Title: Practical Strategies for Learning Disabilities in ADHD Sponsored by Limestone District School Board
1Practical 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
2Disclosures
- 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.
3Objectives
- 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
4Normal 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
5Normal Childhood Development
- Children cry to communicate
6Normal 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
7Normal Child Development
- I look at you
- www.gruberkidz.com
8Normal 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
9You 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
10Normal Development 3-6
- Physical Changes
- Just plain cute
- Connection to Peers
- Gender Identification
- Autonomy
11Normal Development 12-17
- Physical Changes
- puberty
- Connection to Peers
- Sexuality
- Emancipation
- Development of identity
12Normal Development 45-55
- Physical Changes
- Peer Connection
- Sexuality
- Autonomy from your children
13Media Hype and Confusion
14Myths 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
15Diagnosis
- 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
16Main 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
17Twin 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.
18Dopamine 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)
21ADDERALL XR Pulse Delivery System
Adderall is registered in the US patent and
trademark office.
22The CONCERTA Formulation
Laser-Drilled Hole MPH Compartment 1
MPH Compartment2
Tablet Shell
Push Compartment
23CADDRA 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
24The 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
25Holistic Interventions
- The medications are there to facilitate the other
interventions - Behavioral
- Psychological
- School- Educational
- Social
26Important 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
27Reinforcement strategies
- Fixed reward systems
- Token economy
- Variable reward systems
- When low attention and high impulsivity is a
factor
28Ideal 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)
29Time 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
30Perception 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
31Keep the non-dominant brain occupied
- Use a quiet toy for self stimulation
- Background music
- Classical music
- Soft visual background
- lavender
- Tactile friendly environments
32Conclusions
- 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
33Resources 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