John Laing APSY 658

Overview
Overview of ADHD description, core characteristics, prevalence and course Theories and Causes Executive functioning deficits and ADHD Assessment of ADHD
Intervention Summary

Overview of ADHD
2 distinct behavioural dimensions Inattention Hyperactive-Impulsive Behavior Subtypes of ADHD Predominantly inattentive type (ADHD-PI) Predominantly hyperactive-impulsive type (ADHD-HI) Combined type (ADHD-C)

Overview of ADHD
Prevalence 3% to 5% of all school-age children in North America (about 1 student in every class) one of most common referral problems in North America more frequent in boys than girls

boys 6% - 9% girls 2% - 4%

Overview of ADHD
Prevalence Culture and Ethnicity

all social classes, although slightly higher in low SES groups Identified in countries around the world

Overview of ADHD
Course and Outcome symptoms change with development

infancy?? Preschool

appearance of hyperactive-impulsive symptoms

appearance of inattention

Elementary school

Adolescence

continues at rate of 50%

work difficulties, impaired social relations

Adulthood

Overview of ADHD
Course and Outcome Impaired academic functioning Social problems

Theories and Causes

Genetic Influences
Pregnancy, Birth, and Early Development Neurobiological Factors Family Influences

Theories and Causes

Executive Functioning Deficits Barkleys model

Reduced behavioural inhibition as core deficit of ADHD Impaired inhibitory mechanisms interfere with operation of 4 critical executive functions Working memory; self-regulation of affect-regulation-arousal; internalization of speech; and reconstitution (behavioural analysis and synthesis) Deficits at executive level leads to problems of inattention, socially inappropriate behaviour, disorganized behaviour, and other observable ADHD symptoms and become the target of intervention

Barkleys Theory of ADHD

Executive Functioning Deficit
Behavioral disinhibition

Poor Working Memory

Immature Self-Regulation Of Affect/ Motivation/Arousal

Delayed Internalization Of Speech

Impaired Reconstitution

Reduced Motor Control/ Fluency/Syntax

Theories and Causes

Executive System Impairment 3 developmental courses

Children experience delayed maturation of executive functions and will outgrow ADHD Learn to compensate for ADHD Fail to compensate and experience ongoing difficulties into adulthood

Overview of Assessment Methods

Behavioural assessment Multiple methods of data collection across informants and settings Stages of assessment

Screening teacher rating of ADHD symptoms Multimethod assessment of ADHD parent/teacher interviews; review school records; behaviour rating scales; observations; academic performance Interpretation of results ADHD symptoms; deviance from norms; age of onset and chronicity; pervasiveness across settings; degree of functional impairment; rule out other disorders Develop treatment plan based on severity; functional analysis of behaviour; presence of associated disorders; response to prior treatment; community-based resources Assessment of treatment plan periodic collection of assessment data; revision of treatment plan as needed

Intervention
Conceptual Underpinnings Proactive and reactive strategies Intervene at the point of performance Individualized Collaboration

Intervention
Classroom-Based Interventions Contingency management procedures

Token reinforcement programs Contingency contracting Response cost Time-outs Home-Based contingencies

Intervention
Self-Management Strategies Self-monitoring Self-reinforcement

Intervention
Effective Instructional Strategies Teach classroom rules and expectations Instruction and remediation in basic skill areas

reading skill Study and organizational skills

Peer tutoring Task and Instructional modifications Strategy training

Intervention
Home-Based Intervention
Parent training Family therapy Homework interventions Parent support groups

Medication Therapy

Intervention
Important considerations
Modify the environment for those with EF deficits Immediate response to behaviour Intervene at the point of performance

Chunk tasks and scaffold information

Allow some restlessness at work area or desk as long as child is

working Give frequent physical exercise breaks throughout the school day Give smaller quotas of work at a time with frequent breaks Seat the child with ADHD close to teaching area to permit more supervision and frequent accountability for conduct and performance

Conclusion
Those with ADHD have underlying executive

functioning deficits which are the target of intervention Understanding specific executive functioning deficits is important to designing individual treatment plans Combination of several treatment modalities is most effective including collaboration Early and prolonged intervention is key to help avoid academic and social difficulties at school and later in life

References
Barkley, R. (2010). 80+ classroom accommodations for children or teens with ADHD. The ADHD Report, 16(4), 7-10. Barkley, R. (2003). Attention-deficit/hyperactivity disorder. In E. Mash, & R. Barkley (Eds.), Child psychopathology (2nd ed., pp. 75-143). New York: The Guilford Press. Dupaul, G., & Stoner, G. (2003). ADHD in the schools: Assessment and intervention strategies. New York: The Guilford Press. DuPaul, G.J., Stoner, G., & OReilly, M.J. (2002). Best practices in classroom interventions for attention problems. In Thomas, A. & Grimes, J. (Eds.), Best practices in school psychology (pp. 1115-1127). Bethesda, MD: NASP Publications. Lynch, S., Sood, R., & Chronis-Tuscano, A. (2010). The implementation of evidence-based practice for ADHD in pediatric primary care, The ADHD

Report, 18(5), 1-6. Mash, E., & Wolfe, D. (2005). Abnormal child psychology (3rd ed.). Belmont, CA: Thomson Wadsworth Ylvisaker, M. & DeBonis, D. (2000). Executive function impairment in adolescence: TBI and ADHD. Topics in Language Disorders, 20(2), 29-57.