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Practical Strategies for Learning Disabilities in ADHD Sponsored by Limestone District School Board

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Title: Practical Strategies for Learning Disabilities in ADHD Sponsored by Limestone District School Board


1
Practical Strategies for Learning Disabilities in
ADHDSponsored byLimestone District School
BoardJanssen-OrthoLearning Disabilities
Association of Kingston
  • Umesh Jain BSc, MD, FRCPC, DABPN, PhD, MEd
    (Cand.)
  • Medical Director, Adolescent and Adult ADHD
    Research Service, Centre for Addiction and Mental
    Health

2
Disclosures
  • Research
  • Public-based funding
  • Canadian Institutes of Health Research
  • Ontario Mental Health Foundation
  • Ontario Problem Gambling Foundation
  • Ministry of Health of Canada and Ontario
  • Hospital for Sick Children Foundation
  • Industry-based funding
  • Eli Lilly Purdue Pharma
  • GSK (SKF) Janssen-Ortho
  • Celltech Novartis
  • Sponsorships
  • Above plus
  • Abbott Pfizer
  • AstraZeneca Rhone-Poulec
  • Wyeth Apotex
  • Shire Bristol Myers Squibb
  • Current Lecture
  • This lecture sponsored by Janssen-Ortho Inc.

3
Objectives
  • Review of normal child development
  • Quick review of ADHD
  • Understanding the core construct of self esteem
    and the impact on learning
  • Multi-sensory learning as the model
  • Time perception
  • Effort perception

4
Normal Development
  • Understand normal development first
  • Emotional self regulation
  • Construction of self-directedness
  • Basis of interpersonal relationships
  • Self esteem learning self-directedness
  • The internalization of the positive message

5
Normal Childhood Development
  • Children cry to communicate

6
Normal Childhood Development
  • Children cry to communicate
  • Do I want my Mom or Dad?
  • Button pushing is a normal developmental process
  • Children convert this into other forms of button
    pushing

7
Normal Child Development
  • I look at you
  • www.gruberkidz.com

8
Normal Child Development
  • I look at you
  • The anthropological explanation?
  • Rule of child development
  • If you look at a behavior it will go up
  • If you dont look at a behavior it will go down

9
You learn the no word
  • Emotional self control
  • Separation of child from parent
  • I want.
  • Transitional objects and true emancipation
  • Relinquish power and see no as a means to
    protect not reject

10
Normal Development 3-6
  • Physical Changes
  • Just plain cute
  • Connection to Peers
  • Gender Identification
  • Autonomy

11
Normal Development 12-17
  • Physical Changes
  • puberty
  • Connection to Peers
  • Sexuality
  • Emancipation
  • Development of identity

12
Normal Development 45-55
  • Physical Changes
  • Peer Connection
  • Sexuality
  • Autonomy from your children

13
Media Hype and Confusion
14
Myths and Facts
  • ADHD is only a childhood disorder
  • It only applies to boys
  • It is only found in Western countries
  • It is a behavioral disorder
  • It reflects inadequate school funding
  • Kids are overdiagnosed
  • The medical agenda is being pushed by drug
    companies
  • ADHD is lifespan disorder
  • Many girls with inattention are not seen
  • It is a medical disorder
  • The prevalence rates are 5-9 and this is stable
  • Incidence has increased
  • The MTA study was NIMH funded
  • 4128 scientific articles on ADHD

15
Diagnosis
  • Observational diagnosis
  • Meets DSM-TR Criteria
  • Collateral history
  • More than one setting
  • Psychiatric examination
  • Co-morbid vs primary diagnosis
  • Physical examination
  • Not everything walking in the door is psychiatric
  • Psychometric evaluation
  • 40 have learning disabilities

16
Main Current Theories
  • Arousal Hypothesis
  • Abnormal filter- RAS abnormality?
  • Inhibitory Control Model
  • Executive functioning abnormalities- Prefrontal
    cortical problems
  • Lack of Bloodflow- Circuit problems
  • Genetic Hypothesis
  • DRD4.7

17
Twin Studies Show ADHD Is a Genetic Disorder
Height
Asthma
Schizophrenia
Breast cancer
Hudziak, 2000
Nadder, 1998
Levy, 1997
Sherman, 1997
Silberg, 1996
Gjone, 1996
Thapar, 1995
Schmitz, 1995
Edelbrock, 1992
Gillis, 1992
Goodman, 1989
Willerman, 1973
Average genetic contribution of ADHD based on
twin studies
ADHD Mean
Faraone. J Am Acad Child Adolesc Psychiatry.
2000391455-1457. Hemminki. Mutat Res.
20012511-21.Palmer. Eur Resp J.
200117696-702.
18
Dopamine Neurotransmission Relative to ADHD
Dopamine
Nigrostriatal Pathway
  • Enhances signal
  • Improves attention
  • Focus
  • On-task behavior
  • On-task cognition

Mesolimbic Pathway
Substantia nigra
Mesocortical Pathway
Ventral tegmental area
Solanto. Stimulant Drugs and ADHD. Oxford 2001.
19

Parent SNAP-Hyp/Impulsive
Average Score
Assessment Point (Days)
20

Teacher SNAP-ODD/Aggressive
Average Score
Assessment Point (Days)
21
ADDERALL XR Pulse Delivery System
Adderall is registered in the US patent and
trademark office.
22
The CONCERTA Formulation
Laser-Drilled Hole MPH Compartment 1
MPH Compartment2
Tablet Shell
Push Compartment
23
CADDRA Recommendations
  • Long acting agents will be first line
  • Across the lifespan but particularly for
    adolescents and adults
  • Short acting agents will be considered adjuvant
    treatments in the first line

24
The Need for Once-Daily Dosage Options
  • Extended medication coverage needed
  • After school, extracurricular activities
  • Social interactions
  • Homework hours
  • Problems with in-school dosing
  • Privacy issues
  • Ridicule by peers decreased self-esteem
  • Storage of controlled medications
  • Security potential for diversion

25
Holistic Interventions
  • The medications are there to facilitate the other
    interventions
  • Behavioral
  • Psychological
  • School- Educational
  • Social

26
Important to focus on strength
  • We tend to focus on negatives
  • what is it that I want you to do, not what
    irritates me
  • What are they good at?
  • The basis of construction of habits and positive
    reinforcement
  • The management of learning disabilities relies
    heavily on habit development

27
Reinforcement strategies
  • Fixed reward systems
  • Token economy
  • Variable reward systems
  • When low attention and high impulsivity is a
    factor

28
Ideal multi-sensory learning strategy
  • If you can teach it, you must know it!
  • Typical pattern-----
  • Preparation
  • Read it-
  • Scanning vs Recognition vs Recall
  • Speak it
  • Write it (if dysgraphia- then type)

29
Time Perception
  • Notice how time seems to change at will
  • Inattention and poor time perception linked
  • Zoning out
  • Important to use timed-based strategies
  • Timers
  • Schedules- get the white board out
  • Keep it short monitor reward

30
Perception of volume
  • If it looks like it is too much
  • they will shut down
  • Activation- attention- effort
  • Will power vs detachment?
  • Limit informationbite sized chunks
  • Variety and positives
  • Anxiety will cause a block- Fish Called Wanda
    example

31
Keep the non-dominant brain occupied
  • Use a quiet toy for self stimulation
  • Background music
  • Classical music
  • Soft visual background
  • lavender
  • Tactile friendly environments

32
Conclusions
  • Self esteem is key to learning FIRST
  • Construct a learning environment SECOND
  • Understand how sensory inputs affect the
    receptive message
  • Keep it short and reinforce

33
Resources heidi_bernhardt_at_camh.net
  • LD Online www.ldonline.org
  • International Dyslexia Association
    www.ldanatl.org
  • National Center for Learning Disabilities
    www.neld.org
  • Parents and Educators Resource Center
    www.perc-schwabfdn.org
  • Council for Exceptional Children
    www.curry.edschool.virginia.edu
  • Council for Learning Disabilities
    www.winthrop.edu
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