the facts: regulatory disorders adhd, ocd, tourette syndrome · general facts •it is one of the...
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10th Annual SoutheastRegional ADHD Conference ADHD Myth Information:
Separating Fact from FictionJanuary 27, 2018
Sheryl K. Pruitt, M.Ed., ET/P
The Facts: ADHD, OCD, Tourette Syndrome
© Sheryl K. Pruitt, M.Ed., ET/P 2018
Attention Deficit Hyperactivity Disorder
Sensory Defensiveness
TouretteSyndrome
Anxiety Disorders
ObsessiveCompulsiveDisorder
Mood Disorders
© Sheryl K. Pruitt, M.Ed., 1999
Regulatory Disorders
SleepDisorders
AutisticSpectrum Stuttering
The Basal GangliaThe Basal Ganglia
Language Disability
Learning
Disabilities
Executive Dysfunction
© 1999 Sheryl K. Pruitt, M.Ed
Non-Regulatory Disorders
Visual-Motor Disability
Memory Disorders
Slow Processing
Speed
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Hallmarks of ADHD
© Sheryl K. Pruitt, M.Ed., Warren Walter, Ph.D., 1992
• Distractibility
• Dysregulation of Attention
• Impulsivity
• Hyperactivity (optional)
• Impersistence at a Boring Task
• Arousal Difficulties
• Difficulty Initiating
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 pg. 53
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.
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Slow processing speed is reported by researchers to exist in one-fourth to one-half of students with ADHD-Inattentive Type.
©Tigers, Too, 2009
Carlson, Mann,2002, Goodyear, Hynd1992Nigg,Blaskey,Huang-Pollock,Rappley, 2002,Weiler, Bernstein, Bellinger,Waber, 2000, Barkley, 2006
Slow Processing Speed(Sluggish Cognitive Tempo)
• Sustained Attention• Executive Functions• Memory• Academic Achievement• Behavior• Social Competence
©Tigers, Too, 2009 ©Dornbush, M.P. and Pruitt, S. K., 2009
Processing SpeedInfluences:
Treatment for Sluggish
Cognitive Tempo or Slow
Processing Speed Disorder
The Fast ForWord® Program
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)
© 2011 Challenging Kids, Inc.
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CommonObsessions
• Symmetry and Order• “Just Right Feeling”• Doubting and Worrying (leads to indecisiveness)• Perfectionism (work, words, people, appearance)• Need to experience sensations (burn, cuts)• Dirt, germs, cleanliness, contamination• Counting or lucky numbers or words• Aggressive thoughts or images (sexual or gruesome)• Dangerous or terrifying thoughts• Religious or moral scrupulosity
© L.E. Packer, S.K. Pruitt, C.I. Wang, 2000© Teaching The Tiger, pg. 14
Obsessions are intrusive, repetitive, unwanted thoughts, and can provoke profound anxiety.
Common Compulsions
© S.K. Pruitt & C.I. Wang, 1999
Compulsions are repetitive, ritualistic behaviorsfrequently associated with obsessions.
I am not obsessing …I am not obsessing …I am not obsessing...
• “Just Right Syndrome” (e.g. objects, responses)• Ordering, counting, arranging, evening up, checking• Touching, fiddling• Cleanliness, smelling objects • Superstitions• Doing what is forbidden• Needing to finish or ask same questions• Stuck/perseverating, repeating, erasing, rewriting• Picking, nail biting, pulling hair (Trichotillomania)
© Teaching The Tiger, pg. 15
A Real Balancing Act…
Getting OCD Off My Land!
Dr. John Marsh
Exposure Response Prevention Therapy
© Sheryl K. Pruitt, M.Ed., 2003
Anxiety may cause a “fight or flight” response and lead to school avoidance or refusal.
Image courtesy of Silicon Valley Brain Spect Imaging, Inc.
Non-OCD Anxiety Disorders
• Separation Anxiety
• Generalized Anxiety
• Specific Phobias
• Panic
• Post-Traumatic Stress
• Social Anxiety
• Selective Mutism
© 2011 Challenging Kids, Inc.
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The Hallmark of Tourette Syndrome
© Sheryl K. Pruitt, M. Ed., 1992
Motor Tics Vocal Tics Sensory Tics
• Tics are brief, purposeless, repetitive involuntary 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.
Not All That Tics is Tourette
• Chronic Tic Disorders
• Transient tics
• Medication-inducedtics
• Tics due to trauma
© Leslie E. Packer, Ph.D., 2000
General Facts
• It is one of the most common neurological disorders of childhood. It is vastly under diagnosed. It knows no cultural or racial boundaries.
• 1:100 prevalence
• Average onset 3-9 years
• 10% for all tic disorders
• Is passed from generation to generation and can be affected by internal or external stressors in the environment
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Symptoms or Misbehavior?Symptoms or Misbehavior?
• touching
• echopraxia
• copropraxia
• echolalia
• coprolalia
• palilalia
• touching
• echopraxia
• copropraxia
• echolalia
• coprolalia
• palilalia
© L.E. Packer, S.K. Pruitt, C.I. Wang, 1999© L.E. Packer, S.K. Pruitt, C.I. Wang, 1999
Mood Disorders
• Dysthymia
• Depression
• Bipolar Disorder
• Cyclothymia
“When I am depressed, I feel so blue!”
© 2011 Challenging Kids, Inc.
Depressed Recovered
NIMH, 2009
Signs of Mood Disorders
© L.E. Packer & S.K. Pruitt, 2000
Too serious
Hallucinations(voices)
Excessive guilt
Sleep disturbance
Appetite disturbance
Down mood
Feels worthless
Agitation
Concentration impaired
Energy loss
Suicidal thoughts
News Flash: Depression
Students AT RISK!!!_______________________________________________________________________
• Approximately 3.4 million children in the U.S. suffer from depression. Less than half receive treatment.
• 5% of adolescents will experience major depression.
• Suicide is the third leading cause of death in youth aged 15 - 24.
_______________________________________________________________________
© Leslie E. Packer, Ph.D., 1999
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Features of Mania/Hypomania
• Euphoria or marked irritability.
• Grandiose thoughts.
• Impulsivity and/or disruptive behavior.
• Hallucinations (severe cases).
• Change in sleep pattern: insomnia + excessive energy may indicate mania.
• Racing thoughts, rapid speech.
• Highly distractible.
© Leslie E. Packer, Ph.D., 1999
PediatricAutoimmuneNeuropsychiatric DisorderAssociated withStrep
© modified from L.E. Packer and S.K. Pruitt, 1999 Raymond A. Cattaneo, 2011
PediatricInfectionTriggeredAutoimmuneNeuropsychiatric Disorder
PediatricAcute-onsetNeuropsychiatric Syndrome
PANS, PITANDS, and PANDAS,
Oh my!
Autism Spectrum DisorderKey Features
• Social Interaction Difficulties
• Communication Deficits
• Narrow Interests
• Inflexibility and Repetitive Behaviors
• Comprehension Deficits
© Sheryl K. Pruitt, M.Ed., ET/P, 2017
• Impaired attention and memory
• Increased hyperactivity and impulsivity
• Bullying and aggressive behaviors
• More accidents• Depressed mood• Long-term memory
deficits
Sleep Problems
“Just five more minutes!”
© 2011 Challenging Kids, Inc.
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• Takes place from infancy through childhood. A child usually matures and is well integrated by 8-10 years of age, but sensory processing continues to be refined throughout life.
• Occurs on an unconscious level, whereas thinking and cognition are more conscious processes.
• Is developed and/or enhanced by sensory experiences.
SensoryIntegration
© 1997 Parkaire Consultants
• Smelling
• Seeing
• Tasting
• Hearing
• Touching
• Pain*
• Proprioceptive
• Vestibular
Photo Credit C. Wang
Sensory Defensiveness
“Make the firm alarm bell stop!”
© 2011 Challenging Kids, Inc.* Added by Pruitt
Hey, you forgot
Oppositional Defiant
Disorder!!
© L E Packer S K Pruitt C I Wang 1999
Did Not!!!!
The Executive Functions Are the Cuing of the Executive Skills!
©Sheryl K. Pruitt, M.Ed., ET/P, 1995
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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
EXECUTIVE SKILLS
• Set Goals
• Initiate
• Prioritize
• Pace
• Plan
• Sequence
• Organize
© D.G. Pruitt, S. K. Pruitt, L.W. Walter, M.P. Dornbush, L.E. Packer, 2008
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EXECUTIVE SKILLS
• Shift
• Use Feedback
• Inhibit
• Self-Monitor
• Problem Solve
• Execute
• Generalize
© D.G. Pruitt, S. K. Pruitt, L.W. Walter, M.P. Dornbush, L.E. Packer, 2008
EXECUTIVE SKILL
Set Goals
© D.G. Pruitt, S. K. Pruitt, L.W. Walter, M.P. Dornbush, L.E. Packer, 2008
Friends
FamilyWork
© Sheryl K. Pruitt, M.Ed., 1990
EXECUTIVE SKILL
Initiate
© D.G. Pruitt, S. K. Pruitt, L.W. Walter, M.P. Dornbush, L.E. Packer, 2008
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• 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
© Sheryl K. Pruitt, M.Ed., 2001
INITIATEINITIATE EXECUTIVE SKILL
Prioritize
© D.G. Pruitt, S. K. Pruitt, L.W. Walter, M.P. Dornbush, L.E. Packer, 2008
• Divide the assignment into small parts with a definite time schedule.
• Show them what a finished product will look like.
• Monitor progress towards intermediate deadlines.
Written Expression and ProjectsWritten Expression and Projects
© Sheryl K. Pruitt, M.Ed., 1995
EXECUTIVE SKILL
Pace
© D.G. Pruitt, S. K. Pruitt, L.W. Walter, M.P. Dornbush, L.E. Packer, 2008
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Now!Or
Not Now!
© Sheryl K. Pruitt, M.Ed., ET/P, 2001
EXECUTIVE SKILL
Plan
© D.G. Pruitt, S. K. Pruitt, L.W. Walter, M.P. Dornbush, L.E. Packer, 2008
Planning involves anticipating the outcome of your strategy before selecting it.
.
Plan Your Work and Work Your Plan
© Sheryl K. Pruitt, M.Ed., ET/P, 1999
Two-Step Process
+P.L.A.N.Problem defined!
Lay out options!
Act on one!
Now evaluate!
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EXECUTIVE SKILL
Sequence
© D.G. Pruitt, S. K. Pruitt, L.W. Walter, M.P. Dornbush, L.E. Packer, 2008© Teaching The Tiger, 1995
© Sheryl K. Pruitt, M.Ed., 1981
THE SEQUENCE OF LONG DIVISION
VERBAL CUE
Daddy, Mother, Sister, Brother
VISUAL CUE
COGNITIVE CUE
Dirty Marvin Smells Bad(Divide) (Multiply) (Subtract) (Bring
Down)
EXECUTIVE SKILL
Organize
© D.G. Pruitt, S. K. Pruitt, L.W. Walter, M.P. Dornbush, L.E. Packer, 2008
Organizing Materials: Do’s
Have A Stash of Supplies
© Leslie E. Packer, Ph.D., 2000
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EXECUTIVE SKILL
Shift
© D.G. Pruitt, S. K. Pruitt, L.W. Walter, M.P. Dornbush, L.E. Packer, 2008
You announced a change in plans. She’s handling it quite well, isn’t she?
(Pre warnings give them
a head start to change)
© Leslie E. Packer, Ph.D., 2002
EXECUTIVE SKILL
Use Feedback
© D.G. Pruitt, S. K. Pruitt, L.W. Walter, M.P. Dornbush, L.E. Packer, 2008
Executive functions have beenthe “hidden curriculum.* ”
© Leslie E. Packer, Ph.D., 2002* Richard Lavoie
It’s time to explicitly teach them.
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EXECUTIVE SKILL
Inhibit
© D.G. Pruitt, S. K. Pruitt, L.W. Walter, M.P. Dornbush, L.E. Packer, 2008
• 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 SKILL
Self-Monitor
© D.G. Pruitt, S. K. Pruitt, L.W. Walter, M.P. Dornbush, L.E. Packer, 2008
This isn’t it!
© Sheryl K. Pruitt, M.Ed., 1997
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Pictoral Editing Strip
© Tigers, Too 2009 © Sheryl K. Pruitt, M.Ed., 1992
Memory Functioning
Short-Term MemoryImmediate Memory
Long-Term Memory
Declarative MemorySemantic MemoryEpisodic Memory
© Sheryl K. Pruitt, M.Ed., ET/P, L. Warren Walter, Ph.D., 1997
Spared Memory
Memory Functioning
© Sheryl K. Pruitt, M.Ed., ET/P, L. Warren Walter, Ph.D., 1997
Impaired Memory
Short-Term MemoryWorking Memory
Long-Term Memory
Procedural MemoryProspective MemoryMetamemoryStrategic Memory
© Marilyn P. Dornbush, Sheryl K. Pruitt, M. Ed., Tigers, Too, 2009©Tigers, Too, 2009
Memory Functioning
Word Retrieval
Is A
Memory Look Alike
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TEACHER FROM HELL
A B C D E N O P Q R
I J K L M W X Y Z
© S.K. Pruitt & C.I. Wang, 1999
Prepare the child for the path….
Not the path for the child!
© Sheryl K. Pruitt, M.Ed., 2000
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.
© Sheryl K. Pruitt, M.Ed., 2000
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
© Sheryl K. Pruitt, M.Ed., 2000
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Sheryl K. Pruitt, M.Ed., ET/P
www.parkaireconsultants.com