SPED 780

Class 11

ADHD & Executive Functions

Judith Mack, MSEd, MSW

Adjunct Lecturer

Department of Special Education

Agenda

• Presentations (ADHD & Metacognition)

• Key Points ADHD

• ADHD + Executive function (based on Barkley Reading)

• Discussion

• Case Study

ADHD: Review Key Points

• A conservative estimate is that about 20% of students with learning disabilities are also diagnosed with ADHD.

• Reasons for so much overlap between learning disabilities and ADHD:• The learning disability may precede the attention

problems.• The attention problems may precede the learning

disability.• The attention problems and learning disabilities

may be separate conditions that co-occur.

What is Today’s Definition of ADHD?

• Most professionals rely on the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual of Mental Disorders (DSM) for diagnosing children with ADHD.

• The DSM recognizes 4 types of ADHD:• ADHD, predominantly inattentive type• ADHD, predominantly hyperactive-impulsive

type• ADHD, combined type

What is the Prevalence of ADHD?

• Studies indicate that between 3 to 5% of school-age children have been diagnosed with ADHD in the United States.• The combined type accounts for 50 to 75% of all persons with

ADHD.

• Boys diagnosed with ADHD outnumber girls about 3 or 4 to 1.

• Some children are misdiagnosed with ADHD, but some children should be diagnosed and are not.• Boys’ ADHD behavior is sometimes considered “gender

appropriate.”• Girls are more likely to be part of the inattentive subtype, which

is less likely to be diagnosed because their behavior does not attract teacher attention.

How is ADHD Assessed?

• Authorities recommend that a diagnosis of ADHD should include three elements:• Medical exam – helps to rule out any physical

reasons for the inattentive and/or hyperactive-impulsive behavior

• Clinical interview – though somewhat subjective, it is important because it can be used to gather information on the child, the parents, and any siblings

• Rating scales – allow professionals to obtain more objective behavioral information

How is ADHD Assessed?

• Technology is now being used to assess ADHD.• Computerized versions of continuous

performance tests (CPTs) are now available.

• Children with ADHD but no learning disability can now receive services under the other health impaired category.

What are the Causes of ADHD?

• Neurological factors • The most likely sites are in the prefrontal and frontal

lobes, the basal ganglia, and the cerebellum.• The neurotransmitters that are most likely out of balance

in persons with learning disabilities are dopamine and norepinephrine.

• Hereditary factors• Strong evidence supports a hereditary basis to ADHD.• If a child has ADHD, the odds a sibling will also have ADHD are

32%.

• Factors that don’t cause ADHD• Despite myths and some reports in the popular media,

factors that are unlikely to cause ADHD are food additives, sugar, and bad parenting.

What are the Behavioral Characteristics

of Persons with ADHD?

• Most authorities point to impairment in behavioral inhibition as the main characteristic of persons with ADHD.

• Behavioral inhibition is composed of three elements—the ability to:• Delay a response• Interrupt an ongoing response when needed• Protect a response from distracting or

competing stimuli

What Educational Methods are Used

with Students with ADHD?

• Stimulus Reduction• Cruickshank developed a highly structured

program that emphasizes the reduction of inessential stimuli and the enhancement of stimuli essential for learning

• Structure• The teacher should maintain a tightly prescribed

schedule of educational activities for the students

• Functional Behavioral Assessment• Evaluation that consists of finding out the

consequences, antecedents, and setting events that maintain inappropriate behaviors

What Educational Methods are Used

with Students with ADHD?

• Contingency-Based Self-Management• Having students keep track of their own

behavior and then receive consequences for them

• Self-Monitoring of Attention• Self-monitoring – a technique in which

students monitor their own behavior, such as attention to task, and then record it on a sheet

What is the Role of Medicationfor Persons with ADHD?

• Medication has become the most common method of treating children with ADHD.

• Psychostimulants are by far the most commonly used.• Ritalin – enables the brain’s executive functions to

operate more normally• Adderal – as effective as Ritalin but longer lasting

• Side effects• Relatively common with psychostimulants, but

most are not serious

Cautions Regarding Ritalin

• Ritalin should not be prescribed at the first sign of a behavioral problem.

• Parents and teachers should:• Monitor dosage levels closely• Not allow the medication to serve as a

substitute for self-responsibility or self-initiative

• Not view the medication as a panacea• Keep in mind that psychostimulants are a

controlled substance

Psychostimulants

• Ritalin has suffered from negative publicity in the popular media.• Critics accuse parents and teachers of turning

to drugs to make children more docile and compliant.

• Critics argue that Ritalin use encourages children to turn to illicit drugs later in the teenage years.

• Outcomes with ADHD are best when psychostimulants are used in combination with behavior management techniques.

Barkley’s Model of ADHD: Behavioral Inhibition and Time Awareness and

Management

• According to Barkley’s model, the deficit in time awareness and management is the most detrimental for persons with ADHD.

• Barkley notes that persons with ADHD have difficulties with executive functions, which involve:• Working memory• Inner speech• Self-regulation of emotions

What are Executive Functions?

• Working memory and recall (holding facts in mind while manipulating information; accessing facts stored in long-term memory; includes an impaired sense of time.)

• Activation, arousal, and effort (getting started; paying attention; finishing work)

• Controlling emotions (ability to tolerate frustration; thinking before acting or speaking)

• Internalizing language (using “self-talk” to control one’s behavior and direct future actions)

What are Executive Functions?

• Taking an issue apart, analyzing the pieces, reconstituting and organizing it into new ideas (complex problem solving).

• Shifting, inhibiting (changing activities, stopping existing activity, stopping and thinking before acting or speaking)

• Organizing/planning ahead (organizing time, projects, materials, and possessions)

• Monitoring (self-monitoring and prompting)

Barkley Video

http://www.youtube.com/watch?v=GR1IZJXc6d8

Discussion, questions about Barkley article

• Review your notes and the Barkley article, look over the handout which supports the Barkley article.

• In a small group, discuss the various aspects of Executive Function. If it is helpful to make a diagram or chart, please do so.

• Discuss how difficulty with Executive Function may impact learning of students with ADHD and/or learning disabilities.

• Where do memory issues fit in?

• What about behavior?

• Discuss strategies for supporting students.

• Share your ideas and questions with the whole class.

Case Study

• Read through the case study.

• Work with a partner to answer the questions, incorporating all you have learned, read, discussed as well as your experiences and observations.

• There are no “right” answers.

• If there is time, we will share our findings.

For Tomorrow

• Required: