1. Let’s Stay
Focused!

2. What is AD/HD?
A) A vague disorder that is not well
documented or reliably diagnosed
B) A problem caused by a permissive
society
C) A disorder of the brain with well-
documented diagnostic and treatment
guidelines
D) A behavioral problem caused by poor
parenting
1-2

3. AD/HD Types
Specified by the DSM-IV-R
American Psychiatric Association
Diagnostic and Statistical Manual, 4th
Edition
AD/HD Diagnostic Subtypes:
 Primarily Inattentive Type
 Primarily Hyperactive/Impulsive Type
 Combined Type

4. Characteristics of AD/HD
 A chronic disorder
 Characterized by a pattern of inattention
and/or hyperactivity and/or impulsivity
 Significantly impaired age-appropriate
functioning in at least two areas of life, such as
home, social settings, school or work

5. Predominately Inattentive
Type AD/HD-I
At least six of nine characteristics are required for diagnosis:
 Often fails to give close attention to details or makes
careless mistakes in schoolwork, the work environment or
other activities.
 Often has difficulty sustaining attention in tasks or play
activities.
 Often does not seem to listen when spoken to directly.
 Often does not follow through on instructions and fails to
finish schoolwork or other tasks.
 Often has difficulty organizing tasks and activities.
(cont’d.)

6. Predominately Inattentive
Type AD/HD- I
At least six of nine characteristics are required for diagnosis:
 Often avoids, dislikes or is reluctant to engage in tasks
requiring sustained mental effort (school or homework).
 Often loses things necessary for tasks or activities (toys,
assignments, tools).
 Often easily distracted by extraneous stimuli.
 Often forgetful in daily activities.

7. Inattentive Type
Some individuals could have problems with:
 Slow cognitive processing
(speed of comprehension)
 Trouble “filtering out”
distractions

8. What Does it Take to Pay
Attention?
 Focus
 Select
 Sustain
 Resist Distraction
 Shift

9. Predominately
Hyperactive/Impulsive Type
At least six of nine characteristics are required for diagnosis:
Hyperactivity
 Often fidgets with hands or feet or squirms in seat
 Often leaves seat in classroom or other situations in which
remaining seated is the expectation
 Often runs about or climbs excessively in situations in which it is
inappropriate (in adolescents and adults, it may be limited to
subjective feelings of restlessness)
 Often has difficulty playing or engaging in leisure activities quietly
 Often “on the go” or acts as if “driven by a
motor”

10. Predominately
Hyperactive/Impulsive Type
Impulsivity
 Often blurts out answers before
questions have been completed
 Often has difficulty waiting turn
 Often interrupts or intrudes on
others

11. Impulsivity!!!
Behavioral Impulsivity
 Inability to control behavior or delay reacting
 Includes impulsive actions, risk-taking
behaviors

12. Impulsivity!!!
Cognitive Impulsivity
 Impaired ability to inhibit one’s actions
 Jumps into work before reading directions
 Inability to stop and problem solve
 Responds emotionally and makes poor
decisions

13. Tests…
Drawing by Jeffery T. Houghton

14. CHADD Parent to Parent ©
2008
1-14
11-2008
“Children with AD/HD Are
Managed by The
Moment!”
Russell Barkley Ph.D

15. Girls and Women with AD/HD
 Most have inattentive type
 Commonly diagnosed with
depression and/or anxiety
 Hyperactivity can be associated with hyper-talk
 Very good at making themselves appear invisible
 Hormones from puberty on may have a great impact
 May have an increased sense of inadequacy

16. AD/HD Emotional
Characteristics
 Easily angered or has a short fuse
 Moody
 Easily frustrated
 Gets upset or annoyed quickly
 Irritable
 Loses control easily
From “The ADD/ADHD Checklist” by Sandra Rief, M.A.

17. AD/HD… Further Defined
Individuals with AD/HD may also:
 Have difficulty with transitions and changes in
routine or activity
 Become over-stimulated
 Display aggressive behavior
 Have immature social skills
 Be difficult to discipline effectively
 Be extremely insecure and have low self-
esteem
From “The ADD/ADHD Checklist” by Sandra Rief, M.A.

18. Left Untreated…
The Consequences
2-
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 Low self-esteem
 Social and academic failure
 Risk for substance abuse
 Possible increase in anti-social
behavior

19. 2-
19
The Most Debilitating Effect of
AD/HD is the Loss of Self-Esteem

20. Multimodal Treatment
of AD/HD
 Parent and child education about
diagnosis and treatment
 Increased and consistent structure
 Behavior management techniques
 Creative Parenting
 Medication
 School programming and supports
2-
20

21. The Impact of AD/HD on the
Family
& Creating Developmentally and
Age-Appropriate
Positive Behavioral Interventions

22. Solutions for the
Child with AD/HD
 Consistency from both parents is the key
 Follow through with consequences, charts, rules,
time outs
 Create “house rules”
 Clarify expectations, break tasks into small steps
and even photograph the expected result
 Use enforceable statements without anger,
lectures, threats or warnings
 Delay consequences as you think through a plan
without anger

23. “Executive Functioning”
Children with AD/HD generally suffer from
poor “Executive Functioning”
“Executive Functioning” refers to our ability
to organize, prioritize and analyze in order to
make reasonable decisions and plans
6-
23
Revised 7-15-06

24. Utilizing
working
memory
and
accessing
recall
Brown’s Model of Executive Functions
Impaired in AD/HD
Executive Functions
Brown, T.E. Manual for Attention Deficit Disorder Scales for Children and Adolescents; 2001.
Monitoring
and self-
regulating
action
6.
Action
5.
Memory
Managing
frustration
and
modulating
emotion
Regulating
alertness,
sustaining
effort and
processing
speed
3.
Effort
4.
Emotion
1.
Activation
Organizing,
prioritizing,
and
activating
to work
Focusing,
sustaining
focus and
shifting
focus to
tasks
2.
Focus

25. Executive Functioning
Key areas of the brain act as the control center for an array of
“executive functions” which control skills such as:
 Remembering important information – WORKING
MEMORY
 Expressing oneself in written or spoken language
 Organizing time and space
 Starting and finishing projects
 Controlling emotions
 Using internal self-talk to control one’s actions
 Analyzing and solving complex problems, and
 Planning ahead for the future - FORESIGHT

26. Executive Functioning
Dr. Tom Brown uses a metaphor that compares executive
functioning of the brain “to the function of a conductor of
an orchestra.”
 The conductor organizes, activates, focuses, integrates,
and directs the musicians as they play, enabling the
orchestra to produce complex music.
 Similarly, the brain’s executive functions organize,
activate, focus, integrate and direct, allowing the brain to
perform both routine and creative work.

27. Picture courtesy of Marlene Snyder, Ph.D.
and the Cape Cod Times
Stimulant Medication Impacts
Dopamine Receptors
Synaptic Gap 
Dendritic Spine
Dopamine
Receptor
Dopamine
Stimulant medication
floods the gap with
dopamine

28. 1-
28
Creative
Parenting
101

29. Direct verbal / visual
cues
 Get direct eye contact
 Keep messages short
 Teach child to comply within specific behavioral limits
 Provides the child with a verbal cue that signals to pay attention to
something of importance (i.e., “You need to…”)
 Helps prevent parental instructions from becoming “background noise”
 Ask (without sarcasm) what was just stated.
 Eliminate distractions if necessary.
4-
29

30. Let deficits become strengths!
Deficit (Rethink as) Strength
 Hyperactivity
 Distractibility
 Impulsivity
 disorganized
 Focused energy
 Multi - Interested
 Learned
outspokenness
 Creativity outside
limits
1-
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31. The “box”
Typical AD/HD
“Think outside of the box,
Johnny...”
Think outside the what?
What box…
“I live outside the box.”
How many boxes do you want?
Colored?
Designs?
Anything else?
That’s it?
1-
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32. Class pay attention!
Teacher’s Instructions AD/HD Child begins to think
Complete your projects like this..
A,B,C,D…
Next, you will need…
…does anyone have any questions?
Cool if we go D,C, A,B
…or I’ve got another idea…
Next…?? Boy I’m tired, pretty dress,
nextWednesday, I’m bored, Xbox
360 tonight, …you will…huh?
….wonder what they’re having for
lunch, man I’m hun..and we’ll be
graded huh? What’d she say???
…man, I’m lost again…. 
1-
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33. Good news / bad news
Good news
 Your child is different
 Invest yourself with your time.
 You get to grow!
 See “deficits,” as strengths.
 No one gets it “completely”
right.
 A unique dialog awaits you!
 Your child becomes just like
you…except REALLY different!
Bad news
 You’re child’s different
 You’ve just gotten busier!
 Confusion becomes a friend
 Only you will know how to get
this completely right.
 This is not a dialog you’ve heard
before, nor is everyone having it.
 You’re not going to predict how
they’ll come out.
1-
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34. Core approaches that work and
are appreciated
Love
Patience
Forgiveness
Open-mindedness
Assertiveness
Long-suffering
Support
Understanding
Guidance
Educated
Advocate
Able to believe the
unbelievable
Trust
Tangent listening
Teaching on point
Love
Patience
Forgiveness
1-
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35. Challenges (cont’d)
 Problems with intimate relationships
 Time management difficulties
 Difficulty attending to details
 Inability to locate and maintain important
paperwork
 Difficulty managing finances
 Other
7-
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36. The Impact of AD/HD on the
Spouse or Significant Other
 Intimacy
 Communication
 Finances
 Anger Management
 Impulsivity
 Uninvolvement with family
 Hyperactive behavior
 Irritability/frustration
7-
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37. Possible Substance Abuse Problems
in Teens & Adults with AD/HD
 The risk for developing substance abuse
problems is almost twice as high for adults
with AD/HD as those without the disorder
52% vs. 27%
7-
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38. 2-
38
The Most Debilitating Effect of
AD/HD is the Loss of Self-Esteem

39. CriminalCriminal
behaviorbehavior
School exclusionSchool exclusion
Substance abuseSubstance abuse
TeenageTeenage
pregnancypregnancy
Conduct disorderConduct disorder
Lack ofLack of
motivationmotivation
Complex learningComplex learning
difficultiesdifficulties
AD/HD Only
Low self-
esteem
Disruptive
behavior
Poor social
skills
Learning
Delay
Challenging
behavior
ODD
Age 6 10 14–16
Likely Progression of
Untreated AD/HD
Kewley, 1999

40. Collaboration:
Family Centered
Compassionate
Culturally Effective
Comprehensive
Family
Child/Teen
Schools Clinicians:
Primary Care Physician
Pediatric Sub-Specialist
Allied Health Care Professionals
Community
Community Community
Team
Building
Schools
Teachers
5-
Updated October 2007

41. Eligibility for AD/HD at School
Eligibility for school support services is
based on school related performance
and behaviors only.
A child’s functioning at home or outside of
school is not sufficient for consideration
of an evaluation.
Remember – decisions to evaluate must be
based on a variety of data!
5-41

42. Eligibility Under Section 504
For purposes of §504, a “disabled person”
is one who:
 Has a physical or mental impairment
which substantially limits one or more
major life activities
 Has a record of such impairment, or
 Is regarded as having such an
impairment
It is about impairment, not
diagnosis.
34 C.F.R. §104.3(j)(1)
5-42

43. Understanding Classwork and
Homework-Related Problems
 Getting behind in class and/or poor grades
 Failing to write down assignments
 Not understanding what assignments are and
when they are due
(cont'd)
6-
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44. Classwork and Homework-
Related Problems
 Forgetting assignment book/textbooks or
materials needed
 Taking hours to do minutes of homework
 Hassling about when and where to do
homework
 Failing to bring home notes concerning
homework
 Lying about having done homework
(cont'd)
6-
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45. Homework Chart
School Age
Week of 9/12–9/16
Item Tickets Sun Mon Tues Wed Thurs
Sits down by 4 p.m. to do HW 2 tickets 2 2 0 2 2
Records homework in
planner
4 tickets 4 4 4 0 4
Sits in chair for 30 min.
and completes at least one
assignment
4 tickets 2 4 3 4 2
Completes homework
without whining
6 tickets 3 6 4 6 6
totals 11 tickets 16 tickets 11 tickets 12 tickets 14 tickets
Parents can determine if a child should receive a partial payout for a behavior.

46. Review of Executive Functioning:
Practical Implications on
Performance at Home and School
 Getting started
 Remembering chores and assignments
 Memorizing multiplication tables or other facts
 Writing essays
 Remembering what was read (reading
comprehension)
 Controlling emotions
 Analyzing and problem solving
 Planning for the future
Information from Chris A. Zeigler Dendy
6-
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