Exploring & Managing the Impact of ADHD Across the Lifespan

RECORDED WEBINAR VIDEO CONTENT…

While Attention-Deficit/Hyperactivity Disorder (ADHD) is commonly associated with childhood, research indicates that deficits in attention and executive functioning can persist well into adolescence and adulthood. For those individuals whose symptoms are misunderstood or misdiagnosed, these unaddressed deficits are associated with academic underachievement, underemployment, and psychosocial difficulties. The current presentation seeks to explore the literature regarding the long-term impact of unmanaged or undiagnosed attentional deficits and executive dysfunction and how these symptoms can interfere with all areas of functioning.

Hosted by NJCTS (NJ Center for Tourette’s Syndrome)
https://njcts.org/

Presented by:
Hilary Murphy, PhD
CNNH Neuropsychologist

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17 Back to School Tips to Accommodate the ADHD Student

October is ADHD Awareness Month! Here are a few tips to help parents and teachers ensure all students succeed this school year…

1. Ask for a formal reward system in the classroom, and establish it early in the school year

2. Ask for a daily report card! Allows parents and teachers to work together to reinforce behavior and work completion goals at home and school

3. Ask for an extra set of books or relevant classroom materials at home

4. Communicate what works for your child at home

5. Don’t retain!

6. Decrease work expectations to the essential – reduce assignments to show mastery

7. Allow frequent short breaks during the school day

8. Do not send unfinished work to complete at night

9. Consider homework reduction or elimination for elementary school students

10. Get color-coded binders and commercial organizers, make sure that the child uses them

11. Use technology – working on computers and iPads is often more engaging and thus more effective for kids with ADHD

12. Assign a study buddy for a child with ADHD so they can complete classwork and even homework together

13. Use short assignments with clear goals and frequent feedback

14. Have children be involved in stating their work goals

15. Train on keyboarding and allow typing of assignments

16. Encourage continual involvement in lesson when children are reading or listening

17. Establish a quiet area where children can go if they become upset

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Back to School Tips for Managing ADHD

October is ADHD Awareness Month!
Here are some quick tips to help you manage your child as they get ready for the new school year…

Define the house rules!


– Use clear and consistent rules that are applied in all settings
– Post rules visually (in writing for older kids, with drawings for younger kids)

When giving direction…


– Touch your child’s shoulder and encourage eye contact before giving a direction
– Only give a direction when you are able to follow through
– Have your child repeat directions and rules out loud in their own words

Rewards and punishments…


– Focus on the positive and give genuine praise and rewards frequently and immediately (Catch them being good!)
– Give mild but swift punishment for misbehavior
– Use high value rewards
– Change rewards frequently, every two to three weeks, to maintain their motivational value
– Behavior systems only work when they are being implemented, and they require ongoing monitoring and adjustment – Don’t give up too soon!

Other helpful suggestions…


– Establish consistent home routines
– Use clocks and timers for different activities and breaks
– Warn your child in advance of transitions (e.g., 10 minutes, 5 minutes, 1 minute)
– During homework, give frequent breaks (use a timer)
– Plan for problems: Identify times when your child tends to misbehave, discuss expectations in advance, and tell your child what will happen if they do not follow the rules

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What is Dyslexia and What Can We Do About It?

WEBINAR VIDEO RECORDING BELOW

Hosted by the NJ Center for Tourette Syndrome

An in-depth look at Dyslexia identification, research, treatment and outcomes…

This webinar will help parents, educators, and other clinicians learn to identify signs and symptoms of dyslexia, dispel commonly held myths about dyslexia, and discuss the research regarding the etiology/genetics, neuroanatomical underpinnings, neuropsychological profile, and common comorbidities of dyslexia. We will then discuss research supported interventions for individuals with dyslexia and common comorbidities as well as appropriate accommodations for the classroom. Finally, we will discuss long term outcomes of individuals with dyslexia.

Presented by Michelle Humm, PhD, Neuropsychologist at CNNH

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US Dept Education Now Classifies ADHD as a Specific Disability

A recent letter sent to education professionals from the United States Department of Education clarifies new definitions for ADHD as a specific disability under the Americans With Disabilities Amendments Act, affording more protection from discrimination and more support for funding under Section 504 of the Rehabilitation Act of 1973.

View the original letter and accompanying ADHD resource guide >>>

Click the link above to view the original letter plus the accompanying ADHD resource guide, read below for the text of the letter without its references and footnotes:

Because the Americans with Disabilities Act Amendments Act (Amendments Act) clarified the broad scope and definition of the term “disability,” more students with ADHD are now clearly entitled to the protections under Section 504.

Over the past five fiscal years (2011-2015), the Department’s Office for Civil Rights (OCR) has received more than 16,000 complaints alleging discrimination on the basis of disability in elementary and secondary education programs. Approximately 2,000, or one in nine, of these complaints involved allegations of discrimination against a student with ADHD. In resolving such complaints, OCR has found that many teachers and administrators often take appropriate action to ensure that students with ADHD receive the protections to which they are entitled under Federal law, but many others are not familiar with this disorder, or how it could impact a student’s equal access to a school district’s program.

Through our enforcement efforts, we have learned that many students with ADHD are still experiencing academic and behavioral challenges in the educational setting, and that policy guidance is needed to ensure that those students are receiving a free appropriate public education (FAPE) as defined in the Department’s regulations implementing Section 504. OCR investigations have revealed that students with ADHD could be denied FAPE because of problems that school districts have in identifying and evaluating students who need special education or related services because of ADHD. Some of these problems are as follows:

 students never being referred for, or identified by the school district as needing, an evaluation to determine whether the student has a disability and needs special education or related services;
 students not being evaluated in a timely manner once identified as needing an evaluation; or
 school districts conducting inadequate evaluations of students.

In addition, even if properly identified, a student with ADHD who is determined to have a disability may not always receive required services. OCR, through its enforcement efforts, has observed that school districts fail to meet their Section 504 obligations when they:
 make inappropriate decisions about the regular or special education, related aids and services, or supplementary aids and services the student needs, and the appropriate setting in which to receive those services based on a misunderstanding of ADHD and the requirements of Section 504;
 fail to distribute relevant documentation to appropriate staff; or
 consider inappropriate administrative and financial burdens in selecting and providing appropriate related aids and services.

The failure to provide needed services to students with disabilities can result in serious social, emotional, and educational harm to the students involved. It can also unnecessarily drain school district and family resources if the school is ineffectually attempting to meet the needs of students with disabilities through failed interventions or disciplinary consequences.

As outlined in the Department’s regulations implementing Section 504, school districts must conduct individualized evaluations of students who, because of disability, including ADHD, need or are believed to need special education or related services, and must ensure that qualified students with disabilities receive appropriate services that are based on specific needs, not cost, and not based on stereotypes or generalized misunderstanding of a disability.4 These and other Section 504 obligations apply to all students with disabilities and are discussed in this guidance as they specifically pertain to students with ADHD.

Through this letter and the accompanying Resource Guide, OCR seeks to help educators, families, students, and other stakeholders better understand these laws as they pertain to students with ADHD in elementary and secondary schools in order to ensure that these students receive the regular or special education, related aids and services, or supplementary aids and services the student needs to be successful. I encourage you to use this information to ensure that your school district is properly evaluating and providing timely and appropriate services to students with ADHD.
Sincerely,
/s/
Catherine E. Lhamon
Assistant Secretary for Civil Rights

Interventions and Supports for Struggling Learners

Did you know that CNNH sponsors a representative from the Statewide Parent Advocacy Network (SPAN) in our Voorhees office to work exclusively with all CNNH patients? This invaluable resource educates our patients on available resources and funding options.

Students who may be struggling academically and/or behaviorally can often benefit from early and intensive supports. Response to Intervention (RTI) is a multi-tiered process of providing educational support and instruction to struggling learners. Individual progress is monitored and results are used to make decisions about further instruction and intervention. RTI is most commonly used in addressing problems with reading, math, and behavior, but it can also be used in other areas. The RTI process is flexible and is designed by school districts to meet the needs of their students.

It typically has three tiers, each tier providing differing levels of support:

  • Tier I – All students receive high quality curriculum and instruction in regular education classrooms. The teacher assists all learners.
  • Tier II – The school provides interventions to students who need more support than they are receiving from the general education curriculum.
  • Tier III – Students are given individualized instruction.

A key component to the RTI process is progress monitoring. Progress is measured by observations, tests, and other formal and informal assessments that help determine whether an intervention is successful or needs to be changed. Formal guidelines for progress monitoring should be developed by the school that detail how long a child will receive a particular intervention and how they will determine whether the intervention is helping the child.

When the child meets the goals set forth by the school, the intervention is no longer needed and the child continues to receive support from the general education curriculum. When progress monitoring shows that the child is not responding to intervention, another approach or intervention may be tried. When a higher level of support is needed, children are given individualized instruction which may include a referral for special education. RTI does not replace special education and it may not be used to delay or deny the evaluation for receiving special education services. So, any time a parent feels their child has educational needs that may require special education services, they have the right to request an evaluation.

Click on the links below for more information about RTI, including what questions parents can ask about how RTI works in their child’s school and how parents can be involved in the RTI process:

http://www.spannj.org/keychanges/education_materials09/Response_to_Intervention.pdf

http://www.spannj.org/pti/SPAN_Family_Guide_to_RTI.pdf

http://www.spannj.org/keychanges/education_materials09/Parent_Guide_to_RTI.pdf

Effects of Motivation and Medication on Electrophysiological Markers of Response Inhibition in Children with ADHD

FROM THE DESK OF MARK MINTZ, MD

An interesting study from Biological Psychiatry on the importance of behavioral approaches to ADHD. Using a “Go/No Go” task, and an electrophysiological parameter (event-related potentials), the authors provided motivational incentives (reward and/or response cost) to children with ADHD known to be medication responsive, and a control group without ADHD. They found that motivational incentives increased amplitudes (for N2 and P3) of event-related potentials correlating to attention (on-task) and response inhibition (restraining impulsive responses) of those with ADHD toward the baseline of the control group. Overall, findings implied that motivational incentives could effect those with ADHD and those without ADHD in a similar manner, and that there were additive effects of these behavioral interventions with stimulant medications.

Groom M, et al. Biological Psychiatry. 2010; 67(7): 624-631. doi:10.1016/j.biopsych.2009.09.029

Similarly, the landmark Multimodal Treatment Study of ADHD (MTA) looked at four approaches to treating ADHD: carefully monitored medication management (stimulant medication), behavior modification (a very intensive approach), combination of behavior therapy and stimulant medication, and routine community care (which included medication). Compared to community care, medication alone or the combination of behavioral and medication therapy were superior to community care or behavioral therapy alone. The combination showed additional benefits compared to medication alone, although modest.

MTA Cooperative Group. National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: 24-month outcomes of treatment strategies for attention-deficit/hyperactivity disorder. Pediatrics.2004;113:754-761.

Although there cannot be major conclusions from this small study in Bio Psych, it provides reinforcement to the fact that ADHD is a neurobiological disorder, and that adjunctive behavioral strategies are important.

By Mark Mintz