in book by class bell Class assignment neat and 80 accurate or better Yes No Yes No Yes No Yes No
GOAL 8 of 12 YES Desk neat and organized Homework written neatly, accurately in book by class bell Class assignment neat and 80 accurate or better Yes No Yes No Yes No Yes No
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School Behavior InterventionHome School Notes

• Procedures
• Identify target behaviors
• Design school note form
• Identify reinforcers and consequences

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School Behavior InterventionHome School Notes

• Reinforcer Examples
• Wear an outfit of your choice to school
• Get out of a chore
• TV/video games/telephone/computer time
• Allowance
• Token toward weekend activity

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School Behavior InterventionHome School Notes

• Procedures
• Identify target behaviors
• Design school note form
• Identify reinforcers and consequences
• Establish criterion for reinforcement

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School Behavior InterventionHome School Notes

• Procedures
• Identify target behaviors
• Design school note form
• Identify reinforcers and consequences
• Establish criterion for reinforcement
• Increase criterion as progress is made

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School Behavior InterventionHome School Notes

• Procedures
• Identify target behaviors
• Design school note form
• Identify reinforcers and consequences
• Establish criterion for reinforcement
• Increase criterion as progress is made
• Plan for generalization and maintenance

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School Behavior InterventionHome School Notes

• What makes it effective
• Frequent, immediate feedback (school).
• Highly structured (short time).
• Salient consequences (home).

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Self-Monitoring

• Gives motivated student sense of responsibility
• Less work for teacher
• Provides parent/physician with information

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• Date
• Cross off each picture each time you talk without
  raising your hand or having permission. Teacher
  will cross off two pictures if you dont.

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Teenagers with ADHD

• 80 still need medication (NIMH)
• Use a planner
• Keep a routine
• Study skills
• Sleep, Sleep, Sleep

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Accommodations

• Seat placement (front is not always best)
• Small group activities
• Encourage students to pause before answering
  questions
• Keep assignments short or break them into
  sections
• Close supervision with frequent, positive,
  (subtle) cues to stay on task