ADD Resource Center » Parenting

Put Your Anger on Time-Delay

kerch — Mon, 06 Feb 2012 23:02:34 +0000

Okay, so your child/husband/wife/companion, etc. leaves for the day and you discover a number of things that were supposed to be done, but weren’t (taking out the garbage, making the bed, etc.). You’re probably annoyed. Make that really annoyed. Especially if it happens frequently (and given the poor memory, distractibility, avoidance tendencies and lateness problems that many people with ADHD are prone to, it probably does happen with irritating frequency).

Later that day: He or she walks in the door… you’re poised to complain (attack!). Justifiable, probably. Smart, no. It’s tough, but refrain from complaining the second he/she returns home. Make the arrival positive – for both of you. Reinforce that you’re actually pleased to see the person (hate the sin, love the sinner). You have every right to say how you feel about the missed chores, but save it for later (and then say it from your point of view, without attacking the offender – “When you [fill in the blanks], I feel that….”

Remind yourself that If a person believes they’ll be criticized every time they step foot in the door, they’ll soon dread returning home.

Written by: Susan K. Lasky

The ADD Resource Center adhd@mail.com 646/205.8080

CHADD of New York is proud to present: Dr. Edward (Ned) Hallowell, M.D. February 8th, 2012

Harold Meyer — Wed, 01 Feb 2012 16:33:37 +0000

CHADD of New York is proud to present:
Dr. Edward (Ned) Hallowell, M.D.

February 8th, 2012

In this presentation, Dr. Edward M. Hallowell, , a child and adult psychiatrist, founder of the Hallowell Centers in Sudbury and NYC and leading authority in the field of ADHD will focus on his strength-based approach to ADHD presented in his New York Times best-seller book Driven to Distraction and his book Delivered from Distraction. When the diagnoses of ADHD emphasizes what is wrong with a person, that person immediately starts to see himself in those negative terms. Shame, fear and self doubt grow. However, when the treatment of ADHD begins with an effort to find what’s good in a person by using a strength-based approach to ferret out their hidden strengths and emphasizes first and foremost what is positive, then the person sees himself in a positive light. This is Dr. Hallowell’s goal: to help people master the power of ADHD while avoiding its pitfalls. His message will be all encompassing as he talks about what it is like to have ADHD, explains some of the brain science behind it, and discusses how to get diagnosed properly and the available medicinal and non-medicinal treatments. He will also address the many people who have ADHD coupled with other learning issues, worry and ADHD and tips on how to live your life to the fullest if you have ADHD. Join Dr. Hallowell as he:

Presents a strength-based approach to ADHD
Identifies benefits of changing environment to treat ADHD
Explores recent research into ADHD
Examines benefits of exercise, nutrition, and other non-medication approaches
Treats AD/HD in a comprehensive 5 step fashion
1. Connect
2. Play
3. Practice
4. Mastery
5. Recognition

As you set this cycle in motion, you will see positive developments immediately, and they will grow in strength and depth over time

Edward (Ned) Hallowell, M.D., a child and adult psychiatrist and graduate of Harvard College and Tulane Medical School, is the founder of The Hallowell Centers in Sudbury, Massachusetts and in New York City. He was a member of the Harvard Medical School faculty from 1983 until he retired from academics in 2004 to devote his full professional attention to his clinical practice, lectures, and the writing of books. He has authored eighteen books on various psychological topics, including attention deficit disorder, the power of the human connection, the childhood roots of happiness in life, parenting, marriage, methods of forgiving others, dealing with worry and managing excessive busyness. The New York Hallowell Center specializes in diagnosing and treating cognitive and emotional problems in both children and adults, with particular expertise in Attention Deficit/Hyperactivity Disorder (ADHD).

Dr. Hallowell is a highly recognized speaker around the world and has presented to thousands on topics such as ADHD, strategies on handling your fast-paced life, the Childhood Roots of Adult Happiness and other pertinent family and health issues. He has been featured on Oprah, 20/20, 60 Minutes, PBS, CNN, Dr. Phil, The Today Show, Dateline, Good Morning America, The View and many more. He has been interviewed for The New York Times, USA Today, Newsweek, Time Magazine, U.S. News and World Report, the Los Angeles Times, the Boston Globe and many, many more.

In his medical practice, Dr. Hallowell helps adults, as well as children, learn how to lead healthy, happy lives. He agrees with the research that suggests that connection and forgiveness have great power to shape our lives for the positive.

Dr. Hallowell’s web site can be found at www.drhallowell.com where he also hosts a blog.

February 8th 2012 5:55PM (Doors close shortly thereafter) to 7:30PM

65 East 89th Street (Parish Office-St Thomas More) Between Madison and Park – Manhattan

Admission is free. Ten dollar donation suggested.

http://amzn.to/adhdhallowellbooks

CHADD Hotline:212/721.0007

Organization, Time Management and Planning Deficits in Children with ADHD

Harold Meyer — Fri, 06 Jan 2012 17:28:50 +0000

Understanding & Intervening in Organization, Time Management and Planning Deficits in Children with ADHD

An audio presentation by Richard Gallagher, Ph.D

CHADD Mtg: Learning and Attention: A Pediatrician’s Perspective on Attention and Learning Issues

Harold Meyer — Wed, 04 Jan 2012 18:01:47 +0000

CHADD of New York is proud to present:

Jan 9, 2012 – Learning and Attention: A Pediatrician’s Perspective on ADHD, Attention, and Learning Issues

Each student diagnosed with ADHD or learning problems has a unique profile of strengths, challenges, and specific needs. Increasingly, neuroscientists and clinical researchers are learning more about the significance of these differences.

Parents, students, and educators who understand how to recognize variations in learning are in the best position to implement effective strategies and optimize academic performance. In this presentation, Paul B. Yellin, MD, FAAP will share emerging knowledge in the field, and discuss how to utilize new findings for the diagnosis and care of every student.

Target audience:

Parents of children and young adults with learning difficulties, such as ADHD, reading difficulties, math difficulties, etc.; Educators from grades Pre-K through College; Young Adults and College/Post-Graduate students with experience managing attention and related difficulties.

Paul B. Yellin, MD, FAAP, is the Director of The Yellin Center for Mind, Brain, and Education, a learning assessment, student support, and professional development organization based in New York City. Dr. Yellin is a board-certified pediatrician with more than 25 years of experience in improving the well-being and development of children. He is an Associate Professor of Pediatrics at New York University School of Medicine.

January 9th, 2012
5:55PM
Doors close shortly thereafter
65 East 89th Street (Parish Office-St Thomas More)
Between Madison and Park
New York, NY

CHADD Hotline:212/721.0007

Reservations are not required. Please leave the kids at home.

ADHD Assessment Tools

Harold Meyer — Thu, 22 Dec 2011 11:50:55 +0000

These ADHD assessment tools be used for educational purposes only. They are not substitutes for informed psychological advice or training. Do not use this information to diagnose or treat a mental health problem without consulting a qualified health or mental health care provider.

DSM-IV-TR: Attention-Deficit/Hyperactivity Disorder (ADHD) (from Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition Text Revision (DSM-IV-TR))

ICD-10: F90 Hyperkinetic Disorders (from The International Statistical Classification of Diseases and Related Health Problems, tenth revision)

National Initiative for Children’s Healthcare Quality (NICHQ): includes a variety of ADHD- related tools such as rating scales, successful protocols, order sets and forms, and guidelines for implementing key changes. Downloading tools such as the Vanderbilt Assessment Scale for ADHD requires free registration.

ADHD Rating Scale IV — Home Version

ADHD Rating Scale IV — School Version

Child Attention Profile (CAP)

Home Situations Questionnaire [PDF]

School Situations Questionnaire [PDF]

Parents’ Rating Scale for the Attention Deficit Hyperactivity Disorder (requires free registration)

Werry-Weiss-Peters Activity Rating Scale [PDF]

McCann BS, Scheele L, Ward N, Roy-Byrne P.
Discriminant validity of the Wender Utah Rating Scale for attention-deficit/hyperactivity disorder in adults.
J Neuropsychiatry Clin Neurosci. 2000 Spring;12(2):240-5. [Full Text PDF]

Wender Utah Rating Scale (for adults) [DOC]

Adult ADHD/ADD Quiz

The SNAP-IV Teacher and Parent Rating Scale
[Instructions for above]

Adult ADHD Self-Report Scale (ASRS-v1.1) Screener [PDF]

Adult ADHD Self-Report Scale (ASRS-v1.1) [PDF]

Childhood ADHD Symptoms Scale Self-Report [PDF]

Attention-Deficit Scales for Adults (ADSA) [must be purchased]

Conners’ Continuous Performance Test II for Windows (CPT II V.5) [must be purchased]

Gordon Diagnostic System (GDS) [must be purchased]

Test of Everyday Attention for Children (TEA-Ch) [must be purchased]

Test of Variables of Attention (TOVA) [must be purchased]

Conners’ Rating Scales–Revised (CRS–R) [must be purchased]

Brown Attention-Deficit Disorder Scales [must be purchased]

Brown Attention-Deficit Disorder Scales for Children [must be purchased]

Attention-Deficit/Hyperactivity Disorder Test (ADHDT) [must be purchased]

ADHD Symptom Checklist-4 (ADHD-SC4) [must be purchased]

Spadafore ADHD Rating Scale (S-ADHD-RS) [must be purchased]

ADHD Symptoms Rating Scale (ADHD-SRS) [must be purchased]

Copeland Symptom Checklist for Attention Deficit Disorders – Child and Adolescent Version
[must be purchased]

Copeland Symptom Checklist for Attention Deficit Disorders – Adult Version [must be purchased]

CARE – College ADHD Response Evaluation [must be purchased]

ADD-H: Comprehensive Teacher’s Rating Scale: Parent Form (ACTeRS) [must be purchased]

ADD-H: Comprehensive Teacher’s Rating Scale-2nd Edition (ACTeRS) [must be purchased]

—-

Go to: The ADD Resource Center Home Page.

How to Select a Professional to Work with You and/or Your Child

kerch — Mon, 05 Dec 2011 16:12:07 +0000

If you or your child has, or suspect you have, Attention Deficit/Hyperactivity Disorder (ADD or ADHD), you will most likely consult with a specialist or professional at some time, whether for diagnosis, evaluation, treatment, or remediation.

You may decide to have a formal evaluation for ADD/ADHD that may also include testing for learning disabilities and/or neurological issues.
You might seek an independent educational evaluation as to whether or not your child’s school is addressing his or her needs in the most constructive manner.
You may decide your child would benefit from an after-school tutor, or your college-aged child might need help with organization and time management.
You might be considering medication and decide to see a psychiatrist or other medical professional.
You might deside counseling is needed, whether it is with a psychotherapist, psychologist, therapist, social worker or marriage counselor.
You may be interested in the practical skills and accountability that would come from working with a coach.

The Importance of a “Good Fit”

You want to look for a “good fit” between you/your child and the professional—this can make a significant difference in the outcome of the treatment. However, selecting the most appropriate professional is a time-consuming and difficult task.

Based on the experiences of many of our clients, both as adults and as parents, and the suggestions of many professionals, we’ve put together certain questions you can ask, and strategies you can follow, to make this task easier and more successful. These suggestions should help, but here is the most important advice we can give you:

You are the ultimate expert on your child, and yourself. You know your child far better than anyone else does. Your opinions should be taken seriously by any professional you select to work with your child.

Don’t let yourself get caught up by an “expert” who is condescending or intimidating. Listen to your ”gut reaction. ” You are your child’s advocate. You are also your own. If you feel there is no chemistry between you and the professional, reconsider any long-term relationship. (Also be aware that the professional is not there to be your friend, to “yes” you, or to coddle you. You want honesty and directness, and sometimes you’d rather not hear what needs to be said.)

Be an informed consumer. Interview several experts to get a taste of different approaches to treatment; consider which approach might be best for your child; which approach best suits your personality. At the same time, avoid the trap of continually searching for the “ideal” professional.

While you must be responsible for making all major decisions affecting your child, do encourage the child to participate in the decision-making process, wherever appropriate. We all tend to be more invested in the outcome of events when we participate in the planning, and your child is no exception.

Keep in mind that adults with ADD/ADHD are not the best self-reporters. It is often helpful to have a spouse or someone who knows you well at the intake. After all, you want the professional to get as clear a picture of the situation as possible. Leave your ego (the part that wants to show the world only your best aspects, or minimize your child’s problems) at home.

Keep in mind that all children (particularly adolescents, although even 6 year olds) will occasionally resist regular meetings with a long-term treatment specialist (such as a tutor or therapist). However, any ongoing complaints or active non-compliance needs to be examined carefully and discussed openly with your child, listening to his or her comments and feelings. Encourage your child to “buy in” to the process. When there are problems, it may be advisable to meet with the professional to discuss this issue.

Sometimes, an individual’s needs will change over time and one therapist, whose work has been helpful in the past, will become ineffective. Plan to reassess any long-term arrangement at regular intervals, and stay flexible and responsive to your child’s/your own changing requirements.

It is difficult, as a parent, not to be drawn to the professional who provides the most positive prognosis. Try to meet with enough professionals to form a realistic picture, even if it’s not the one you would like to hear. Don’t shop around for the most optimistic diagnosis—look for the best relationship and a realistic approach to diagnosis and treatment.

Locate Suitable Professionals

Some of the professionals you may be looking for, over a period of time, may include diagnostic (pediatric neurologist, child psychiatrist, psychologist, educational evaluator, etc.) and treatment (psychologist, social worker, speech/language therapist, occupational therapist, tutor, psycho- pharmacologist, pediatrician, etc.).

Contact different sources for recommendations as to suitable professionals:

In NYC: CHADD of New York City (212) 721-0007
Resources for Children with Special Needs (212) 677-4650
Advocates for Children (212) 947.3089
The ADD Resource Center: (646) 205-8080
Outside of NYC: Contact CHADD National for a local chapter near you: chadd.org
Your MD
Your child’s school
Friends and acquaintances with similar issues
Resources for Children with Special Needs (212) 677-4650
Advocates for Children (212) 947.3089
It is recommended that you interview at least three professionals.

Initial Phone Contact

Make this contact short and sweet.
Indicate you are seeking a consultation.
Give name, address, sex and age of your child.
Offer the name of referring source (how you located this professional).
State problem as you see it; as others (schools, etc. see it). If you suspect your child may have ADD/ADHD, say so.
If your child has been previously diagnosed, state who did the diagnosis and when. If your child has not been previously diagnosed by a qualified professional, state this fact.
If your child is already on ADD/ADHD medication, give the name and amount, results as you see it.
Ask about this professional’s training and background in his/her area of expertise. If appropriate, inquire as to affiliations with hospitals, clinics, etc.
Confirm that it is the person you are speaking with, rather than an associate, who would be seeing the child.
Ask your questions, and set up the initial meeting, only with the person who will be seeing the child.
Ask specifically about his/her experience working with children with ADD/ADHD and their families.
Note: This can be discussed during the actual interview, but you might be able to save time and eliminate inappropriate candidates by well-chosen telephone questions.
Clarify the role you would like this professional to play in providing assistance to your family.
Have questions prepared that will help you determine whether you feel this professional would be a good match for your child.
Inquire about fees, fee scale, insurance payments, etc.
If interested in pursuing an initial interview/consultation, check whether there is a fee.
Find out how the professional prefers the initial session; with only the parents, with the child, or as a family group, etc. Note: Question carefully any treatment professional who doesn’t want to see the child prior to agreeing to treatment. This is less important with an educational evaluator, neuropsychological tester or psychopharmacologist, where expertise is the only critical criteria for selection.

Make the Initial Appointment

Inquire exactly what will be reviewed at the initial session.
Ask if you should send copies of any documents you have prior to the interview.
lf the professional you’re speaking with will be seen regularly over a period of time (psychologist, speech and language or occupational therapist, reading specialist, etc.) and time is extremely limited so you can only schedule regular sessions for specific hours, you should check now to see if the person you would be seeing is there at an acceptable time.
You should meet with the professional first, without the child. Only after you’ve determined there is a potentially good relationship, but before you’ve made any commitments, should you have the professional meet with the child. (This applies more for therapeutic services.)
If you’re making the second appointment (for the therapist or evaluator to meet the child), leave time to speak with the professional after he/she meets your child. Do not go in first, as this sets the relationship up in the eyes of the child as primarily between the parent and therapist. If you have a young child, find out if there is some provision for watching the child for part of the session so you can speak privately. Can you bring someone along for that purpose?

The Appointment

Both parents, if possible, should attend.
Briefly review with the professional all that was said on the phone.
Bring copies of all records pertaining to your child. (Although the professional may not wish to read these documents during the session.)
Discuss in what ways, and with which approach/technique the professional could help your child.
Specifically determine whether your child’s issues are within that person’s realm of expertise.
Be prepared to give a child and family background (the nature and extent of this depending upon the type of professional service being sought). Note: The intake interview, where this information is usually discussed in detail, should be scheduled only after you’ve decided this is the professional you want to use.
Discuss the professional’s experience with ADD/ADHD.
Ask the professional to offer his/her view on the cause(s) of ADD/ADHD—this gives you some idea of how involved the person is with the topic; whether they know of current neurological studies, etc.
Ask the percentage of current patients with ADD/ ADHD.
Ask if the professional is familiar with CHADD or is a member.
Inquire how quickly he/she will return phone calls.
Check on references. Ask if you can speak with the parent of a client.
If more than one professional is involved in your child’s treatment, ask this professional if he/she is:
Willing to work closely with other professionals who are also working with the child and family, including school staff.
Will he/she write reports if needed (fee?), attend meetings, have phone discussions, etc.?
Discuss the specific contact, if any, the professional will have with your child’s teacher
If the professional is an MD, find out how he/she will work with your child’s psychologist, if any; and if the person you’re interviewing is a psychologist or social worker, ask how they work with the medical doctor.
One person should be clearly designated the coordinator. This is usually one or both parents, but it can be anyone on the child’s team.
Review prospective starting date and available hours.
Check on charges for cancellations.

Summarize the Interview, in case of any misunderstandings, then:

Ask the professional if, given what he/she has been told about the child and what they’ve seen, do they think this is a good match for his/her services, or could they recommend another professional who might be even more appropriate for this child?
If the person indicates a desire to work with you and your child, ask them to be specific as to why they think they can help in your particular situation.
Ask if there are any special issues he/she would like to discuss that might influence your choice of professional.
Request a day or as long as you need to think about it, make your decision and get back to them.

After the Interview

Write a brief note to the various professionals you interviewed, thanking them for their time and insights, and for those not selected, a short comment to the effect that you’ve decided to work with someone you feel is more suitable for your child (and/or your pocketbook).
For the professional you do select, it is a good idea to get a written confirmation of the particulars of treatment(frequency and length of sessions with child, with family, types of tests, costs, etc.)

Following are questions specific to a particular need, be it diagnosis, evaluation, treatment or remediation:

Questions if you are seeking a Diagnosis (Medical, Psychological, Educational, etc.):

Ask for an outline of the methodology to be used to insure an accurate diagnosis. What criteria will be used? Will other professionals be included?
What tests will be utilized? Will a school or home visit be necessary? How much time will it take? What additional costs can be anticipated?
What treatment plan is likely to be recommended if the diagnosis is positive?
Will the person making the diagnosis be the same person who will do ongoing treatment? Note: This is not necessarily the case. Some professionals specialize in diagnostics; others in treatment.
Find our whether the evaluation will include a written report, specific recommendations (for the school, tutor, parents, etc.).
Ask whether the tester is willing to meet with the school and explain test results, and whether he/she will be available in the future for any questions you still may have.
Questions if the Professional is going to provide Therapy for your child (primarily Psychological); also applies to working with a Coach:
What is the type of therapy used (“treatment modality”) Le.: individual, group, family, tri-modal?
Review what the therapy “should” accomplish, from your perspective and from that of the professional.
Ask how often the sessions will take place.
Discuss if the professional sees this as totally open-ended or if he/she can assign a time frame to length of treatment.
Ask how he/she (and you) will know the treatment is working. What criteria will be used to measure success? How much time is needed before this judgment can be made?
Find out how you would be kept appraised of your child’s progress (Le., occasional phone calls, once a month meetings, etc.)
Find out how the professional views the confidentiality of his/her meetings with your child—will they alert you to critical issues or consider it patient confidentiality?
Inquire how frequently the treatment professional would like the child followed up by a psychopharmacologist.

Questions regarding Medication (primarily for the Psychopharmacologist):

Discuss the pros and cons of medication and how monitoring is accomplished if medication is indicated.
Ask what medications he/she is familiar with and has successfully used with ADD/ ADHD children; how long he/she has been prescribing each; personal preferences and reasons for them.
Ask how each medication works and what are its side effects and contraindications.
Ask how the medication is administered and adjusted.
Ask the psychopharmacologist how he/she (and you) will know the medication is working? How will he/she/you know if is isn’t working? How long will it take to make this judgment?
Ask how often the doctor needs to see the child and what will occur at these visits.

Questions about Testing (primarily for the Psychological/Educational Evaluator):

Ask what tests will be administered to your child, at what location and by whom -Request specific names and forms.
Ask why these tests are included in the test battery. What does each test show? How will each relate to your child’s specific diagnosis?
Ask how many test sessions will be needed.
Check that the evaluation includes a written report and specific recommendations (for the school, tutor, parents, etc.) Ask how long it will take for the test report to be ready. Specify if you have a time deadline.
Ask how test results will be explained to you; how will further questions be answered?
Ask whether the consultant is willing to meet with the school and explain test results, and whether he/she will be available in the future for any questions you still may have.
State who should receive copies of the test report.
Check on additional fees for reports, etc., if any.

Questions to ask the Educational Consultant/Advocate:

Ask about the advocate’s experience with public, private and special education schools.
Ask about his/her philosophy of appropriate educational placement for ADD/ADHD children.
Ask about his/her knowledge of due-process rights for ADD/ADHD children in your school district.
What is the person’s usual course of action with ADD/ADHD children? How much time is usually needed (and what outlay of money) to achieve the results you desire? Is there a retainer fee or an hourly rate?
What is the typical cost of the service? Clarify your financial obligations for known items (i.e., school visit) and future possibilities (school board hearing).
Ask how much parental participation is required? What will you be expected to do? What will the consultant/advocate do for you?
Be clear as to what meetings he/she will attend, and with whom? Are there any meetings the advocate would want to instigate?

Questions for the Tutor/Educational Therapist:

Ask about the tutor’s professional background (teaching experience, training, professional affiliations).
Ask specifically about the tutor’s experience with working with children with ADD/ ADHD and the age range of those children.
Ask about his/her philosophy of teaching children with ADD/ADHD. Does he/she have any negative feelings about medication as part of the treatment plan?
Ask if the tutor is familiar with your child’s school and/or has ever worked with children from the school.
Describe any academic difficulty your child is having. How might she/he approach this problem?
Does the tutor work primarily on skills development, compensatory learning strategies or homework help?
Is the tutor willing to maintain regular contact with the school if parent and school request it. Is there an additional fee for school visits?
Ask how much parental involvement in the tutoring process is expected. Will the child be expected to complete homework from tutoring as well as assignments from school?
Ask if the tutor will administer his/her own battery of tests before beginning instruction or will those administered by the educational evaluator be sufficient to begin.
Ask how progress will be monitored.
Ask about additional fees for written reports, missed sessions, etc.
If you have additional tips or suggestions, please send them to us at the address below.

With special thanks to the following:

Arlene Landes, CSW	Susan Luger, MSEd, CSW
Harold Meyer, DaD	Susan Lasky, MoM
Eileen Marzola, EdD	Virginia Sterling, Academic Language Therapist

For information on CH.A.D.D. (Children and Adults with Attention-Deficit/Hyperactivity Disorder), visit to chadd.org

TDAH, Funciones Ejecutivas y Exito Escolar

kerch — Mon, 21 Nov 2011 13:35:23 +0000

TDAH, FUNCIONES EJECUTIVAS Y EXITO ESCOLAR

Chris A. Zeigler Dendy, Maestra en Ciencias

Hace cinco años, la mayoría de los padres y maestros de estudiantes con TDA no sospechaba siquiera que el éxito académico de un niño está supeditado al desarrollo sólido de sus funciones ejecutivas. Hoy en día, sin embargo, muchos padres informados y educadores han caído en la cuenta de que los déficits en las capacidades cognitivas conocidas como funciones ejecutivas (FE) evolucionan más despacio en los niños que padecen de TDA. En 2007, algunos investigadores hicieron un descubrimiento sorprendente: los cerebros de quienes padecen de TDA maduran tres años más despacio que los de sus pares. Este descubrimiento sirve para explicar el atraso en el desarrollo de las funciones ejecutivas de estos niños.

Impacto del TDA y los Déficits en las Funciones Ejecutivas en el Proceso de Aprendizaje y Comportamiento. Hablando de manera práctica, se puede decir que las dificultades con el “centro directivo del cerebro” (brain’s CEO) ocasionan varios problemas: desorganización, dificultad para iniciar y terminar trabajos, dificultad para recordar tareas, dificultad para memorizar datos, escribir ensayos o reportes, resolver problemas matemáticos complejos, recordar material de lectura, completar proyectos de largo plazo, estar a tiempo, controlar las emociones y, planear para el futuro.

Antes de entender el papel de las funciones ejecutivas, tanto padres como maestros se frustraban cuando los estudiantes, aún los intelectualmente dotados, se encontraban al borde del fracaso escolar. Desafortunadamente, para aquellos no suficientemente informados, los déficits en las funciones ejecutivas se consideraban con frecuencia rasgos de “desidia o falta de motivación”. Cuando un estudiante tenía dificultades para empezar o terminar un ensayo o ejercicio de matemáticas, se asumía fácilmente que el estudiante elegía no terminar el trabajo.

Definición de las Funciones Ejecutivas. A pesar de que los científicos no han llegado a un consenso sobre los elementos exactos que componen las funciones ejecutivas, dos investigadores especializados en TDA, los doctores Russell Barkley y Tom Brown, nos han proporcionado descripciones interesantes de las mismas. El doctor Barkley define las funciones ejecutivas como “aquellas acciones sobre nosotros mismos, o dirigidas a nosotros mismos, que nos permiten alcanzar el auto-control, desarrollar comportamientos orientados a metas, y maximizar resultados futuros”. Mediante el uso de la metáfora, el doctor Brown nos proporciona una útil descripción visual al comparar las funciones ejecutivas con el papel de un conductor de orquesta. El conductor organiza varios instrumentos para que se toquen ya sea de forma individual o colectiva, integra la música haciendo y omitiendo ciertas acciones, y controla su ritmo e intensidad. El doctor Gerard Gioia y sus colegas también han contribuido a nuestros conocimientos sobre las funciones ejecutivas con el desarrollo de BRIEF (Behavior Rating Scale of Executive Functions) (escala de comportamiento de las funciones ejecutivas).

Investigación en Funciones Ejecutivas. Los reportes de investigadores varían ampliamente sobre la frecuencia de déficits de este tipo en estudiantes con TDA. No obstante, el Dr. Russell Barkley, reconocido experto en TDA, señaló que entre 89 y 98 por ciento de los niños con TDA presentan déficits en sus capacidades ejecutivas. El Dr. Barkley piensa que los resultados de las escalas que miden las capacidades ejecutivas son indicadores más acertados del funcionamiento en el mundo real que los bajos resultados de tasas de prevalencia de déficits que se reportan en tests tradicionales que miden habilidades ejecutivas.

De acuerdo con el Dr. Barkley, los estudiantes con TDA presentan aproximadamente un treinta por ciento de retraso en el desarrollo de habilidades sociales y organizacionales. Básicamente, esto significa que los niños con estas características aparentan menor madurez y responsabilidad que sus pares. Por ejemplo, con frecuencia las habilidades ejecutivas de un niño de doce años se parecen más a las de un niño de ocho años de edad. Para garantizar el éxito académico en estos estudiantes, los padres y maestros deben proporcionar mayor supervisión y seguimiento que lo acostumbrado para la edad correspondiente. Me gusta referirme a esto como “supervisión acorde al desarrollo”.

Impacto en el Mundo Real. A pesar de que nuestro hijo Alex superó con éxito los años de educación temprana, finalmente se topó con “el muro de piedra del TDA” (ADHD brick wall) cuando llegó a la educación media. Tardíamente caí en la cuenta de que en la secundaria la necesidad de las habilidades ejecutivas aumenta exponencialmente (trabajar de forma independiente, organización personal, empezar proyectos, recordar múltiples tareas). Aun como maestra y psicóloga escolar que fui, por muchos años no reconocí que un coeficiente intelectual alto no se traduce necesariamente en buenas calificaciones. No fue sino hasta que el Dr. Barkley identificó el papel central que tienen las funciones ejecutivas en el desempeño escolar, que finalmente entendí porqué la escuela era tan difícil para mi hijo. Los maestros solían decirnos: “Alex es brillante; tendría mejores calificaciones si se esforzara más”. La realidad es que los niños realmente tratan de hacer un mejor esfuerzo, sin embargo, no pueden tener buenas calificaciones sin los apoyos académicos y tratamiento apropiados. La conclusión – la causa principal por la que Alex tuvo dificultades en el ámbito académico fue padecer de déficits en sus funciones ejecutivas, no el TDA.

Componentes de las Funciones Ejecutivas.

Tomando como referencia lo que han escrito Barkely, Brown y Gioia, a continuación señalo ocho componentes generales de las funciones ejecutivas que afectan el desempeño escolar:

1. Memoria de trabajo y la capacidad de recordar (retener datos en la mente a la vez que se manipula información; recordar hechos almacenados en la memoria de largo plazo; incluye una noción deficiente del tiempo)

2. Activación, motivación y esfuerzo (empezar algo; poner atención; terminar lo que se empieza)

3. Control de las emociones (habilidad de tolerar la frustración; pensar antes de actuar o hablar)

4. Internalización del lenguaje (usar el lenguaje interno para controlar el propio comportamiento y dirigir acciones futuras)

5. La capacidad de aislar un hecho, analizarlo por partes, reconstruirlo y reorganizarlo como nuevas ideas (resolución compleja de problemas)

6. Capacidad de cambio e inhibición (cambiar de actividades, hacer un alto en las que se están desempeñando, detenerse a pensar antes de actuar o hablar)

7. Organización/planeación anticipada (manejo del tiempo, proyectos, materiales y posesiones)

8. Monitoreo (auto-monitoreo y auto-motivación)

Dos Categorías de Déficits en las Funciones Ejecutivas. Me ha parecido útil separar los déficits en las funciones ejecutivas en dos categorías generales:

1) Habilidades académicas específicas, tales como escribir ensayos, recordar lo que se lee (comprensión de lectura), memorizar información, resolver problemas matemáticos complejos, y

2) Habilidades esenciales relacionadas, tales como la capacidad de organizarse, empezar y terminar trabajos, recordar tareas y fechas límite de entrega, completar en tiempo asignaciones y proyectos de largo plazo, procesar información de forma eficiente y puntual, tener buena noción y administración del tiempo, internalizar el lenguaje para dirigir el propio comportamiento, usar reportes semanales y planear para el futuro.

Los déficits en las habilidades esenciales relacionadas se pueden confundir con holgazanería. Toda vez que las deficiencias en las habilidades académicas específicas se detectan fácilmente, los maestros están más dispuestos a dar los apoyos necesarios. No obstante, los maestros no tienen la misma disposición cuando se trata de deficiencias en las habilidades esenciales relacionadas tales como la desorganización, la falta de iniciativa y la incapacidad de entregar asignaciones en tiempo. Desafortunadamente, a primera vista, la incapacidad de llevar a cabo estas tareas parece ser una elección voluntaria; sin embargo, no es el caso, ya que un déficit neurológico hace que estas tareas se vuelvan extremadamente difíciles para quienes padecen de TDA. En consecuencia, los padres y maestros deben tener siempre en mente que, antes que otra cosa, este es un problema neurológico y no de holgazanería.

Elemento crítico de las funciones ejecutivas.

Analicemos más a fondo uno de los elementos de las funciones ejecutivas – el déficit en la memoria de trabajo y capacidad de recordar – y su impacto en el desempeño escolar.

Deficiencia en la Memoria de Trabajo y Capacidad de Recordar.

Contrario a lo que se cree, los investigadores han señalado que la funcionalidad de las habilidades de memoria es mejor indicador del éxito académico que los resultados que miden el coeficiente intelectual. Esto explica porqué los niños con TDA y altos coeficientes intelectuales pueden tener dificultades en el ámbito escolar. Tener un déficit en la memoria de trabajo y capacidad de recordar puede afectar negativamente a los estudiantes en varios aspectos:

1. El aquí y el ahora. Los niños con TDA tienen una capacidad de memoria de trabajo limitada que se refleja en sus comportamientos en casa y en el salón de clases:

- al recordar y seguir instrucciones,

- memorizar datos matemáticos, el deletreo de palabras y fechas,

- realizar cálculos mentales como por ejemplo cálculos matemáticos,

- completar problemas matemáticos complejos (algebra),

- recordar parte de una tarea mientras se trabaja en otra sección de la misma,

- parafrasear o resumir, y

- organizar y escribir ensayos.

2. Noción de eventos pasados: Toda vez que nuestros estudiantes tienen dificultades para recordar el pasado, tienen una visión retrospectiva limitada; es decir, no aprenden fácilmente de comportamientos anteriores. Esto puede explicar porqué los niños repiten frecuentemente malos comportamientos.

3. Noción del tiempo: Muchos estudiantes con TDA tienen dificultades para tener en mente ciertos eventos y usar su noción del tiempo para prepararse para eventos próximos y futuros. En consecuencia, tienen dificultades para juzgar el trastorno del tiempo con precisión.

4. Conocimiento de uno mismo: Como resultado de un pobre conocimiento de sí mismos, estos estudiantes no pueden fácilmente examinar o cambiar su propio comportamiento. Quizá esto explica porqué no son conscientes muchas veces de conductas que pueden alejar a sus amigos.

5. Noción del futuro: La mayoría de los estudiantes con déficits en la memoria de trabajo se enfocan en el aquí y el ahora y son menos propensos a hablar del tiempo o hacer planes para el futuro. De esta forma, tienen una capacidad de prevención limitada; en otras palabras, tienen dificultades para aprender de lecciones pasadas y cambiar comportamientos futuros. No es sorprendente, entonces, que tengan dificultades para prepararse para el futuro.

Problemas Académicos Comunes Relacionados al TDA y Deficiencias en las Funciones Ejecutivas

Muchos estudiantes con TDA presentan deficiencias en la memoria de trabajo y algunos incluso una lenta velocidad de procesamiento, mismos que son elementos críticos de las funciones ejecutivas. Estas habilidades son indispensables para escribir ensayos y resolver problemas matemáticos.

Un estudio reciente de Mayes y Calhoun ha identificado la expresión escrita como el problema de aprendizaje más común en estudiantes con TDA (65 por ciento). En consecuencia, escribir ensayos, preparar reportes de libros o contestar preguntas en exámenes o tareas es un gran reto. Por ejemplo, a la hora de escribir ensayos, los estudiantes suelen tener dificultad para retener, tener en cuenta y organizar ideas, hacer uso de reglas de gramática, pronunciación y puntuación almacenadas en la memoria de largo plazo, manipular información, recordar ideas para escribir, organizar material en secuencias lógicas, y finalmente revisar y corregir errores.

Dado que aprender es relativamente fácil para la mayoría de nosotros, algunas veces olvidamos lo complejas que pueden ser tareas que parecen sencillas a simple vista tales como memorizar tablas de multiplicar o resolver problemas matemáticos. Por ejemplo, cuando un estudiante resuelve un problema matemático, debe poder alternar sus habilidades analíticas y varios niveles de memoria (de trabajo, de corto y largo plazos). En el caso de problemas de palabras, debe poder retener números y preguntas mientras decide la solución al problema. Enseguida, debe poder accesar su memoria de largo plazo para encontrar la regla matemática adecuada para resolver el problema. Finalmente debe poder retener datos importantes mientras aplica reglas y usa información alternando entre su memoria de trabajo y la de corto plazo para resolver el problema y encontrar una solución.

Para complicar más las cosas, en algunos casos el TDA presenta comorbilidad con otros padecimientos graves. De acuerdo con en un estudio clave del Instituto Nacional de Salud Mental (National Institute of Mental Health) sobre el TDA (conocido como MTA), dos terceras partes de los niños con TDA presentan al menos un padecimiento coexistente como la depresión y ansiedad. ¡Es fundamental entonces proporcionar apoyos a los estudiantes con casos complejos de TDA! Estos niños están en mayor riesgo que sus compañeros de presentar una serie de problemas escolares tales como reprobar un grado, saltarse clases, ser suspendidos o expulsados, y en algunas ocasiones, dejar la escuela y no continuar con la educación media y superior.

Estrategias de Éxito Favoritas de las Escuelas

Con los años, he identificado varias estrategias de enseñanza y adaptaciones que funcionan bien con los estudiantes que presentan TDA. A continuación señalo algunas de mis favoritas:

Estrategias Generales de Enseñanza

- Hacer el proceso de aprendizaje tan concreto y visual como sea posible.

Expresión escrita

- Dictar información a algún “escriba” o a los padres.

- Usar organizadores gráficos que sirvan como recordatorios visuales.

- Usar notas “post-it” cuando se haga lluvia de ideas para escribir ensayos.

Matemáticas

- Apoyarse en un compañero que haga las veces de tutor.

- Trabajar en pares (el profesor explica un problema, los estudiantes hacen sus propios ejemplos, intercambian sus trabajos y discuten las respuestas).

(Después de aprobar con dificultad álgebra en la preparatoria y universidad, mi hijo logró la calificación más alta en cálculo además de un promedio de 10 en sus exámenes cuando el profesor utilizó esta estrategia).

Memoria

Usar estrategias nemotécnicas (estrategias de memoria) tales como acrónimos o acrósticos. Por ejemplo, HOMES para recordar los nombres de los Grandes Lagos.

Usar material visual con información clave en tiras de cartulina.

Modificar los métodos de enseñanza:

Usar un proyector para demostrar cómo se escribe un ensayo (los padres pueden usar una hoja de papel o una computadora para enseñar esta habilidad).

Usar colores para destacar información importante.

Usar organizadores gráficos para ayudar a que los estudiantes organicen sus pensamientos.

Modificar las tareas – reducir el trabajo escrito.

Hacer las tareas más cortas.

Revisar el tiempo que se dedica a tareas, y reducirlo si se considera apropiado (cuando el total de la tarea toma poco más de 10 minutos por grado tal y como lo han recomendado los lineamientos del PTA/NEA (PTA/NEA Policy); un estudiante de séptimo grado debe dedicar 70 minutos)

Escribir solamente las respuestas, no las preguntas (fotocopiar las preguntas).

Modificar exámenes y calificaciones.

Dar mayor tiempo para contestar exámenes.

Dividir proyectos de largo plazo en segmentos con fecha límite y calificaciones independientes.

Promediar dos calificaciones en ensayos – una para contenido y otra para gramática.

Modificar el nivel de apoyo y supervisión.

Designar “capitanes de fila” para revisar que se lleven a cabo tareas y posteriormente se entreguen a los maestros.

Aumentar el tiempo de supervisión y monitoreo para estos estudiantes, si es que presentan dificultades.

Emplear tecnología.

Usar computadoras tan frecuentemente como sea posible.

Usar software para enseñar habilidades.

Desafortunadamente, los estudiantes con TDA son castigados frecuentemente por sus deficiencias en funciones ejecutivas tales como falta de habilidades organizacionales y de memoria que interfieren con su capacidad de llevar a casa las tareas y libros adecuados. Espero que después de leer este artículo, maestros y padres de familia desarrollen estrategias de intervención más innovadoras. Por ejemplo, una alternativa efectiva sería que alguien (amigo o asistente de profesor) se reuniera con el estudiante en su locker para recoger los materiales necesarios para tarea. A la larga, este proceso de “moldeado” del comportamiento en el “punto crítico de desempeño” ayudará al estudiante a dominar habilidades, o por lo menos, le enseñará a compensar sus limitaciones.

En Conclusión

Claramente el ámbito escolar presenta dificultades para los estudiantes con TDA. Sin embargo, cuando el TDA se acompaña de deficiencias en las funciones ejecutivas, los problemas que se presentan pueden ser abrumadores para los estudiantes y sus familias. Tradicionalmente, maestros y padres de familia eran poco conscientes o comprensivos ante los retos derivados de dichas deficiencias. ¡Con suerte, hoy en día maestros y padres de familia entenderán que el TDA es un padecimiento muy complejo! Es mucho más que un caso de hiperactividad. Cuando existen además déficits en las funciones ejecutivas y problemas de aprendizaje relacionados, ¡los estudiantes fracasarán en la escuela a pesar de hacer su mejor esfuerzo!

¿Qué deben hacer entonces los maestros y padres de familia con esta información novedosa? Identificar:

1) Los problemas de aprendizaje específicos del estudiante (por ejemplo, la expresión escrita o las matemáticas), y

2) sus déficits en las funciones ejecutivas (por ejemplo, memoria de trabajo, desorganización, descuidos, o limitada noción del tiempo) y, ¡proporcionar apoyos en ambas áreas!

Les dejo una idea para pensar: “¡Tener éxito en la escuela es una de las experiencias más terapéuticas que puede tener un niño! ¡Haga cualquier cosa que sea necesaria para ayudarle al niño a tener éxito en el ámbito escolar!”

Comentario Personal: Nuestro hijo menor, Alex, tuvo muchas dificultades en la educación media y superior a causa del TDA y déficits en las funciones ejecutivas. Estamos orgullosos de que desafió la adversidad y se graduó de la universidad. Así que si su hijo está teniendo problemas en la escuela, no se dé por vencido. Mi familia es ejemplo de esperanza y apoyo para quienes presentan TDA y padecimientos coexistentes.

Por favor visite mi página electrónica www.chrisdendy.com para tener más información de mi familia y de cómo hemos sobrellevado el TDA. Están también a su disposición varios artículos para descargar y compartir con amigos. ¡Les deseo éxito escolar a ustedes, sus hijos y a los estudiantes que padecen de déficit de atención!

Referencias:

Barkley, Russell A. Attention Deficit Hyperactivity Disorder, (3era edición) Nueva York: The Guilford Press, 2006.

Brown, Thomas E. Attention Deficit Disorders and Comorbidities in Children, Adolescents, and Adults.

Washington, DC: American Psychiatric Press, 2000.

Dendy, Chris A. Zeigler. Teaching Teens with ADD, ADHD, and Executive Function Deficits, Bethesda, MD.

Woodbine House, 2000 (2da edición lista en el verano del 2011)

Dendy, Chris A. Zeigler. Teenagers with ADD and ADHD, (2da edición) Bethesda, MD: Woodbine House, 2006.

Deschler, Donald D., Edwin S. Ellis, y B. Keith Lenz. Teaching Adolescents with Learning Disabilities Denver, CO: Love Publishing Company, 1996.

Levine, Mel Educational Care. (2da edición) Cambridge, MA: Educators Publishing Service, 2002.

Mayes Susan D. y Susan Calhoun “Prevalence and Degree of Attention and Learning Problems in ADHD and LD”. ADHD Reports, v. 8, n.2, Abril 2000.

Chris Dendy tiene más de 40 años de experiencia como profesora, psicóloga escolar, consejera y administradora en salud mental además de, quizás lo más importante, ser madre de tres hijos ya mayores con TDA. La Sra. Dendy es la autora de tres libros reconocidos en TDA y la productora de tres videos, Teen to Teen, the ADD Experience y Father to Father. Un nuevo DVD para niños y adolescentes, Real Life ADHD, con la participación de 30 adolescentes, se encuentra actualmente en producción. Ella y su hijo Alex son coautores de un libro específico para adolescentes: A Bird’s-Eye View of Life with ADD and ADHD: Advice from Young Survivors. Ella y su esposo son miembros del Consejo Presidencial de CHADD. Formó parte del Consejo de Administración Nacional de CHADD de 2001 a 2005. Fue incluida en el Salón de la Fama de CHADD por sus destacadas aportaciones al campo.

More by Chris Dendy: Click here.

Extended time improves reading comprehension test scores for adolescents with ADHD

kerch — Mon, 07 Nov 2011 20:19:19 +0000

OJP.RdgArticle.2011Open Journal of Psychiatry, 2011, 1, 79-87 OJPsych
doi:10.4236/jsemat.2011.13014 Published Online October 2011

CLICK here to read the complete Article

Given the findings of this study, it would seem advisable
forclinicians assessing individuals with ADHD to inquire directly
about whether they are able to complete tests involving reading
comprehension within the time usually allowed. If the student
reports frequent inability to complete such tests, the student
should be referred for a full psychoeducational evaluation,
including the NDRT or a comparable measure, to establish whether
accommodations including extended time for tests and examination
are appropriate and should be provided.

Report Finds Parent Training Effective for Treating Young Children With ADHD

kerch — Mon, 31 Oct 2011 17:59:53 +0000

Report Finds Parent Training Effective for Treating Young Children With ADHD

Press Release Date: October 24, 2011

Formal training in parenting strategies is a low-risk, effective method for improving behavior in preschool-age children at risk for developing attention deficit hyperactivity disorder (ADHD), while there is less evidence supporting the use of medications for children younger than 6 years old, according to a new report from the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ).

The report found that formal parenting interventions—known as parent behavior training or PBT—are supported by strong evidence for effectiveness for children younger than the age of 6, with no reports of complications or harms. However, one large barrier to the success of PBT is parents who drop out of therapy programs, the report found. For children older than age 6, the report found that methylphenidate (sold under the brand name Ritalin) and another drug used to treat ADHD symptoms, atomoxetine (sold as Strattera), are generally safe and effective for improving behavior, but their effects beyond 12 to 24 months have not been well studied. Little information is available about the long-term effects of other medications used to treat ADHD symptoms.

The report, a comparative effectiveness review prepared for AHRQ’s Effective Health Care Program by the McMaster Evidence-based Practice Center in Hamilton, Ontario, is available at www.effectivehealthcare.ahrq.gov.

“ADHD can place many challenges on families with young and school-age children,” said AHRQ Director Carolyn M. Clancy, M.D. “This new report and these summary publications will help children, parents and their doctors work together to find the best treatment option based on the family’s values, preferences and needs.”

Children with ADHD, a condition characterized by inattention, overactivity and impulsivity, are most frequently identified and treated in primary school. It is estimated that approximately 5 percent of children worldwide exhibit behavior consistent with ADHD, with boys twice as likely to be classified as having ADHD than girls.

However, identification and management of ADHD can be challenging, and diagnosis and treatment vary greatly depending on geography and culture. Many preschool-age children who exhibit aggressive or noncompliant behavior and may eventually develop ADHD initially receive a more general diagnosis of disruptive behavior disorder.

Ritalin was first used in the 1950s to treat disruptive behavior, and the use of drug-based treatment has increased since then, along with refinements in understanding and recognition of ADHD as a disorder. By 1999, approximately 11 million prescriptions for Ritalin were written annually in the United States, with another 6 million prescriptions written for amphetamines. There has been ongoing uncertainty about accurate diagnosis of ADHD and potential overprescription of Ritalin and other drugs, particularly in recent years as drug treatment has spread to other populations.

In the past 25 years, four major PBT methods have been developed. These programs are designed to help parents manage their child’s problem behavior with more effective discipline strategies using rewards and nonpunitive consequences. Each promotes a positive and caring relationship between parents and their child, and seeks to improve both child behavior and parenting skills.

The AHRQ report found that these PBT interventions are effective, with no reported risk of complications for preschool-age children with disruptive behavior disorder, including ADHD. For older children, the report found that methylphenidate and atomoxetine are effective in controlling ADHD symptoms without significant risk of harms for up to 2 years, although research on longer-term effectiveness and possible adverse effects is sparse.

The report, “Attention Deficit Hyperactivity Disorder: Effectiveness of Treatment in At-Risk Preschoolers; Long-Term Effectiveness in All Ages; and Variability in Prevalence, Diagnosis, and Treatment,” is the latest comparative effectiveness review from AHRQ’s Effective Health Care Program. The Effective Health Care Program helps patients, doctors, nurses, pharmacists and others choose the most effective treatments by sponsoring the development of evidence reports and technology assessments to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. More information about the program can be found at http://www.effectivehealthcare.ahrq.gov.

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Log on to:http://www.addrc.org/parenting-skills/

ADHD Executive Function And School Success

kerch — Thu, 06 Oct 2011 16:29:23 +0000

ADHD, EXECUTIVE FUNCTION AND SCHOOL SUCCESS

Chris A. Zeigler Dendy, M.S.

(updated in 2011)

Five years ago, most parents and teachers of students with ADHD didn’t have a clue that a child’s academic success was contingent upon strong executive skills. However, today’s savvy parents and educators realize that deficits in critical cognitive skills known as executive functions (EF) are slower to mature in many children with ADHD. In 2007, researchers made a startling discovery: the brains of students with ADHD mature three years more slowly than their peers. This helps explain why their executive skills are delayed. Two years later, scientists found that the part of the brain that enables students to work on “boring tasks” such as school work has a reduced number of dopamine receptors and transporters. More simply stated the reduced levels of brain chemistry in this key area explains why students can play video games for hours but struggle to complete their homework in a timely manner.

Impact of ADHD and Executive Function Deficits on Learning and Behavior. Practically speaking, problems with the “brain’s CEO” contribute to several problems: disorganization, difficulty getting started and finishing work, remembering homework, plus difficulty memorizing facts, writing essays or reports, working complex math problems, remembering what is read, completing long-term projects, being on time, controlling emotions, and planning for the future.

Before we understood the role of executive functions, parents and teachers were often baffled when students, especially those who were intellectually gifted, teetered on the brink of school failure. Unfortunately, to the uninformed, deficits in executive skills often appeared to be a simple matter of “laziness or lack of motivation”. When a student had trouble getting started and finishing an essay or math work, it was easy to assume that the student chose not to do the task.

Executive Functions Defined. Although scientists have not yet agreed on the exact elements of executive function, two ADHD researchers, Dr. Russell Barkley and Dr. Tom Brown, have given us insightful working descriptions. Dr. Barkley describes executive function as those “actions we perform to ourselves and direct at ourselves so as to accomplish self-control, goal-directed behavior, and the maximization of future outcomes.” Through use of a metaphor, Dr. Brown gives us a helpful visual image by comparing executive function to the conductor’s role in an orchestra. The conductor organizes various instruments to begin playing singularly or in combination, integrates the music by bringing in and fading certain actions, and controls the pace and intensity of the music. Dr. Gerard Gioia and his colleagues also contributed to our knowledge of executive functions when they developed the BRIEF (Behavior Rating Scale of Executive Functions).

Additional Research on Executive Functions. Researchers vary widely in reports about the frequency of these deficits in students with ADHD. However, Dr. Russell Barkley, a noted authority on ADHD, reported that 89-98 percent of children with ADHD have deficits in executive skills. Dr. Barkley believes that the scores on EF rating scales are a better predictor of real world functioning than the lower EF deficit prevalence rates reported on traditional tests of executive skills.

According to Dr. Barkley, students with ADHD experience roughly a thirty percent developmental delay in some skills such as, organizational and social skills. Basically this means our children appear less mature and responsible than their peers. For example, a twelve year old’s executive skills are often more like those of an eight-year-old. To ensure academic success for these students, parents and teachers must provide more supervision and monitoring than is normally expected for this age group. I refer to this as providing “developmentally appropriate supervision.”

Real World Impact. Although our son Alex successfully struggled through the early school years, he finally hit the proverbial “ADHD brick wall” in middle school. Belatedly I realized that the demands for executive skills increase exponentially in middle school (working independently, organizing oneself, getting started, remembering multiple assignments). As a former teacher and school psychologist, I’m also embarrassed to say I failed for many years to recognize that a high IQ score alone was not enough to make good grades. It wasn’t until Dr. Barkley identified the central role executive function plays in school success, that I finally understood why school was so difficult for my son. Teachers would say, “Alex is very bright; he could make better grades if he would just try harder.” In truth, our children often do try harder, but even then, cannot make good grades without proper treatment and academic supports. Bottom line–the executive function deficits were the primary cause of Alex’s academic struggles, not the symptoms of his ADHD.

Components of Executive Function

Based upon material from Barkley, Brown, and Gioia I have outlined eight general components of executive function that impact school performance:

1. Working memory and recall (holding facts in mind while manipulating information; accessing facts stored in long-term memory; includes an impaired sense of time.)
2. Activation, arousal, and effort (getting started; paying attention; finishing work)
3. Controlling emotions (ability to tolerate frustration; thinking before acting or speaking)

4. Internalizing language (using “self-talk” to control one’s behavior and direct future actions)

5. Taking an issue apart, analyzing the pieces, reconstituting and organizing it

into new ideas (complex problem solving).

6. Shifting, inhibiting (changing activities, stopping existing activity, stopping and thinking before acting or speaking)
7. Organizing/planning ahead (organizing time, projects, materials, and possessions)
8. Monitoring (self-monitoring and prompting)

Two categories of Executive Function Deficits. I’ve found it helpful to view the practical impact of executive function deficits in two general categories:

1) specific academic challenges like writing essays, remembering what is read (comprehension), memorizing information, and completing complex math and

2) essential related skills like organization, getting started on and finishing work, remembering tasks and due dates, completing homework and long-term projects in a timely manner, processing information in an efficient and timely manner, having good time awareness and management, using self-talk to direct behavior, using weekly reports, and planning ahead for the future.

Essential related skill deficits may be mistaken for laziness. Since these common academic challenges such as a writing disability are easily recognizable, teachers are more willing to provide necessary accommodations. However, educators may be reluctant to provide needed supports for essential related executive skill deficits such as disorganization, getting started, and failure to submit completed homework in a timely manner. Unfortunately, on the surface, failure to perform these tasks looks like a simple choice was made to be lazy and not complete the work. However, that’s not the case; a neurological deficit makes these tasks extremely difficult for students with attention deficits. Consequently, parents and teachers must always keep in mind that, first and foremost, this is a neurological problem, not laziness.

One critical element of executive functions.

Let’s take a more in-depth look at just one element of executive functions – deficits in working memory and recall—and their impact on school work.

Poor Working Memory and Recall

Contrary to conventional wisdom, researchers report that working memory skills are a better predictor of academic achievement than IQ scores. This explains why children with ADHD and high IQs may still struggle in school. Deficits in working memory and recall negatively affect these students in several areas:

1. The “here and now”: Our children have limited working memory capacity that often impacts their behavior at home and in the classroom:

- remembering and following instructions.

- memorizing math facts, spelling words, and dates.

- performing mental computation such as math in one’s head.

- completing complex math problems (algebra)

- remembering one part of an assignment while working on another segment.

- paraphrasing or summarizing.

- organizing and writing essays.

2. Sense of past events: Because our students have difficulty recalling the past, they have limited hindsight; in other words, they don’t learn easily from past behavior. This may help explain why our children often repeat misbehavior.

3. Sense of time: Many students with ADHD also have difficulty holding events in mind and using their sense of time to prepare for upcoming events and the future. Consequently, they have difficulty judging the passage of time accurately. Practically speaking, they don’t accurately estimate how much time it will take to finish a task, thus they may not allow enough time to complete the work.

4. Sense of self-awareness: As a result of their diminished self-awareness, these students don’t easily examine or change their own behavior. Perhaps this explains why they often are unaware of behaviors that may alienate friends.

5. Sense of the future: Most students with a working memory deficit focus on the here and now and are less likely to talk about time or plan for the future. Thus, they have limited foresight; in other words, they have difficulty projecting lessons learned in the past, forward into the future. Not surprisingly, they have difficulty preparing for the future.

Common Academic Problems Linked to ADHD and Executive Function Deficits

Many students with ADHD have impaired working memory and some also have slow processing speed, which are critical elements of executive function. Not surprisingly, these skills are critical for writing essays, working complex math problems *Algebra), remembering what is read, and completing long-term projects.

A research study by Mayes and Calhoun has identified written expression as the most common learning problem among students with ADHD (65 percent). Consequently, writing essays, drafting book reports or answering questions on tests or homework is often very challenging. For example, when writing essays, students often have difficulty holding ideas in mind, acting upon and organizing the ideas, quickly retrieving grammar, spelling and punctuation rules from long-term memory, manipulating all this information, remembering ideas to write down, organizing the material in a logical sequence, and then reviewing and correcting errors.

Since learning is relatively easy for most of us, sometimes we forget just how complex seemingly simple tasks such as memorizing multiplication tables or working a math problem really are. For example, when a student works on a math problem, he must fluidly move back and forth between analytical skills and several levels of memory (working, short-term, and long-term memory). With word problems, he must hold several numbers and questions in mind while he decides how to work a problem. Next he must delve into long-term memory to find the correct math rule to use for the problem. Then he must hold important facts in mind while he applies the rules and shifts information back and forth between working and short-term memory to work the problem and determine the answer.

To further complicate matters, other serious conditions may co-occur with ADHD. According to a landmark National Institute of Mental Health study on ADHD (known as the MTA), two-thirds of children with ADHD have at least one other coexisting problem, such as depression or anxiety. Accommodating students with complex cases of ADHD is critical! These children are at greater risk than their peers for a multitude of school problems, for example, failing a grade, skipping school, being suspended or expelled, and sometimes, dropping out of school and not going to college.

Favorite School Success Strategies

Over the years I have identified several teaching strategies and accommodations that work well for students with ADHD. So here are just a few of my favorite tips:

General Teaching Strategies

Make the learning process as concrete and visual as possible.

Written expression

Dictate information to a “scribe” or parents.
Use graphic organizers to provide visual prompts.
Use “post-it” notes to brainstorm essay ideas.

Math

Use a peer tutor.
Use paired learning (teacher explains problem, students make up their own examples, swap problems, and discuss answers).

(After barely passing high school and college algebra, my son made an A in calculus plus had a 100 average on tests when the professor used this strategy.)

Memory

Use mnemonics (memory tricks), such as acronyms or acrostics, e.g., HOMES to remember names of the Great Lakes.
Use “visual posting” of key information on strips of poster board.
Consider “Times Alive” to assist with memorizing multiplication tables.
Modify teaching methods.
- Use an overhead projector to demonstrate how to write an essay. (Parents may simply write on paper or a computer to model this skill.)
- Use color to highlight important information.
- Use graphic organizers to help students organize their thoughts.
- Modify assignments – reduce written work.
  - Shorten assignments.
  - Check time spent on homework, and reduce it if appropriate (when total homework takes longer than roughly 10 minutes per grade as recommended in a PTA/NEA Policy, e.g. 7^th grader = 70 minutes).
  - Write answers only, not the questions (photocopy questions).
  - Modify testing and grading.
    - Give extended time on tests.
    - Divide long-term projects into segments with separate due dates and grades.
    - Average two grades on essays– one for content and one for grammar.
  - Modify level of support and supervision.
    - Appoint “row captains” to check to see that homework assignments are written down and later turned in to the teacher.
    - Increase the amount of supervision and monitoring for these students, if they are struggling.
  - Use technology.
    - Use a computer as often as possible.
    - Use software to help teach skills.

Unfortunately students with ADHD are often punished for executive function deficits such as lack of organizational and memory skills that interfere with their ability to bring home the correct homework assignments and books. Hopefully, after reading this article, teachers and parents will develop more innovative intervention strategies. Having homework posted on a website plus keeping an extra book at home for subjects with frequent homework assignments can be very helpful. In addition, have someone (a friend or teacher aide), meet the student at his locker to get the necessary homework materials together. Ultimately, this process of “modeling” and “shaping” behavior at the critical “point of performance” –the point in time when the students decides which books should be taken home–will help the student master skills or at a minimum, teach him to compensate for deficits.

In Closing

Clearly school is often very difficult for students with ADHD. However, when executive function deficits are also present, the accompanying problems are often overwhelming to the student and family. Traditionally, some parents and teachers have had little awareness or sympathy for the challenges presented by these combined deficits. Hopefully, teachers and parents of today realize that ADHD is often a very complex condition! It is much more than just a simple case of hyperactivity. When deficits in executive function and related learning problems are also present, students can try their very best and still not succeed in school!!

So what should parents and teachers do with this new information?

1) Identify the student’s specific learning problems (e.g. written expression or math) and

2) Identify their executive function deficits (e.g. working memory, disorganization, forgetfulness, or impaired sense of time) and

3) Provide accommodations in both areas!

I leave you with this food for thought, “Succeeding in school is one of the most therapeutic things that can happen to a child!! So do whatever it takes to help the child succeed in school.”

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The primary source for this article was my new Teaching Teens with ADD, ADHD, & Executive Function Deficits, 2^nd ed (2011)

A Personal Comment: Our youngest son, Alex, struggled terribly throughout his high school and college years with ADHD and executive function issues. We’re proud that he beat the odds and graduated from college. So if your child is struggling in school, don’t give up. My family offers living proof that there is hope and help for ADHD and coexisting conditions.

Please visit our website www.chrisdendy.com to learn more about my family and how we have coped with ADHD. Several helpful articles are also available for you to download and share with friends. Best wishes for school success to you, your children and students with attention deficits!!

References:

Barkley, Russell A. Attention Deficit Hyperactivity Disorder, (3^rd ed.) New York: The Guilford Press, 2006.

Brown, Thomas E. Attention Deficit Disorders and Comorbidities in Children, Adolescents, and Adults.

Washington, DC: American Psychiatric Press, 2000.

Dendy, Chris A. Zeigler Teaching Teens with ADD, ADHD, and Executive Function Deficits. Bethesda, MD:

Woodbine House, 2011.

Dendy, Chris A. Zeigler Teenagers with ADD and ADHD, (2^nd ed.) Bethesda, MD: Woodbine House, 2006.

Deshler, Donald D., Edwin S. Ellis, and B. Keith Lenz Teaching Adolescents with Learning Disabilities.

Denver, CO: Love Publishing Company, 1996.

Levine, Mel Educational Care.(2^nd ed.) Cambridge, MA: Educators Publishing Service, 2002.

Mayes Susan D. and Susan Calhoun “Prevalence and Degree of Attention and Learning Problems in ADHD

and LD.” ADHD Reports, v.8, n.2, April 2000.

Chris Dendy has over 40 years experience as a teacher, school psychologist, mental health counselor and administrator plus perhaps more importantly, she is the mother of two grown sons and a daughter with ADHD. Ms. Dendy is the author of three popular books on ADHD and producer of three videos, Teen to Teen: the ADD Experience and Father to Father. A new DVD for children and teens, Real Life ADHD, featuring 30 teens is currently available. She and her son Alex coauthored a book specifically for teenagers: A Bird’s-Eye View of Life with ADD and ADHD: Advice from Young Survivors. She and her husband are members of CHADD’s President’s Council. She served on the national CHADD Board of Directors from 2001-2005. She was inducted into the CHADD Hall of Fame for outstanding contributions to the field.