The Benefits & Challenges of Having ADD/ADHD

ADD/ADHD Resources: Gregory A. Fabiano, Ph.D. Assistant Professor of Counseling, School, and Educational Psychology, University at Buffalo C. Wayne Jones, Ph.D., Philadelphia Child & Family Therapy Training Center American Academy of Child & Adolescent Psychiatry Dr. Larry Silver, MD, Director of Training in Child & Adolescent Psychiatry, Georgetown University National Resource Center for ADHD, CHADD Dr. Anthony Kane, MD, ADD/ADHD Advantages Roy Smith, Ph.D., President, Pennsylvania Counseling Services

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Contact Information

Randell D. Turner, Ph.D. Senior Associate Child & Family Therapist Phone: 717-968-9838 E-mail: [email protected]

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A G E N D A

PART 1: The Benefits and Challenges of Having Attention-Deficit Disorder (ADD)/Attention-Deficit Hyperactivity Disorder (ADHD) PART 2: Discipline Tools for Working with Children Who Have Attention-Deficit Disorder (ADD)/Attention-Deficit Hyperactivity Disorder (ADHD) Workshop Objectives Millions of children around the world have and are being diagnosised with ADD/ADHD. Yet many parents & teachers struggle to understand how ADD/ADHD affects their children. Our objectives in this workshop are to: ¾ Gain a better understanding of how ADD/ADHD affects your child. ¾ What do we know about the causes of ADD/ADHD ¾ Understand how ADD/ADHD affects boys and girls differently. ¾ What are the benefits of having ADD/ADHD? ¾ Discipline Tools for Working with ADD/ADHD kids. ¾ How parent & teacher involvement in therapy makes a difference for the child. This is an interactiveworkshop, questions are encouraged!

Workshop Agenda A. Welcome & Introductions B. Overview of ADD/ADHD C. What does it feel like to have ADD/ADHD? D. How ADD/ADHD affects boys and girls differently. E. Benfits of Having ADD/ADHD F. Effective treatment of children with ADD/ADHD G. Discipline Tools for working with ADD/ADHD kids H. Parenting and Teacher involvement in therapy I. Questions & Answers The Father's Workshop International, Randell D. Turner, Ph.D., © 2007 All Rights Reserved

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ADHD & THE FAMILY What is the nature of ADHD and how it affects your child? The nature of ADHD on the brain is that it interrupts the ability to block out interrupting thoughts. Consequently the interrupting thoughts happen so quickly that it totally distracts your child from what he or she was thinking of or what they were asked to do just a few seconds earlier. For example, your child receives an instruction from you such as ““take out the trash””. As they are listening and thinking about doing what you have asked them to, interrupting thoughts coming in from the television, sounds or movement of household pets, smells or a piece of lint on there sleeve will interrupt the original thought ““take out the trash”” so much so that with in a few seconds your child doesn’’t even remember that you asked them to do anything. Everyone has interrupting thoughts that try to interfere with what we are thinking or doing. These interrupting thoughts can be caused by visual distractions such as movement out of the corner of your eye, a commercial on television or the wind blowing something across the lawn. Interrupting thoughts can be created by a smell, a sound or memories that we all carry within us. As we mature our brain helped us to learn how to maintain concentration and block out interrupting thoughts. Unfortunately, the neurological function of a child with ADHD does not have the ability to block out any interrupting thoughts. That is why many are on medication. The medication increases their ability to concentrate and stay on task, but it does not cure the neurological dysfunction. The combination of medication and family therapy help your child to learn to grow up and thrive even with ADHD.

How does ADHD affect your child? ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦

Inability to pay close attention to details Inability to sustain attention to a task or even play Inability to listen even when spoken to Inability to follow through on instructions Fails to finish chores, schoolwork or duties in the workplace Difficulty organizing tasks & activities Often avoids or dislikes tasks that require sustained attention Often loses things, toys, tools & school assignments Often distracted by others or outside distractions such as movement or sounds outside the room Often very forgetful in daily functions

ADHD with Hyperactive impulsivity ♦ ♦ ♦ ♦

Fidgets with hands, feet or squirms in their seat Often leave their seat Often runs about or climbs excessively (THEY CRAVE MOVEMENT!) Difficulty playing in leisurely activities quietly The Father's Workshop International, Randell D. Turner, Ph.D., © 2007 All Rights Reserved

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♦ Often ““on the go”” acts if driven by a meteor. ♦ Excessive talking.

ADHD with Impulsivity ♦ ♦ ♦ ♦

Often bursts out with the answer even before the question is completed Often difficulty waiting his or her turn Often interrupts or intrudes on others Butts into conversations or games.

Struggles children with ADHD often experience: ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦

General immaturity (they can be as 50% socially-emotionally less mature that children their age) Poor self-esteem and demoralization Low frustration tolerance, tendency to over-react Self-centeredness Rejection by peers due to their intrusiveness Misattribution of others’’ intent Inadequate regard for social consequences of their actions Immature play and social interests.

Conditions that often occur with ADHD ♦ ♦ ♦ ♦ ♦ ♦ ♦

Oppositional-Defiant Disorders (60%) Conduct Disorder (45%) Delinquency/Anti-Social Behavior (25%) Anxiety Disorders (30%) Major Depression (33%) Somatization Disorder (24-35% of teens) Learning Disabilities (35%)

Adolescents & young adults with ADHD: School/work outcomes ♦ ♦ ♦ ♦

Under productivity at work (90%) Excessive variability of work (90%) More likely to be fired from jobs (55% vs. 23%) School underachievement ƒ Grade retention (42% vs. 13%) ƒ H.S. School drop-out (32% vs. 0%) ƒ Lower Grade Point Average (1.7 vs. 2.6) ƒ Fewer enter college (22% vs. 77%) ♦ School suspensions (60% vs. 19%)

The Father's Workshop International, Randell D. Turner, Ph.D., © 2007 All Rights Reserved

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Adolescents & young adults with ADHD: Social outcomes ♦ High frequency of interpersonal problems (75%) ƒ Fewer close friends ƒ Heterosexual relationships tend to be of shorter duration ♦ High sexual-reproductive risks ƒ Earlier initiation of sex activity (15 years vs. 16 years) ƒ More lifetime sex partners (18.6 vs. 6.5) ƒ Greater risk of teen pregnancy (38% vs. 4%) ƒ More likely to contract STDs (16% vs. 4%) ♦ 54% of ADHD adults do not have custody of their kids (FATHERS)

Adolescents & young adults with ADHD: Behavioral outcomes ♦ Drug and Alcohol abuse/addiction ƒ 25-35% of teens and 10-15% adults ♦ Frequent moves (3x average) ♦ High risk for auto accidents (3x average) ƒ Poorer steering, more false braking, slower reaction times ƒ Greater percentage of crashes with serious injuries (60% vs. 17%) ƒ High teen auto death rate (4x higher than average) without medications ♦ Greater traffic citations (4x average) ♦ Greater license suspensions (24% vs. 5%) ♦ Police involvement (50%) ♦ Physical aggression (20% higher in a 3 year time-span)

What are the best practices for treating ADHD? ♦ ♦ ♦ ♦

Medication Classroom modifications Behavioral management Family Therapy

Children with ADHD tend to do better when: ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦

They are involved in ““one-to-one situations vs. group settings Their fathers are more involved with their daily routine They are involved in new/novel experiences vs. familiarity They have frequent feedback on how they are doing vs. infrequent feedback They are give or experience immediate consequences vs. delayed consequences High vs. low salience of consequences What they are doing is intrinsically interesting vs. boring, tedious task They work better earlier in the day vs. late in the day due to medications wearing off an brain fatigue Their working environment is supervised vs. unsupervised. The Father's Workshop International, Randell D. Turner, Ph.D., © 2007 All Rights Reserved

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Behavior Management Principles for Parents of ADHD Children ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦

Immediacy of consequences Frequency of consequences Saliency of consequences Act, don’’t yak Positive before negative reinforcement Anticipate problems Maintain priorities Keep a disability perspective Don’’t personalize Practice forgiveness

Top Nine Reasons ADHD Children Misbehave & Parents Lose Control ♦ Unclear rules or consequences (off-the-cuff decision making) ♦ No troubleshooting, failure to take into account the child’’s tendency toward literal thinking) ♦ Not understanding how the child processes information, (how does ADHD affect the child’’s ability to cooperate or be effective?) ♦ Button pushing-parents go into child-like emotional positions ♦ Child becomes drunk with power-learns that they can control the emotions of the house ♦ The pleasure principle-living for the moment, not consistent with boundaries and consequences ♦ Underestimation of the power that their peers have on their thinking and behaviors ♦ Absence of a co-parenting alliance, the child causes division between parents then exploits it. ♦ Misuse of outside forces-parental authority is handed over to counselors, school or caseworkers

Parental strategies for working with your ADHD Child ♦ Tackle only one or two problems at a time ♦ Convert problems into clear rules and expectations ♦ Create a well-written consequence ƒ Identify the child’’s Achilles’’ heel (assume the out of control child operates on the pleasure principle) ƒ Have a plan B ♦ Use both positive and negative consequences ♦ Include the child’’s input and expertise if age appropriate ♦ Give frequent positive feedback for small changes, i.e. parent notice and call attention to the child making good decisions.

The Father's Workshop International, Randell D. Turner, Ph.D., © 2007 All Rights Reserved

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Top Ten Consequences or Incentives for Children with ADHD ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦

Screen time: Computer, Game systems, TV/Video Freedom Clothing Loosing restrictions Trust/Positive regard Appearance (looking good in front of peers) ƒ Clothes and the right to fit in or ““be cool”” Possessions (CDs, cell phones, games etc. Money Telephone Spending quality time with a parent

The Positive Incident Report; Magnifying Small Changes with Frequent Praise and Positive Reinforcement ♦ Don’’t expect the child to receive the positive feedback with open arms-the child will be suspicious of the parents angle or hidden agenda ♦ Give out Positive Reinforcement or Praise for: ƒ Using planning skills (was ready for test, project done on time) ƒ Performed well under stress (didn’’t give up, avoided a meltdown) ƒ Performed beyond the call of duty (extra chores) ƒ Used self-control (avoided argument or fight) ƒ Showed concern for others (helped out, said nice things) ƒ Did something they didn’’t like to do (go to school, get up on time, homework)

ADHD Internet Resources My ADHD; http://myadhd.com Excellent collection of articles, diagnostic questionnaires, monitoring tools and interventions, etc. National Resource Center for ADHD: http://www.chadd.org ADD Warehouse: http://addwarehouse.com

The Father's Workshop International, Randell D. Turner, Ph.D., © 2007 All Rights Reserved

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NOTES

The Benefits and Challenges of Having Attention-Deficit Disorder (ADD)/Attention-Deficit Hyperactivity Disorder (ADHD) Workshop Notes: 1. Overview of ADD/ADHD ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 2. What does it feel like to have ADD/ADHD? ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 3. How ADD/ADHD affects boys and girls differently. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 4. Benfits & Gifts of Having ADD/ADHD ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ The Father's Workshop International, Randell D. Turner, Ph.D., © 2007 All Rights Reserved

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5. Effective treatment of children with ADD/ADHD ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 6. Parenting and Teacher involvement in therapy ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 7. Questions & Answers ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

The Father's Workshop International, Randell D. Turner, Ph.D., © 2007 All Rights Reserved

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NOTES

PART 2: Discipline Tools for Working with Children Who Have Attention-Deficit Disorder (ADD)/Attention-Deficit Hyperactivity Disorder (ADHD) Workshop Notes: J. Benefits & Gifts of Having ADD/ADHD ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ K. Discipline Tools for working with ADD/ADHD kids ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ The Father's Workshop International, Randell D. Turner, Ph.D., © 2007 All Rights Reserved

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____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ L. Parenting and Teacher involvement in therapy ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ M. Questions & Answers ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

The Father's Workshop International, Randell D. Turner, Ph.D., © 2007 All Rights Reserved

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Pennsylvania Counseling Services 128 North George Street York, Pennsylvania 17401

Behavior and Homework Report Teachers, please date and sign for each day Day/Date

Class

Teacher

Behavior Rate 1-5, (one being lowest)

The Father's Workshop International, Randell D. Turner, Ph.D., © 2007 All Rights Reserved

Homework Assignment

The Father's Workshop International, Randell D. Turner, Ph.D., © 2007 All Rights Reserved

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