ADHD Co-existing Problems Interventions

1. ADHD Co-existing Problems Interventions Presented by: Dianne ZaccheoMSW FTC Medical Family Therapy Consultant The Coaching Centre, London England ZaccheoTM is a trademark protected copywrite

2. 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 ZaccheoTM is a trademark protected copywrite

3. 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 ZaccheoTM is a trademark protected copywrite

4. 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 ZaccheoTM is a trademark protected copywrite

5. 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’ ZaccheoTM is a trademark protected copywrite

6. 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 ZaccheoTM is a trademark protected copywrite

7. 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 ZaccheoTM is a trademark protected copywrite

8. 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 • Tourette’s, Autistic Spectrum & Asperger’s • 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 ZaccheoTM is a trademark protected copywrite

9. Adolescents with ADHD at Risk ZaccheoTM is a trademark protected copywrite

10. 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 AN IMPARED SENSE OF TIME ZaccheoTM is a trademark protected copywrite

11. We Know what ADHD is…… We just don’t agree about what to do about it… Hey Stupid Treatments? Vitamins Psychotherapy God Help us! Ritalin???? Pray Punishments? Parent-Child Strategies ZaccheoTM is a trademark protected copywrite

12. 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 ZaccheoTM is a trademark protected copywrite

13. 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 ZaccheoTM is a trademark protected copywrite

14. 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 ZaccheoTM is a trademark protected copywrite

15. 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 ZaccheoTM is a trademark protected copywrite

16. 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 ZaccheoTM is a trademark protected copywrite

17. 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 ZaccheoTM is a trademark protected copywrite

18. 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 ZaccheoTM is a trademark protected copywrite

19. 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 ZaccheoTM is a trademark protected copywrite

20. 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 ZaccheoTM is a trademark protected copywrite

21. 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 ZaccheoTM is a trademark protected copywrite

22. 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 ZaccheoTM is a trademark protected copywrite

23. 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/erickson.shtmlt • http://www.childdevelopmentinfo.com/disorders/depression_in_children_and_teens.htm • http://www.childdevelopmentinfo.com/disorders/anxiety_disorders_in_children.htm • http://childdevelopmentinfo.com/disorders/tourette_syndrome.shtml • http://childdevelopmentinfo.com/disorders/child_OCD.htm ZaccheoTM is a trademark protected copywrite

24. 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 ZaccheoTM is a trademark protected copywrite

25. 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 AS Problems with Play & Social Friendship ZaccheoTM is a trademark protected copywrite

26. 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 ZaccheoTM is a trademark protected copywrite

27. 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 • Don’t try to talk during full blown upset • Use a problem wheel to look at what patterns exist ZaccheoTM is a trademark protected copywrite

28. 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 ZaccheoTM is a trademark protected copywrite

29. 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, ZaccheoTM is a trademark protected copywrite