challenging kids, regulatory disorders challenged parents · 6 1. set up clear objectives. 2....

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Faith Lutheran SchoolFebruary 23, 2012

Sheryl K. Pruitt, M.Ed., ET/Pwww.parkaireconsultants.com

Challenging Kids,Challenged Parents

© Sheryl K. Pruitt, M.Ed., ET/P 2012

Attention Deficit Hyperactivity Disorder

Sensory Defensiveness

TouretteSyndrome

Other Anxiety Disorders

ObsessiveCompulsiveDisorder

Mood Disorders

© Sheryl K. Pruitt, M.Ed., 1999

Regulatory Disorders

SleepDisorders

AutisticSpectrum Stuttering

Speech Disorders

Language Disability

Learning Disabilities

Executive Dysfunction


Non-Regulatory Disorders

Visual-Motor Disability

Memory Disorders

Slow Processing

Speed

Non-verbalLearning

Disability

Image Courtesy of Silicon Valley Brain Spect Imaging, Inc.

• Tics are brief, purposeless, repetitive unvoluntary movements or sounds that usually occur in bouts.

• Tics may be simple or complex and are often confused with allergies, habits, or misbehavior.

Tourette syndrome

© 2011 Challenging Kids, Inc.

“Why does the teacher think I would do this on purpose and embarrass myself in

front of my friends?”

Tips for Tourette syndrome


• Let student leave the room to discharge tics in private place.

• Reduce production demands when tics interfere with performance during times of tic worsening.

• Allow student to engage in highly motivating tasks.

• Used to be called Habit Reversal Training

• First cognitive treatment for tics

• Need to treat co-morbids first unless a dangerous or socially destructive tic

• Douglas Woods, Ph.D. and John Piacentini, Ph.D. are gurus in this area.

Cognitive-Behavior Intervention for Tics

© Sheryl K. Pruitt, M. Ed., ET/P, 2010

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Image: www.cerescanimaging.com/

• Intrusive, repetitive unwanted thoughts (obsessions), and/or

• Repetitive or ritualized behaviors (compulsions)

• Some compulsions may not be observable (such as counting)

Obsessive-Compulsive Disorder (OCD)


• Reduce handwriting.

• Do not give more than student can finish in allotted time.

• Remove triggers for compulsive behavior if possible, e.g., use of a word processor instead of handwriting.


“I can’t go to school because I can’t keep people from touching

my stuff!”

Tips and Strategies for OCD

• First effective cognitive treatment for OCD.

• Set program with a strict protocol with a hierarchy of obsessions and compulsions with a specific treatment program coupled with relaxation techniques to help when breaking the anxious habit.

Exposure Response Prevention Therapy

© Sheryl K. Pruitt, M. Ed., ET/P, 2010

This is what your brain looks like “ON” ADHD.

Who turned out the Lights?!

Photo Source: Zametkin et al., 1990© 1999 Leslie E. Packer, Ph.D.


• Externalize motivation.

• Alternate quiet activities with opportunities to move around.

• Externalize instructions.

• Pause or use fillers to allow sufficient time to process.

“What did I do wrong this time?!”

Tips for ADHD Primary Mood Disorders

• Depression

• Bipolar Disorder

“Life’s too hard…I can’t go on.” © 2011 Challenging Kids, Inc.

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"Graceful Exit"

• Accommodate impaired focus, memory, and concentration.

• Allow for “graceful exits”and permanent passes, as needed.

• Assist with social/peer issues.

Tips for Mood Disorders


PediatricAutoimmuneNeuropsychiatric DisorderAssociated withStrep

© L.E. Packer, 1999

• Impaired attention and memory

• Increased hyperactivity and impulsivity

• Bullying and aggressive behaviors

• More accidents• Depressed mood

Sleep Problems

“Just five more minutes!”


• Screen for sleep problems.• Allow student to start day

later and/or end it earlier.• Provide parents with sleep

hygiene handout.• Open the blinds in the

classroom to allow in as much natural light as possible.

Tips for Sleep Problems

“Just five more minutes!”


• Smelling

• Seeing

• Tasting

• Hearing

• Touching

• Pain

• Proprioceptive

• Vestibular

Photo Credit C. Wang

Sensory Defensiveness

“Make the firm alarm bell stop!”


• Screen for occupational therapy.

• Do not touch the child lightly, wear heavy perfumes, or seat student near noise or distraction.

• Avoid sensory overload settings; allow child to leave.

© 2011 Challenging Kids, Inc.* Photo credit C. Wang

“Make the firm alarm bell stop!”

Tips for Sensory Defensiveness

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• Set Goals

• Initiate

• Prioritize

• Pace

• Plan

• Sequence

© D.G. Pruitt, S. K. Pruitt, L.W. Walter, M.P. Dornbush, L.E. Packer, 2008

Executive Function


• Organize

• Shift Flexibly

• Use Feedback

• Inhibit

• Self-Monitor

• Execute

Executive Function

The “Dreaded Book Bag Diagnostic

Test”

Photo credit, Colleen Wang

© Sheryl K. Pruitt, M. Ed., 1995

CLUECLUE© Sheryl K. Pruitt, M. Ed., 1995

“He is such a good boy. I just don’t know enough things to tell him not to do.”

- Ferrell Sams

“…Coaching for the neurologically impaired focuses… on helping people with TS, OCD, ADHD, EDF and WM… to

identify and modify problematic personal behaviors and to develop more effective self-management skills.”

Adapted by Daniel Pruitt fromThomas E. Brown, Ph.D. in Attention-Deficit Disorders and Comorbidities in Children, Adolescents, and Adults, 2000

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Set Goals


Executive Function The Universe

Sheryl K. Pruitt, M.Ed., ET/P, Darin Bush

Friends

FamilyWork

© Sheryl K. Pruitt, M.Ed., 1990 © D.G. Pruitt, S. K. Pruitt, L.W. Walter, M.P. Dornbush, L.E. Packer, 2008

Executive Function

Initiate

• Routines with checklists• Verbal or visual cue to

start• Work with peers • Break up tasks • Activity before starting• Provide model work

sample• Teach brainstorming • Pick topics of interest


Initiate


Executive Function

Prioritize

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1. Set up clear objectives.

2. Define vocabulary.

3. Watch video tape or TV program.

4. Overview the chapter or book prior to reading.

5. Read questions at end of the section.

6. Look at pictures and graphs

7. Read the chapter.

© Teaching the Tiger, l995

How To Read a Chapter


Executive Function

Pace

Now!Or

Not Now!

© Sheryl K. Pruitt, M.Ed., ET/P, 2001 © D.G. Pruitt, S. K. Pruitt, L.W. Walter, M.P. Dornbush, L.E. Packer, 2008

Executive Function

Plan

Anticipating the outcome of your plan before selecting it.

Plan Your Work and Work Your Plan

© Sheryl K. Pruitt, M.Ed., ET/P, 1999

+P.L.A.N.

Problem defined!

Lay out options!

Act on one!

Now evaluate!

Two-Step Process

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Executive Function

Sequence

Maintain Routine

Lay Out Everything in Order© Sheryl K. Pruitt M.Ed., 1999


Executive Function

Organize

• Color code research notes and cards by subject areas.

• Use color coding on mind maps to relate to those on cards or files.

• Use color to code items taken off websites when researching.

• Color code by subjects and be consistent from one year to the next.

Color Coding



Executive Function

Shift

You announced a change in plans. She’s handling it quite well, isn’t she?

© Leslie E. Packer, Ph.D., Sheryl K. Pruitt, M.Ed., ET/P, 2002

Pre- warnings give them a head start to change

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Executive Function

Use Feedback

Executive functions have beenthe “hidden curriculum.* ”

© Leslie E. Packer, Ph.D., 2002* Richard Lavoie

It’s time to explicitly teach them.


Executive Function

Inhibit

• Put your hand in front of your mouth.

• Write your question on a piece of paper so you can wait without forgetting.

© Sheryl K. Pruitt, M.Ed, Bob Rogers., 2002

Blurt Blockers


Executive Function

Self-Monitor


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Pictoral Editing Strip

© Tigers, Too 2009 © Sheryl K. Pruitt, M.Ed., 1992

Memory Functioning

• Short-Term Memory- Immediate Memory

• Long-Term Memory

- Declarative Memory- Semantic Memory- Episodic Memory

© Sheryl K. Pruitt, M.Ed., ET/P, L. Warren Walter, Ph.D., 1997

Spared Memory

© Sheryl K. Pruitt, M.Ed., ET/P, L. Warren Walter, Ph.D., 1997

• Short-Term Memory- Working Memory

• Long-Term Memory

- Procedural Memory- Prospective MemoryMetamemoryStrategic Memory

Memory Functioning

Impaired Memory Just Try

Harder!

© Leslie E. Packer, Ph.D., 1999


The Right Trick

Can Be Magic

PrepositionsPrepositions© Sheryl K. Pruitt, M.Ed., 1990

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Cognitive Strategies

• Cognitive strategies are particularly helpful to children and teens with executive dysfunction, as they enable the student to:

• Encode the information.

• Retain the sequence of information.

• Retrieve the information.

© 1999 Sheryl K. Pruitt, M. Ed.

• Show them what a finished product will look like.

• Divide the assignment into small parts with a definite time schedule.

• Monitor progress towards intermediate deadlines.

Written Expression and ProjectsWritten Expression and Projects


7 x 8 = 56

Think of the two numbers before 7 and 8. The 5 and 6 give you the answer (56)

5 6 = 7 x 8

© 1992 , D. Cherry & S. K. Pruitt

Math TricksIs the Battle Over the

Assignment Book Worth It?Is the Battle Over the

Assignment Book Worth It?


Lack of paying attention to the future…

Why do your homework if you do not see the future?

©Sheryl Pruitt, M.Ed., 1989

IT TAKES A TEAM


• Student• Parents• Educators • Case Manager• Educational Therapist • Advocate• Medical Doctors• Mental Health

Professionals• Related Services• Support Group

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Put Your Oxygen Mask on First!

© Sheryl K. Pruitt, M.Ed., ET/P, 1990

• Identify your genetic disorders.

• Get treatment for them.• Acquire medical education for you and your family.

• Get a support group.• Know to take it one day at

a time.

Prioritize Treatment

• Money• Time• Sibling Impact• Emotions


What Is The Behavioral Communication?


Bad Day!?!

© L.E. Packer, S.K. Pruitt, C.I. Wang, 1999

• Neurochemistry

• Brain “off”

• Medication problem

• Illness

• Lack of sleep

• Unable to do it!

Curiosity vs. Judgment!

Sleepy

Underarousal Overarousal

Arousal Curve

Memory for complex, unfamiliarinformation and behavioral control

Optimal Arousal

Hyperactivity

Arousal

Tests

Storms

Couch Potato

© Teaching the Tiger, pg. 18, 1995 © Sheryl K. Pruitt, M.Ed., 1991© Daniel and Sheryl Pruitt, M.Ed., 1989Teaching The Tiger

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Brain StormMay be able to control symptoms for seconds to hours (depending on severity of the case)

Severely exacerbated by stress

Extensive control can lead to explosive build-up or storm

Stress Overarousal Explosive Build-up Storm

© S.K Pruitt & C.I. Wang, 1999

Hole In The Wall SyndromeHole In The Wall Syndrome


Who Owns the Problem?

© Sheryl K. Pruitt, M.Ed., 1989© Teaching The Tiger

Grandma’s Rule

“Cool Down”


Use graceful exit to safe place or person. Help child save face. Provide a safe way to expend energy. Allow them to do a calming activity.

When a storm is coming at you, you

do not try to interrupt or reason with it.

Protect the safety of child, family

members, and property.

© Leslie E. Packer, Ph.D., Sheryl K. Pruitt, M.Ed., ET/P, 1999

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Once a storm begins, it can not be stopped.

Avoid sensory input of any kind and the storm

will decrease.

Do not take storms personally

Three Rules


• Health and Safety• Respect for Self and

Others• Target Behavior

• Consequences • Short• Many• Quick

Family Meeting

Naughty or Neurology?

© 1996, Sheryl K. Pruitt, M.Ed.

Reparations

© Sheryl K. Pruitt, M.Ed.,1999

Social Difficulties

© Daniel G. Pruitt, PCC, SCAC, Sheryl K. Pruitt, M.Ed., 2009

Social skills gets you your job, your

mate, and your friends when you

grow up!

One of the leading causes of teenage

depression is social failure.

InstantReplay


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Prepare the child for the path….

Not the path for the child!


Tigers, Too

Tigers, TooSupplements

1. Checklists and

Objectives for

the Classroom

and

2. Assessment

www.parkairepress.com

Challenging Kids,

Challenged Teachers

www. parkaireconsultants.com

© Challenging Kids, Challenged Teachers, 2010Leslie E. Packer, Ph.D., Sheryl K. Pruitt, M.Ed., ET/PWoodbine House

Download the handouts for this presentation at

www.parkaireconsultants.com/FLS

Credits….

Thanks go to Leslie Packer, Ph. D. for her constant support and contributions for several of the power point slides used here today.

Thanks also to Marilyn Dornbush, Ph.D. and Warren Walter, Ph.D. for their contributions and support to several power point slides today.

Thanks especially to my husband, Daniel G. Pruitt, PCC, SCAC, who has been my supporter, partner in our clinic, my publisher, and a contributor to this presentation.


This program is cheerfully dedicated to the author’s family, who have cleverly managed to have almost every problem described. Any problem my husband and I did not have I gave birth to. They are my first, and best, teachers.

Dedication

© Shari Zellars Photography, 2009


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Sheryl K. Pruitt, M.Ed., ET/P

www.parkaireconsultants.com

Memory

Long-Term Memory Short-Term Memory *Strategic Memory

*Procedural Memory Declarative Memory Immediate Memory *Working Memory

Semantic Memory Episodic Memory Long-Term Memory is the ability to store information over a long period of time. There are several types of

long-term memory.

• Procedural Memory is memory for skills such as throwing a ball, programming your VCR, or doing your bathroom routine in the morning.

• Prospective Memory is memory for the future.

• Meta Memory is to understand and use memory strategies, e.g., verbal rehearsal.

• Declarative Memory is memory for specific facts and events that can be said out loud, presented in a

picture, or done in another form.

○ Semantic Memory is knowing what a vocabulary word means and memorizing facts..

○ Episodic Memory is knowledge of specific events, e.g. what you ate for breakfast today. Short-Term Memory is the memory used to temporarily store information in a conscious way while it is processed.

• Immediate Memory is the first step in short-term memory. Immediate memory can only hold a little information for a very short time, e.g., the letter “a”.

• Working Memory has more ability to hold information than immediate memory and operates along with

executive functioning to use that information to guide behavior. Strategic Memory is a special sort of memory that requires working memory along with executive functioning. For example, in a word-list learning task, if the words can be categorized and remembered better by the examinee, then the active categorization would be using strategic memory. *Deficit areas when EDF is present as an associated disorder with TS, OCD, ADHD, and Mood Disorders.

© Adapted by Daniel Pruitt and Sheryl Pruitt from L. Warren Walter, PhD 1997.

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Executive Function Definition: Executive functions are control processes. They involve inhibition and delay of responding. They can be divided into the realms of initiating, sustaining, inhibiting/stopping and shifting. Another important aspect of executive function is planning and organization, which requires “attention to the future.” (From Attention, Memory and Executive Function, Chapter 15, Martha Bridge Denckla, MD)

Hallmarks Of Executive Function

1. Initiating 5. Prioritizing 9. Organizing 2. Goal Setting 6. Executing 10. Shifting flexibly 3. Planning 7. Inhibiting 11. Using Feedback 4. Pacing 8. Sequencing 12. Self-Monitoring MP Dornbush, LE Packer, SK Pruitt, LW Walter, 1999. Goal Formulation Planning ●Decipher motives & develop intent ●Sequencing ●Understand what the goal is ●Organization ●Setting Priorities ●Flexibility (needs sustained attention) Carrying Out Goal Effective Performance ●Directed plans ●Respond to feedback ●Receive feedback (while ●Monitoring actually doing it) ●Self-correcting ●Flexibility (capacity to shift) ●Regulating (intensity/tempo) Based on a theory by Muriel Lezak, Ph.D., Neuropsychological Assessment, published in 1983. Compiled by LW Walter, Ph.D. and S K. Pruitt, M.Ed. Executive Functioning

• Executive functions are simply a name for those higher-order systems of the brain that activate, integrate, coordinate, and modulate a variety of other cognitive functions. - Thomas Brown, Ph.D (2001)

• “Executive Functions”, as it relates to students with ADHD, are “actions we perform to ourselves

and direct at ourselves so as to accomplish self-control, goal-directed behavior, and the maximization of future outcomes.” Most of these actions are cognitive – in other words, “done in our heads,” and thus not observable. - Dr. Russell Barkley

• Executive functions are goal formulation, planning, carrying out a goal, and effective

performance. Goal formulation consists of deciphering motive and developing intent, understanding what a goal is, and setting priorities. Planning is sequencing, organization, and flexibility. Carrying out a goal is directed plans, monitoring, self-correcting, and regulating the intensity and tempo. - Based on a theory developed by Muriel Lezak, Ph.D., in her book, Neuropsychological Assessment published in 1983. Compiled by Warren Walter, Ph.D., and Sheryl K. Pruitt, M.Ed.

• Executive dysfunction (EDF) impacts academics, behavior, and social skills. Executive

dysfunction is essentially a learning disability in common sense. EDF impairs the ability to see the future. Without this skill there is no reason to do homework, save money, or plan for and act as if one is going to college, or has a need to train for a job. Executive dysfunction unremediated can rob one of friends, the ability to get a job interview, and the ability to create a successful family. EDF is the most underdiagnosed and underestimated destroyer of the ability to use a person’s IQ points for one’s own success.

©Sheryl K. Pruitt, M.Ed., 1996

Executive Function

Executive function is often difficult to understand. There are differing definitions and many component parts. A person can have one or more of the functions not working correctly. This is called Executive Dysfunction (EDF). The following are definitions and examples of the component parts of EDF. Goal Setting refers to the ability to set goals that are realistic and attainable.

Example: Wanting to play many sports but realizing that it is important to set a successful goal and choosing one per season.

Initiating involves starting a boring job. When you love something, your chemistry changes to allow for easy starting. It is only difficult to start the jobs that are not intrinsically interesting.

Example: Learning what makes starting homework easier, e.g., promising a reward such as playing an electronic game afterwards.

Problem Solving is the ability to generate solutions to a problem. Example: Knowing how to repair a relationship when you have hurt someone’s feelings. Prioritizing is understanding the relative importance of all the items within a group.

Example: Deciding to do homework even when playing an electronic game is more fun.

Pacing is the ability to establish and adjust rate of work so that the goal is met by specified completion time or date. Pacing is using your awareness of time to control your actions.

Example: Knowing how long it takes to do your homework. Planning is the ability to break down the process of accomplishing a goal into efficient steps that can fit into your daily schedule.

Example: Being able to break down a long-term project into individual homework assignments.

Sequencing is understanding the relative order of things. It is knowing the order of the steps needed to accomplish a task

Example: Putting ideas in order for a book report or term paper. Organizing is the ability to arrange items in an efficient and easily retrievable manner.

Example: Organizing is the ability to keep bookbag organized.

Daniel G. Pruitt, CPCC, PCC and Sheryl K. Pruitt, M.Ed., ET/P, 2007

Shifting Flexibly is the ability to change from one activity or idea to another with ease.

Example: Being able to easily put away books from one subject and shift to the next subject without any difficulty.

Using Feedback is being aware of your impact on the environment and using that information to alter your behavior.

Example: Noticing people staring when you stand to close and moving back. Inhibiting is the ability to know that you need to inhibit. ADHD frequently imitates this but the ADHD person without EDF is aware that they are not able to inhibit.

Example: Being aware of the need to raise your hand before speaking in class. Self –Monitoring is the ability to maintain awareness of yourself in your environment.

Example: Knowing how loud to speak when in class. Executing is completing all the details necessary to finish a job.

Example: Finishing your project and handing it in. Generalizing is the ability to understand what is learned in one setting can apply to another. Example: Realizing that if I hurt my friend’s feelings by talking about his weight, then I probably do not need to mention anyone’s weight in any social setting.

Tips and Tricks

• Know what you do not know, e.g. what EDF is and how it impacts you. • Become self-aware. • Learn to talk to yourself about what is going on around you. • Get a notebook and write down what the problems are that interfere with your life. • Choose the most important thing to work on by what is the most serious problem. • Get a clue when you are not clear what to do. • Next time you make a mistake, find someone to help you understand why. Problem solving

is a difficult task for people with EDF. • Have an assortment of people available to give you strategies. • Remember that if nothing changes, nothing changes. This takes work! • Go to an ADHD coach when you are stuck and cannot figure out what to do.

Daniel G. Pruitt, CPCC, PCC and Sheryl K. Pruitt, M.Ed., ET/P, 2007

challenging kids, regulatory disorders challenged parents · 6 1. set up clear objectives. 2....

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