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ADHD Co-existing Problems Interventions . P resented b y: D ianne Z accheo MSW FTC M edical F amily T herapy C onsultant The Coaching Centre, London England. This Presentation Will. Explain ADHD Characteristics Comorbidity & Related Problems Children with ADHD Experiences

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adhd co existing problems interventions

ADHD Co-existing Problems Interventions

Presented by:

Dianne ZaccheoMSW FTC

Medical Family Therapy Consultant

The Coaching Centre, London England

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this presentation will
This Presentation Will
  • Explain
  • ADHD Characteristics
  • Comorbidity & Related Problems
  • Children with ADHD Experiences
  • Academic underachievement & failure
  • What is Best Treatment
  • The Zaccheo Coach model
  • A Call for Increased Recognition

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what is adhd
What is ADHD?
  • A Neurobiological Disorder
  • Brain Regions and Genetic Factors
  • Twin Studies: highly genetic in twins
  • Cardinal Symptoms:
  • Inability to Sustain Attention
  • Distractibility
  • Hyperactivity
  • Three Sub-Types
  • DSM-IV vs. ICD-10

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historical overview
Historical Overview
  • Dr George F Still, British Paediatrician, Original Quotes Lancet, 1902:
  • A persistence in a degree unusual
  • not corresponding to environment
  • Abnormal incapacity for sustained attention, parents & teachers notice these children are
  • a danger to self & others
  • Below average degree of moral control
  • Call for active recognition

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research findings
Research Findings

Research confirms

Studies show the rate of brain utilising glucose is lower in ADHD

Significant evidence of brain regions: Prefrontal cortex which regulates attention, distraction leading towards ‘self regulation’ B.

Developmental delays up to 3 years, Dr Shaw Chicago

Exercise and its enormous benefits

Newer medications to fine tune effects non stimulant types

The uses of Coaching approaches

Boy to girl ratio increasing ‘4 to 1’

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dsm iv adhd subtypes
DSM-IV ADHD & Subtypes
  • Innattentive Type
  • Hyperactive Impulsive Type
  • Combined Type
  • ADD highlighted by daydreaming forgetful
  • under activity difficulty sustained effort
  • ADHD highlighted by over-activity racing
  • Impulsivity, excessive behaviours fidgety
  • Combined Type both inattentive & hyperactive impulsive usually adolescents

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children adolescents adults with adhd have problems
Children, Adolescents & Adultswith ADHD Have Problems:
  • Hyperactivity, Inattention, Impulsiveness
  • Trouble sustaining mental efforts
  • Poor working memory forgetfulness
  • Internal motivation goal directed self-talk
  • Organisation losing things
  • Making & prioritising decisions
  • Readiness towards responsibility
  • Remaining on task
  • Communication and articulation skills
  • Social interaction skills

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comorbidity co existing related disorders
Comorbidity: Co-Existing & Related Disorders
  • Self development, Behaviour, Education, Social, Family & Community
  • Low Self Esteem & Low Self Worth
  • Faulty distorted self perception
  • Oppositional Defiant Disorder/Conduct Disorder
  • Tourette’s, Autistic Spectrum & Asperger’s
  • Language & Communication disorders
  • Development Delay
  • Social and relationship problems
  • Academic under performance and achievement
  • Depression, Anxiety, OCD, Substance Abuse,
  • Self Harming, Eating Disorders, Suicidal
  • Criminality, Gambling

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adolescents with adhd at risk
Adolescents with ADHD at Risk

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an impared sense of time
Has no 'sense of time'

Does not get ready on time

Does not plan for future

Does not estimate time correctly

Crises may be frequent

This affects




Following a Plan


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we know what adhd is
We Know what ADHD is……

We just don’t agree about what to do about it…

Hey Stupid





Help us!




Parent-Child Strategies

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  • Long term studies over 30 Years
  • 70 -80% of Children with ADHD developed Conduct Disorder & Oppositional Defiant Disorders
  • Links between aggression in Boys to skill deficits especially Executive Functions: poor planning,
  • abstract reasoning, problem solving, attention span,
  • concentration, inability to delay gratification,
  • controlling short term behaviour to achieve long term goals

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  • 30 -50 % of Adolescents with ADHD will exhibit pervasive conduct problems into adulthood
  • 35- 55% Adolescents with ADHD show significantly higher arrest rates
  • Conduct Disorder increases risk of criminality 55%
  • 35 % of Children with ADHD leave school with no qualifications

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statistics taken from prison
Statistics taken from Prison
  • Untreated ADHD and Co-existing Problem?
  • Prisoners: Personality disorders & reading disorders cause problems of great magnitude
  • 56% found positive for ADHD scores
  • 48% exhibit neurological impairment
  • 62.% Positive for Dyslexia
  • ADHD & Conduct Disorder highly associated with Driving Offences

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what evaluations can be done
What Evaluations can be done
  • Medical Diagnosis & Testing
  • Medication for Symptom Relief
  • Psychological & Mental health for Comorbidity
  • Intellectual Assessment
  • Academic assessment, interventions & support IEP
  • Speech and Language Assessment
  • Learning Disorders Assessment
  • Neurological Assessment
  • 12 to 37 % may have: Chromosome abnormalities, thyroid
  • Neurofibromatosis, other neurological disorders

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what works best treatments interventions
What works Best? Treatments & Interventions
  • Gain as much information as possible
  • Learn about individual ‘uniqueness’
  • Be Consistent, patient & flexible
  • Structure environments at home & school
  • Teach appropriate behaviour
  • Prompt and Reward appropriate behaviour
  • Academic support

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interventions and treatments
Interventions and Treatments
  • Interventions for Home Environment
  • Skill Building for Developmental Delays
  • Self Esteem building
  • Coaching (versus Traditional Therapy)
  • Exercise, Relaxation Techniques
  • Social Skills Training
  • Art & Music Therapy, Support Groups
  • Equine & animal therapy Neurofeedback

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forms of therapeutic help
Forms of Therapeutic Help
  • Direct planning & instructions
  • Role modelling situations
  • Role play
  • Positive reinforcement
  • Therapist and Coach giving feedback
  • Peer feedback
  • Peer interaction
  • Conversational, social, emotional skills training
  • Frequent Coaching and maintenance

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family management
Family Management
  • Parents learning about ADHD
  • Child management strategies
  • Parental ADHD Under Control
  • Juggling ADHD & Sibling Issues
  • Parent Teacher Child Relations
  • Parent Advocacy Programmes
  • ADHD Support Groups
  • Consensus & Continuing Education

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designing interventions
Designing Interventions
  • Knowledge
  • Trust & Respect
  • Clear Rules & Routines
  • Structure & Boundaries
  • Fair but Firm
  • ADHD is an explanation not an excuse
  • Accept Differences & Uniqueness
  • Learn About Medication
  • Protection From Risk factors & Potential Threats
  • Consistency, Reliability, Responsibility
  • Reframing ADHD builds hopes & bridges

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multi disciplinary team approach
Multi-Disciplinary Team Approach
  • Reaching Consensus in Service delivery
  • Education for professionals
  • Advocacy for children & families
  • Appropriate Courses and Skill Building
  • Community Outreach
  • Local Support Groups
  • Self education for sufferers

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is it adhd asd aspergers hfa depression odd cd ocd pdd ld mr rad gifted
Is it ADHD, ASD, Aspergers, HFA, Depression, ODD, CD, OCD, PDD, LD, MR, RAD, Gifted, ???
  • Statistics 70% will have 2nd or 3rd disorder
  • Assessments must be multi-disciplinary
  • Intellectual, psychological, language, social, behavioural, overshadowing symptoms
  • There are more than 10 possible co-existing conditions to test for

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how to make comparisons
How to make comparisons
  • Make complete lists of all behaviours
  • Check off the similarities to other disorders
  • Understand stages of childhood development
  • Seek out Specialists Doctors, Psychologists, etc.

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compared to adhd problems in communication
Compared to ADHDProblems in Communication

Here follows a list for Aspergers Syndrome:

Monopolises discussion

Of topic with own agenda

Unable to read non-verbal



Advanced vocabulary

Limited facial gestures

And facial expressions

Trouble joining in with conversations

Bland emotional expressions

Limited range of topics

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as problems with play social friendship

Imaginative play

Poor cooperative play

Dominates play

Insists other play same

Way as them

Trouble with play group

Invades personal space

Plays along side not w-peers

Uses playmates as objects

Difficulty sharing things

Poor sportsmanship

Wants complete control

over whatever is happening

Poor eye contact

Little interest in others

Lacks empathy

Egocentric bubble

May prefer to be alone

Fails to compliment peers, friends, others

Cannot function in groups

Lacks social sense

Unable to read social cues/ feedback

Better w-younger peers

Better with adults

Emotionally detached

Lacks reciprocity in relationships

AS Problems with Play & Social Friendship

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as social skill deficits
AS Social Skill Deficits
  • Repetitive organising of toys Does not repair conflicts
  • May prefer to play alone Does not accept views others
  • Limited pretend or thematic play Cannot tolerate criticism
  • Lacks flexibility in play Does not initiate contact
  • Ritualistic forms of play Does not express joy easily
  • Rigidity in rules /everything Limited shared enjoyment
  • Limited play interests
  • Accepting suggestions 4 play Accepting others mistakes
  • Apologising
  • Voice volume may be loud Accepting losing at games

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tips to help you calm upset
Tips to help you calm upset
  • Remain calm regardless of how out of control
  • Prompt to use cool down methods- breathing
  • Intervene before the upset know the patterns
  • Attempt to redirect with pleasurable tasks
  • Praise attempts at cooling down/successfully
  • Find persons he/she can talk to when upset
  • Provide safe calm spaces to go when upset
  • Stay out of power struggles Be a soothing presence
  • Reduce your language lower the tone of your voice
  • Find the root of the problem No demands except for safety
  • Don’t try to talk during full blown upset
  • Use a problem wheel to look at what patterns exist

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123 problem wheel shows what the pattern is
123 Problem Wheel shows what the pattern is

Every pattern has a trigger

When same repeats

Same happens



There is a point

of no return

There is manipulation

There is a pay-off

There are habits that drive

Behaviours wanted or other

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a call for urgent recognition
A Call For Urgent Recognition
  • Uniformity among all professionals
  • Awareness & Education re: ADHD
  • Early Recognition of children in Schools
  • Parents Training Programmes
  • Awareness in the community
  • Police, Dept SS all Service Delivery
  • Appropriate Provisions in Health Care
  • Mental Health Care Doctors
  • Police, Prisons,

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