Title: Treating ADHD, Predominantly Inattentive Type with Integrated Psychosocial Treatment
1Treating ADHD, Predominantly Inattentive Type
with Integrated Psychosocial Treatment
Linda Pfiffner, Ph.D. Childrens Center at
Langley Porter University of California, San
Francisco
2What is ADHD-I?
- Case Description Kayla
- 8 y/o girl, 3rd grade, private school
-
- Referred due to concerns about attention mind
floats, lives in fantasy world, organizational
problems, needs to be redirected. Also concerns
about social interaction problems. - Family background lives with her biological
mother and sister parents are divorced. History
of ADHD, behavior problems, depression in family.
Mother works full-time. - Birth, medical and developmental history
normal, but slightly late in some fine and
gross motor skills.
3- School History
- Problems with attention, focus and completing
tasks began during first grade and have worsened
each year. - Teacher comments
- Capable, but works slowly
- Doesnt use class time well, mostly in her own
world - Concentration problems worse as day progresses or
if activity is lengthy - Lack of attention leads to missing directions
- Needs 11 or small group to stay on task and
achieve - Work is often sloppy, messy, incomplete, not
turned in - Academic ability on grade level
- Very imaginative, artistic
- Few behavior problems
4- Peer Relations
- Immature, fits in better with younger children
- Has a few friends but does not seek new friends
- Makes up stories
- Can be bossy
- Some teasing by peers
- Teacher describes as eccentric
- Home Behavior
- Daily routine activities and homework are an
ordeal. - Takes forever to get things done
- Lots of frustration and conflict over need for
reminders and not completing tasks - Needs constant supervision
- Affects getting ready in am, homework, chores,
bedtime - High levels of mother-daughter conflict, but
evidence of loving relationship
5Teacher Ratings
- Teacher CSI ADHD IA 8/9 often or very often,
H/I 0/9 - SCT 11/15 often or very often
- APRS 50 work completed, often completes work
in careless fashion, often requires assistance
to complete work, quality of work is more
successful than poor - Peer Relations Scale often chosen late, never
sought after by peers, none would like for a best
friend, none would wish she was not in class - School Situations Q moderate-severe in 4/8
areas - SSRS SS Scale 79, AC88, PB130
6Parent Interview and Ratings
- Parent KSADS and CSI IA 9/9, H/I2/9, past sep
anx disorder. - Home Sit. Q. moderate in 10/13 areas
- HPC very often 17/20 items
- SSRS SS Scale 67, PB Scale134
- PSI P-C Dys Interaction 99, Difficult Child
97, Total Stress 97 - ABAS Gen Adaptive Composite 72
7Test Results
- Behavioral Observations cheerful, rapport each
to establish, somewhat slow to respond, compliant
and friendly - WASI FSIQ108, Verb114, Perf102
- WIAT II WR93, MR106, S96
- MASC T65, elevated
- CDI T47, normal range
- DSM-IV Diagnosis ADHD-I
8Life in families with ADHD-I
- Homework vacillates between a struggle and a
crisis - Routine activities and chores are forgotten
- Getting ready in the morning is a formidable
challenge - Dawdling and procrastination means things are
done at the last minute - Bedrooms and play areas usually messy and
disorganizedclothes laying in the same spot they
were dropped toys, papers, books, and magazines
in disarray. - Lots of time spent looking for lost things
- Off in own world," not listening and not
following through
9School (cont.)
- Academic underachievement, learning disabilities
(McBurnett et al., 1999 Carlson Mann, 2000) - These problems may be less extreme in early
elementary years, but as demands for independence
increase with each grade, these problems can be
quite severe by middle and high school.
10Peer Relations in ADHD-ICarlson Mann, 2000
Maedgen Carlson, 2000 Blachman Hinshaw, 2002
- Tend to be passive and withdrawn
- Often play by themselves play with others for
only short periods of time. - Often shy, not tuned in to group conversation.
- Poor tracking and processing of social cues,
- Not well-accepted by peers teased, unpopular,
neglected rather than openly rejected. - Deficits in knowing what to do when interacting
with others, not just a performance problem.
11DSM-IV ADHD-I Must occur OFTEN, cause
IMPAIRMENT, X 2 settings
- Inattentive (6)
- Fails to give attention to details/makes careless
mistakes - Difficulty sustaining attention
- Seems not to listen
- Fails to finish tasks
- Difficulty organizing
- Avoids tasks requiring sustained attention
- Loses things
- Easily distracted
- Forgetful
- Hyper/Impulsive (5-)
- Fidgets or squirms in seat
- Difficulty remaining seated when asked to
- Runs about or climbs on things when asked not to
- Difficulty playing quietly
- Acts on the go or driven by a motor
- Talks excessively
- Blurts out answers
- Difficulty awaiting turn in group activities
- Interrupts people, butts into others activities
12Sluggish Cognitive Tempo(McBurnett et al., 2001
Carlson et al., 2002
- Daydreams
- Sluggish or drowsy
- Confused or in a fog
- Absent-minded
- Apathetic or unmotivated
- Stares blankly
- Underactive or unmotivated
- Forgetful
13Attention Problems in ADHD-I vs. ADHD-C
- ADHD-I more severe alertness/orientation problems
than ADHD-C (McBurnett et al., 2001). -
- ADHD-I more problems in focused or selective
attention ADHD-C more problems with persistence,
working memory and behavioral inhibition
(Barkley, 1997). - Both types share deficits on tests of frontal
lobe functions, but additional problems in
perceptual-motor speed and slow processing
specific to ADHD-I (e.g., Barkley et al., 1992)
14Work Style in ADHD-I vs. ADHD-C (Booth et al.,
2001 Carlson et al., 2002)
- ADHD-I and ADHD-C-
- lower motivation for learning
- less interest in challenging tasks
- less persistent and more easily discouraged
- ADHD-I prefer cooperative work setting ADHD-C
prefer more competitive environment. - ADHD-I motivated to please teacher, make good
grades more so than for own curiosity, interest
or internal drive. - ADHD-C more likely to value being perceived as
high performing and successful than those with
ADHD-I.
15Comorbid DisordersCarlson Mann, 2000
- Oppositional Defiant Disorder and Conduct
Disorder less in ADHD-I than ADHD-C - Anxiety and Depression comparable or more in
ADHD-I than ADHD-C - Learning Disorders comparable or more in ADHD-I
than ADHD-C (esp. math achievement)
16Tailoring psychosocial treatment to ADHD-I
- Academic impairment -- necessitates close
involvement with school direct intervention for
homework. - Work style issues use non-competitive external
rewards for specific goals accommodations to
tasks and assignments to address slow processing
speed - Social difficulties-- teach and practice specific
skills provide opportunities and reinforcement
for approaching and interacting with peers.
17Tailoring Tx (cont.)
- Lack of independence in daily living tasks-- most
efficiently increased with routines, parent
monitoring and reinforcement. - Fewer disruptive behavior problems-- Limit
setting strategies (time-out) less useful.
Instead, positive reinforcement targeting
specific goals and routines indicated.
18Why psychosocial treatment?
- Medication may be less helpful for ADHD-I than
ADHD-C. (Barkley et al, 1991 Greenhill et al,
2000) - Social impairment in ADHD-I (social
passivity/withdrawal, lack of social knowledge)
likely to be more amenable to PST than ST
(Pfiffner et al, 2000) - ST side effects of social withdrawal (Granger et
al., 1996) may be less acceptable in children who
already have social withdrawal problems - ST often does not normalize functioning the
inclusion of PST may be necessary to produce
excellent treatment response - Parents show a significant preference for
behavioral treatments over pharmacological
treatment alone (Pelham, 1999) - These factors suggest that psychosocial
interventions may be even more important for this
subtype.
19Life Skills Training for ADHD-Inattentive Type
- Exploratory/Developmental 3 year grant funded by
NIMH (2002-2005) - Treatment incorporates rehabilitation approaches
based on similarities between ADHD-I and mild
brain injuries (e.g., sluggish cognitive tempo,
forgetfulness) - Emphasizes adaptive skills, functional
competence, compensatory strategies - Uses cues, prompts, routines
- Involves teachers and parents to provide
necessary environmental supports at school and at
home
20Child Life Skills Program
- Study Screening and Assessment Process
- Telephone screenings (parent, teacher)
- Agreement from school to participate
- Standardized rating scales completed by parent
and teacher (symptoms, impairment) - Clinic visit for family
- Clinical Interview
- KSADS Diagnostic Interview
- WASI and WIAT II screener
- Child self-report MASC, CDI
- Parent-completed PSI, APQ
-
21Child Life Skills Program
- Study design
- 28 children (age 7-11) randomly assigned to
- Life Skills Training program, or
- Assessment only group (Treatment as usual)
- DSM-IV Diagnoses
- ADHD-I only 61
- Comorbid ODD 32
- Comorbid anxiety disorder 21
- Comorbid depressive disorder 4
- Parent and teacher ratings gathered at
pre-treatment, post-treatment and follow-up
22Participant Characteristics
Standard deviation (SD) in parentheses.
23Child Life Skills Program
- Treatment Components
- Child
- Weekly Child Group meetings (90 min.) for eight
weeks, concurrent with Parent Group meetings. - Four family meetings with study therapists
- Parent
- Weekly Parent Group meetings (90 min.) for eight
weeks, concurrent with Child Group meetings - Four family meetings with study therapists
- Teacher
- Five consultations with study therapists,
families attend part of meetings
24Child Component Skills Taught
- Independence Modules
- Homework/study skills
- Self-care skills
- Getting chores done
- Routines, organization and time tools
- Public Situations
- Social Skills Modules
- Friendship-making
- Handling teasing
- Assertion
- Accepting
- Being a good sport
- Problem-solving
25Structure of each Child Group
- Review homework, previous skills taught, stars
earned at home and school - Present skill of the week
- Skill game
- Role Plays
- Independence Stations and/or free play to
practice new skills - Reinforcement
- Review and meet with parents
-
26Parent Component Skills Taught
- Positive communication (attending, praising,
quality time) - Use of more powerful reinforcement programs to
support daily living skills (e.g., star systems,
home challenge) - Use of effective instructions and commands
- Prudent discipline (planned ignoring, response
cost)
27Parent Component (cont.)
- Using routines and plans to promote success
- Morning and evening routines
- Homework
- Playdate plan
- Chores
- Child skill of the week also reviewed with
parents to promote generalization - Social skills
- Independence Modules
28Outline of session content
- Week 1
- Child Group Session 1
- Friendship-making Skills
- Good Sportsmanship
- Parent Group Session 1
- Overview of ADHD, Child Life Skills Program
- Behavioral Model of Child Behavior
- Attending and Quality Time
- Positive Attention and Verbal Praise
- Teacher Component (Orientation)
- Overview of Child Life Skills Program, behavioral
intervention, classroom accommodations - Classroom Challenge overview
29- Week 2
- Child Group Session 2
- Whats my job? Intro to routines
- Morning routine planning
- Accepting
- Parent Group Session 2
- Rewarding behavior with praise, activities and
privileges - Token Economy
- Effective use of Positive Reinforcement (novelty,
consistency, specificity) - Effective Communication with school and teacher
(Classroom challenge)
30- Week 3
- Individual Family Session 1
- Review of home programs
- Individualized feedback and assistance
- Review classroom challenge
- Parent/Teacher/Child Meeting 1
- Discuss and develop classroom challenge
- Review homework routine, modify as needed
31- Week 4
- Child Group Session 3
- Homework and study skills
- Remembering important things
- Parent Group Session 3
- Strategies for Handling Homework Problems
- Review Teacher Homework Expectations
- Discuss a Script for Parent-Teacher Meetings
- Plan Homework Program
32- Week 5
- Child Group Session 4
- Homework and study skills practice
- Assertive Behavior
- Parent Group Session 4
- Effective vs. Ineffective Commands
- How to Structure Antecedents to Improve Peer
Relations - Practice Homework Routine
33- Week 6
- Individual Family Session 2
- Review and Troubleshoot Home Programs
- Individualized Feedback and Assistance
- Practice Using Script for Parent-Teacher Meetings
- Review classroom challenge
- Parent/Teacher/Child Meeting 2
- Review classroom challenge, modify as needed
- Review homework routine, modify as needed
- Review accommodations
34- Week 7
- Child Group Session 5
- Dealing with Teasing
- Lets Make a Plan!
- Parent Group Session 5
- Reducing Problem Behavior by Planned Ignoring
- Effective Strategies for Changing Antecedents
- Applying Antecedents to Evening Routine or Other
Activity - Parent/Teacher/Child Meeting 3
- Review classroom challenge, modify as needed
- Review homework routine, modify as needed
- Review accommodations, modify as needed
35- Week 8
- Individual Family Session 3
- Troubleshoot and Individualize Other Home
Programs - Review Parent-Teacher Meetings
- Review classroom challenge
- AND
- Child Group Session 6
- Study Skills and Homework Practice
- Problem Solving and Organization
- Parent Group Session 6
- Response Cost (and Fines)
- Using Punishment Effectively
- Approaches to Problem Solving and Organization
with my Child
36- Week 9
- Child Group Session 7
- Time Management Tools
- Do it Now! Overcoming Procrastination
- Parent Group Session 7
- Improving My Childs Organization and Time
Management Skills - Planning Activities in Advance
- Promoting Independence in Public Places
- Parent/Teacher/Child Meeting 4
- Review classroom challenge, modify as needed
- Review homework routine, modify as needed
- Review accommodations, modify as needed
- Individual Family Session 4 (if needed)
37Week 10
- Child Group Session 8
- Review all skills taught
- Select personal challenge
- Parent Group Session 8
- Review all skills taught
- Discuss strategies for maintaining gains working
with new teachers - Being prepared for future problems
- Plus monthly family meetings until follow-up
38Sample Home Challenge
Name Date
39Sample home target behaviors
- Complete morning routine (e.g., get up w/o
complaining, get dressed-all items, put backpack
by front door) - Complete H/W assignment independently (e.g.,
start with one page, increase with success
strategies for going on when stuck) - Complete chores
- Complete evening routine independently (e.g.,
bathe, dressed, clothes in hamper, brush teeth in
x mins).
40Name DateHome Challenge
41Teacher Component
- Orientation meeting with teacher and therapist
- Overview of ADHD-I and the Child Life Skills
Program - Overview of behavioral interventions and
classroom-based accommodations for ADHD-I - Overview of Daily Report Card (Classroom
Challenge) - Four meetings between teacher, therapist and
family focus on - Homework Plan
- Classroom Challenge
- Classroom-based accommodations
42Homework Expectations
- When, what and how is homework assigned?
-
- Should parent help child with homework or correct
homework? - How important is neatness?
- How long should it take?
- Is homework meant for practicing skills or is
there some other purpose?
43Homework plan
- Own desk
- Organize space with paper sorter, etc.
- Lighting
- Prioritize, break down h/w
- H/W sheet checked each day
- Built in breaks
- Closely supervised H/W, incidental teaching, not
just giving answers
44Sample Classroom Challenge
Name Date
45Steps to set up Classroom Challenge
- Select target behaviors
- List target behaviors on the CC Card
- Discuss logistics during school day
- Discuss logistics when at home
46Sample target behaviors
- Academics/ Study habits
- completes assigned work accurately
- has materials necessary for task
- completes and returns homework
- keeps desk area organized/neat
- starts work with X or fewer reminders
- Peers
- plays with other children
- shows good sportsmanship
- Rules/behavior
- accepts consequences
- follows rules/directions
47Steps (cont.)
- Identify reinforcers for the child to earn at
home - Discuss baseline ratings Match Game
- Review plan do a walk-through of procedure
with child - Schedule Follow-up meeting for 1-2 weeks after CC
begins
48Communication styles for working with attention
problems
- Giving directions
- Praise
- Corrective feedback
49Give clear directions
50Effective and Ineffective Praise You should
always keep your desk that clean!! Your desk is
spotless!! Finally you remembered your
homework. I like the way you remembered your
homework today. I hope you can put your things
away like this all the time. Its so helpful when
you have your things away on time. You ignored
Sallys teasing right now. I just hope you dont
get back at her when I leave. You made a super
effort at ignoring Sallys teasing. Why cant
your desk look like this all of the time? Your
desk looks very organized.
51Prudent and Imprudent Feedback
52Classroom Accommodations for Attentional Problems
- For problems following instructions and
directions - Keep instructions brief (one or two parts),
specific, and step-by-step. - For problems completing assignments and tasks
- Reduce length of assignment (break into smaller
parts). - Allot extra time for work completion.
- Give assignments one at a time, rather than all
at once. - Set time limits or challenges for completion of
tasks. - Include some method of checking work.
53Classroom Accommodations (cont.)
- For problems with organization, planning, or
beginning assignments or tasks - Encourage child to make to do lists and use
organizer notebooks or folders. Monitor these
regularly. - Teach child to organize assignments by
completion notes according to chronological
order, etc. - Teach outlining and note-taking skills (e.g., by
providing outlines for child to complete). - Praise child for getting started on a task.
54Classroom Accommodations (cont.)
- For problems staying focused and on task
- Seat child away from doors, windows, areas of
frequent activity or noise, and disruptive
students. - Place child near teachers desk to help teacher
monitor more closely whether child is paying
attention to oral instructions and completing
work. - Provide quiet zone (e.g., desk with study
carrel located in a corner) in which child can
sit while taking tests, or at times when
distracted or having trouble concentrating.
55Classroom Accommodations (cont.)
- Cue child when it is important to pay attention
by putting important information on chalkboard or
introducing it with verbal prompts (for example,
This is important). - Cue child in advance about times or tasks where
independence is needed, and encourage
non-disruptive activities while waiting (for
example, reading, journal writing, doodling, note
taking). - Instruct child to move on to another task when
work finished early or to continue on easier
parts of an assignment or task while waiting for
assistance.
56Classroom Accommodations (cont.)
- For problems working independently
- Reward child for finishing small portions of an
assignment on his/her own gradually increase the
requirement as s/he is successful. - Set time limits or challenges for completion of
tasks.
57Kayla Home program
- H/W moved work station into bedroom too noisy
in kitchen area due to remodeling. Made sure
desk area stocked and clean/organized - To remember assignments and bring back, CC and
prompting most helpful - AM routine added checklists and daily rewards
get up earlier- reward with shower in am. - Commandsdistant commands decreased
58- Playdates
- during playdates would withdraw into own activity
and engage in parallel play. Parent monitored
more often and found alternatives for interactive
play - Selected specific girls for playdates
- Planned activities in advance
59Kayla School program
- Listening target implies social behavior of
less chatting, more eye contact. Teacher took
the time to define and troubleshoot. Used
praise. - H/W target implies remembering to get it home.
Needed reminders/cues. Tried - Visual sticker in cubby
- Hawaiian dress key chain on backpack
(laminated)jingly noise helped the most - Self-monitoring whats the first thing I need
to do when I get to the classroom - Teacher posted homework sign for all
60 61Dennis, 9 years, 3rd grade
- Getting started target due to spacing out,
forgetting instructions. Teacher agrees to
accommodate cross checking that he understood
instructions - Organization target mastered in 2 weeks
- Completing work half of problems assigned to
the rest of classskill development still
accomplished with half the problems. - Child identified problems to work on, he helped
set the goal which increased motivation
62 63Tips for making a DRC work
- Define target behaviors very specifically
- Organized desk give examples of criteria
- Vague targets (paying attention) hard to track
- Include easy target behavior
- Change target behaviors or requirements if not
working take flexible approach
64Tips (cont.)
- Be encouraging and positive use praise
- Integrate self-monitoring, Match Game
- Make homework expectations clear
- Maintain close communication between home and
school
65Troubleshooting a program
- Are target behaviors clear to the child (and
teacher) and appropriate? - Does child understand the program?
- Does child remember the target behaviors during
the day? - Are the criteria realistic?
- Is the child getting sufficient feedback during
day about his/her progress? - Is child interested in the rewards? Are more
immediate rewards at school needed?
66Progress during Teacher/Family meetings, Sample
Case ADHD-ILD
- Meeting 1
- Pxs distractibility and not completing work
- When distracted go to secret spot
- Complete all in-class assignment during class
time - Meeting 2
- Modify in-class assignments to writing only
- Decrease doodling on h/w (parent reluctant to set
higher expectations) - Meeting 3
- Good progress, mostly 2s on CC
- Secret spot not used, add ignoring to CC
- Add completion of h/w problem in homework clinic
67- Meeting 4
- Mostly 2s on CC for writing assignments
- Ignoring a px, modify to before lunch, using sign
(could use response cost) - Not doing h/w problem in h/w clinic teacher had
not communicated with homework clinic staff
68Progress during family meetingsSample case
ADHD-ILD
- Meeting 1
- Px with am routine, hard to get out of bed
- Dad doing h/w for her pessimistic
- Set up HC targeting h/w and am program, use
stickers for daily reward and weekly video - Meeting 2
- Not much improvement in h/w
- Modify after school routine dad picks up 30 min
early, small snack, start h/w earlier, make sure
rewards given (parent did not believe in
incentives)
69- Meeting 3
- Program is working Dad goes through h/w
instructions, but she does it without Dads help.
- Earning daily and weekly rewards
- Dad says still distractible. Get a desk and put
in her room. - Meeting 4
- Desk has greatly helped decrease distractions
- Routine and rewards working, earning free time
- Using incidental teaching (not giving the
answers) - For am, using alarm clock and stars
- Parents did not think much could change, but
small modification made a big difference. She is
happy on playground, increased confidence, doing
better with social entry, less snippy with peers,
and has playdates for first time.
70Mean scores for Child Life Skills and Assessment
Only groups at baseline and post-treatment,
Parent Report
71Mean scores for Child Life Skills and
Assessment-Only groups at baseline and
post-treatment, Parent Report
72Mean scores for Child Life Skills and Assessment
Only groups at baseline and post-treatment,
Teacher Report
73Parent Consumer Satisfaction Ratings
- Attention Difficulties 90 improved or much
improved - Change in Target Behaviors
- 88 improved or much improved
- Morning routine
- Social Skills
- Homework
- Classroom
- Home and School Challenge 100 helpful or very
helpful - Usefulness of Skills Taught 95 useful or
extremely useful - Satisfaction With Treatment 100 satisfied or
very satisfied
74Teacher Consumer Satisfaction Ratings
- Classroom Challenge 100 helpful or
very helpful - Effort required to participate 88 not too much
- Continued use of Classroom Challenge
- 80 likely or very likely
- Recommendation of the program to other parents
and teachers - 93 recommend or strongly recommend
- Use of program to treat attentional/academic/socia
l skills problems
100 appropriate or very appropriate
75Child Consumer Satisfaction Ratings
- (Ratings on 5- point scale not at all, a little,
somewhat, pretty much, a lot) - How much did you like the group? 90 pretty much
or a lot - How much did you learn in group? 90 pretty much
or a lot - How much did the Home Challenge help you do
better at home? - 85 pretty much or a lot
- How much did the School Challenge help you do
better at school? - 80 pretty much or a lot
- How much would you like to continue in the group?
- 80 pretty much or a lot
- Note for all questions, one child rated
sometimes
76Common Issues
- Family fails to do homework
- Does not understand
- Too angry
- Disagrees with need
- Too much effort
- No time (and didnt get needed supplies)
- Forgot
- Kitchen-sinking, hard to stay on topic
- Child tests the system
- Siblings
- Teacher/school not supportive or parents and
teacher fail to communicate
77Common Issues (cont.)
- Resistance to using rewards re-name, hear about
success from other parents, use small, practical
rewards - Managing parent affect and emotion increase
awareness, coping strategies - Anxiety and perfectionism in implementing
program lower the threshold for success, step
back, be more supportive and catch them being
good
78What was most helpful?
- Using consequences rather than repeating
directions over and over. - Attending and praising
- Setting time limits, using a timer
- Ignoring outbursts
- Using varying levels of rewards cuddle time,
computer time, having friend over, dessert
choice, movie, lunch date with mom, bike to park - Using job jar for infractions (home tasks)
- Applying the program consistently
79- Giving immediate commands (e.g., do xyz, rather
than when this is over can you do this?) - Playdates
- Plans importantactivity, length, practice
setting up, use telephone, coaching before child
came, rewarding afterwards - Using a chart
- Having a defined program allowed for more
couples time without constant discussion of
parenting/child.
80What did parents like about the program?
- Groups
- Children in own peer group made it fun
- Relating to other parents
- Feeling supported, individualized advice,
sharing info - Group size great
- Therapists addressed concerns well, responsive
to feedback - Educating parents (informative), increased
awareness of parenting - Program
- Separate family and teacher components, holistic
approach - Positive reinforcement and praise for target
behs, home and classroom challenges - Rewards program for children
- Organized (structured), common sense approach
that values the child - Parenting Help
- Parenting tips, ABC, social skills for children
- Immediate change in childs beh
- Learning that children need limits
81What did teachers like about the program?
- Effort
- Quick and efficient, meetings were short and
productive - Easy target behaviors to work on
- Minimal effort
- Teacher-Child Relationship
- Daily feedback, classroom challenge helped
student and teacher focus on behaviors - One-on-one work
- Hands-on nature
- Seeing child pleased with ratings
- Made teacher pay close attention to child
- Gets student involved in own decision-making
- School/Family Relations
- Educating, involving both teachers and parents
82Barriers to treatment
- Parent psychopathology
- Low SES (transportation, childcare px, no job/
neighborhood factors) - No coverage for mental health services
- Marital conflict (and inconsistent parenting)
- School not willing or able to participate
- Insular family, lack of social support
- Language and/or learning px in parent
83Methods for tailoring behavioral intervention
- Parenting skills Group vs. family format
- Child skills Group vs. individual, need to
teach basics to parents/teachers - School List accommodations, request 504 or IEP
(if comorbidities present) to formalize. Daily
report card almost always helpful during
school-age years.
84Reference for Child Life Skills Program
- Pfiffner, L.J. (2003). Psychosocial treatment
for ADHD-Inattentive Type. The ADHD Report, 11,
1-8.