Download Helping Children and Adolescents

ADHD
Co-existing Problems
Interventions
Presented by:
Dianne Zaccheo MSW FTC
Medical Family Therapy Consultant
The Coaching Centre, London England
ZaccheoTM is a trademark protected copywrite
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
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
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
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
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
Children, Adolescents & Adults
with 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
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
Adolescents with ADHD at
Risk
ADHD
Speech and Language
Substance
Abuse
Poor
achievement
Academic Failure
Motor problems
Dyspraxia
Trouble with
The Law
ASD
Aspergers
Learning
Disorders
Conduct
Disorders
ODD
Emotional Maturity
Intelligence
ZaccheoTM is a trademark protected copywrite
AN IMPARED SENSE OF TIME










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
ZaccheoTM is a trademark protected copywrite
We Know what ADHD is……
We just don’t agree about what to do about it…
Treatments?
Hey
Stupi
d
Vitamins
God
Help
us!
Ritalin????
Punishments?
Parent-Child Strategies
ZaccheoTM is a trademark protected copywrite
Pray
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
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
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
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
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
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
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
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
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
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
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
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_childr
en_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.ht
m
ZaccheoTM is a trademark protected copywrite
Compared to ADHD
Problems 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
AS Problems with Play & Social Friendship














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
ZaccheoTM is a trademark protected copywrite
AS Social Skill Deficits










Repetitive organising of toys
May prefer to play alone
Limited pretend or thematic play
Lacks flexibility in play
Ritualistic forms of play
Rigidity in rules /everything
Limited play interests
Accepting suggestions 4 play
Apologising
Voice volume may be loud
Does not repair conflicts
Does not accept views others
Cannot tolerate criticism
Does not initiate contact
Does not express joy easily
Limited shared enjoyment
Accepting others mistakes
Accepting losing at games
ZaccheoTM is a trademark protected copywrite
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
123 Problem Wheel shows
what the pattern is
Every pattern has a trigger
When same repeats
Same happens
2
1
Honeymoon
time
There is a point
of no return
There is manipulation
There is a pay-off
3
ZaccheoTM is a trademark protected copywrite
There are habits that drive
Behaviours wanted or other
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