An Introduction to ADHD – Attention-Deficit / Hyperactivity Disorder

Lindsay L. Wray, Psy.D.

It is also important to note that most children grow out of ADHD, but for some, the symptoms can continue into adulthood. The behaviors that mark the disorder — namely having a limited attention span (inattentiveness) and / or being unusually active or impulsive (hyperactivity) — can occur in very young children, though in most cases the signs and symptoms become apparent when children reach school age.

ADHD is not a developmental disorder like autism but is a brain disorder influenced by a variety of factors including genetics, exposure to toxins during pregnancy and low birth weight. Medication is often appropriate to treat ADHD but is not always the only option available to treat the disorder. Behavioral therapy – with or without medication – may be helpful in eliminating symptoms that are significantly interfering with a child’s daily life functions and ability to adapt to different situations.

With behavioral therapy, which is based on principles of applied behavior analysis or ABA, a child can be taught new or different behaviors to replace problematic ones. Part of the appeal of behavioral therapy is that the benefits of modified, learned behavior can continue into adulthood, so the child is not just experiencing a better childhood, but is learning behaviors and skills that can last for a lifetime.

There are three types of ADHD:

• Predominantly Inattentive Presentation. Common signs and symptoms include frequent daydreaming, lack of focus or poor concentration, making careless mistakes in schoolwork, not listening when spoken to directly, or being easily distracted or forgetful.
• Predominantly Hyperactive Presentation. Common signs and symptoms include impulsive behavior, moving constantly with an intention to distract others, inability to stay seated when sitting still is expected, talking excessively when quiet is preferred, lack of patience and interrupting others.
• Combined Presentation. Common signs and symptoms include a mix of the above. For example, one minute the child is daydreaming and cannot focus and the next minute the child is getting up and out of his or her seat.

All children have moments of inattentiveness and hyperactivity. It is only a problem when the symptoms impair every day functions, with the child having difficulty regulating and shifting behaviors to perform basic and necessary daily activities.

If you have observed inattentiveness and hyperactivity in your child that seems to be excessive, it is worth exploring further to determine if ADHD may be the underlying cause. Your first step is to discuss the situation and your observations with your child’s primary care physician or pediatrician, or with a psychologist or psychiatrist. These healthcare professionals may offer a referral to a specialist for an evaluation.

Evaluating a child for ADHD involves administering a battery of assessment tools used to evaluate thinking, reasoning and remembering (cognitive functions), as well as assessment tools used to evaluate functions of the nervous system (neurological functions). These tests are combined with interviews with caregivers and teachers and observation in a clinic or at school. The evaluation process, when conducted by a trained professional, is friendly and non-threatening.

Receiving a referral for an evaluation does not necessarily mean your child has ADHD. In many cases the evaluation will not indicate attention-deficit/hyperactivity disorder. But if there is a diagnosis of ADHD, a good clinician will help you identify an appropriate course of action and treatment that will help address the problem behaviors and that ensures your child is treated with care and compassion.

Learn more about our evaluation & diagnostic services or ABA-based behavioral therapy services available through 360 Behavioral Health.

How Positive Reinforcement Helps Shape Desired Behavior

Jeremy Wilson, PhD, BCBA-D

Many of us have experienced positive reinforcement in our lives. Maybe your boss asked you to write a report, give a speech, or complete a project, and when you were done, she said, “Great job!” She was using positive reinforcement strategy to “set the stage” for your next assignment. The praise was the reward that made it more likely you would willingly take on the next task.

Positive reinforcement is not a thing. It is a well-studied system that involves the addition of a stimulus intended to increase the likelihood that similar behavior will occur in the future in similar situations or environments.  More simply put, positive reinforcement helps shape behavior under similar conditions. Positive reinforcement is used beyond the business world, and is an important tool used at home and in school for those with autism.

Through social interactions, children learn to behave in ways that effectively communicate their needs and wants. Parents can help shape desired behavior by using positive reinforcement – correctly and in a timely manner. For parents of children with autism, positive reinforcement is a key strategy. It’s very important to anticipate the child’s needs and have reinforcers ready. Here’s one example.

A child with autism, who is not yet speaking, attempts to tell his mother he is hungry. He points to the shelf where there is a box of crackers. When his mother sees the child pointing, she looks at the shelf, and then at the child, and says, “Do you want a cracker? Let me get one for you.” The child’s attempt to communicate is now reinforced, and he is very likely in the future to ask for a cracker in a similar manner.

However, reinforcement cuts both ways. What if, in this illustration, the mother is busy working around the house or caring for her other children, and doesn’t notice the child who is pointing or doesn’t realize it is a request for something specific?

Children will respond differently. Some might withdraw if their mother doesn’t notice the pointed finger and try again later. But other children may respond with screams and throwing a toy across the room, which may result in getting the cracker. Providing the cracker reinforces the screams and throwing toys.

Thankfully, one misstep does not ruin everything. Human behavior allows for second chances, so a supportive adult can create another opportunity for a child to learn to ask for things through more desirable behavior.

It’s important to understand that positive reinforcement (rewards) are not the same as bribes. Bribery is trying to persuade someone to act in one’s favor (typically dishonest or undesired acts) and often has the threat of punishment attached. As we know, bribery and punishment procedures are generally not accepted, nor are these efficient and sustainable practices like positive reinforcement. People also tend to take positive reinforcement for granted, without stopping to think about the effect this activity has on behavior. It’s important to understand how it works to know why it works.

There is some misconception about behavior therapies used with children with autism. The misconception is that bribery and punishment are often used as behavior change procedures. That’s not the case. Those who work with children and others with autism make exhaustive use of positive reinforcement to shape all types of behavior.

For these professionals, observation and planning are critical for designing individualized programs, too. Some children need immediate feedback, while others may be fine with a short delay. Still others may need praise more frequently over a longer period of time.

Positive reinforcement is the primary system we have to help children learn how to effectively communicate their needs and wants throughout their lives. This strategy can quickly help improve the child’s quality of life, as well as the lives of the other family members.

Learn more about how ABA-based therapy can help shape behavior though positive reinforcement.

Does Your Child Need More Help In School?

Judith S. Cohen, Psy.D., LMFT

Home-based behavioral services for children with autism are aimed at helping them develop and live as independent a life as possible.

In school, the aim is the same – to help a child develop independence while providing a school-based education that facilitates independent living. Helping children whose behaviors interfere with getting the most out of their education is difficult work, especially when teachers are overwhelmed with large numbers of children in their classroom. This is when schools can use our help.

When a child’s behaviors interfere with their ability to learn, it is important for the parents and the school to recognize and figure out a plan to assist learning and development. If your child has an autism eligibility, then he/she has been through a special education assessment which resulted in the development of an Individualized Educational Program or IEP. The IEP Team determined that your child requires goals and services to help them progress in the school setting. Your child’s IEP outlines how your child performs in academics (reading, writing, arithmetic) and socially. Depending on needs identified in the IEP, additional services such as speech and language, occupational therapy and a behavioral aide may be offered.

Sometimes your child may demonstrate disruptive behaviors, such as being non-compliant, having difficulty paying attention, throwing a tantrum or even running away – which interfere with their learning. Classroom structure can be challenging for children with developmental delays. Your child may not have the skills needed for independent planning, organizing, sitting, listening, initiating and following through on assignments or tests. Children, for example who have difficulty paying attention to a classroom activity might feel anxious and refuse to participate.

There is a way to help! That help can be given in school by using a highly trained and qualified behavior specialist who will guide your child throughout their school day. Behavior Intervention Implementation or BII and Behavior Intervention Development or BID are services that can be offered to help them. BII services are a direct, one-to-one service provided by a trained behavior expert who collects data and has expertise in targeting problem behaviors that interfere with your child’s learning. This can be provided throughout the entire day or as identified in their IEP. BID services provide supervision to the BII, and an assigned BID is responsible to write reports based on the data collected by the BII, dialogue with parents and attend IEP meetings. Parents HAVE a say and if they feel BII services are needed, then they should speak up and let the IEP Team know.

A Behavior Intervention Plan or BIP is additional documentation that is part of your child’s IEP. It identifies the behaviors that interfere with learning, what is missing or needed in the school environment to insure success, and a strategy to guide the teaching replacement behaviors. Ways of reinforcing the replacement behaviors are designed based on what your child responds to and can change from time to time.

BII and BID services offer opportunities for your child’s long-term success in life.

Learn more about how a school-based behavioral therapy program works.

Or schedule a one-on-one consultation with one of our behavior therapy experts.

Managing Stress with Mindfulness

Helpful Tips for Parents of Children with Autism

Caroline Hardman, MS, BCBA, Qualified MBSR Instructor

To be mindful is essentially being aware in the present moment, on purpose, without judgment. Imagine saying, “I will be calm if my child throws a fit at Target” and then being determined to follow through. Setting our intention dramatically increases the likelihood that we’ll remain calm. But just being present is not easy; our thoughts tend to be restless and uncontrolled. We tend to make many judgments, too, about ourselves and those around us.

Think of mindfulness as a camera lens: it captures just the moment without judgment or labels. It just sees. And the path to mindfulness, like any other brain training, takes practice. Just as muscles get stronger with exercise, so does the mindful mind.

There are several exercises that can help us respond with calm and ease to stressful events. Here are three.

Awareness of Breath
For a couple of minutes, with eyes closed, bring your attention to your breath as it comes in and leaves the body, without trying to change it. Notice your breath in the expanding and contracting of the abdomen and hold your attention there. When you notice your mind wandering, kindly usher your awareness back to the breath.

Awareness of Daily Tasks
Think of something that happens every day more than once; something you take for granted, like opening a door. At the moment you touch the doorknob, stop for a moment and be mindful of where you are, how you feel in that moment and where the door will lead you. Instead of automatically going through daily motions, take occasional moments to stop and be aware of what you are doing and the blessings these daily movements mean in your life.

Mindful Listening
Learn to open your ears to sound without being swayed by memories of or preconceived notions about music. Select a piece of music you have never heard. Close your eyes, and if you like, use a pair of headphones. Don’t think about the type of music it is, the title or the artist. Just hear it. Become absorbed in the sound. Listen to the contributions of each instrument. Then concentrate on the voice or voices. The idea is to experience listening without making judgements.

This lovely quote by the renowned author Elisabeth Kübler-Ross clarifies the value of mindfulness quite beautifully – “It’s only when we truly know and understand that we have a limited time on earth – and that we have no way of knowing when our time is up – that we will begin to live each day to the fullest as if it was the only one we had.” Perhaps this “attitude of gratitude” for the everyday moments – mundane, painful, or joyful – are what allow us to appreciate even the most challenging work given to us in this life.

Preventing Caregiver Burnout

Yelba Diaz, BA

Some parents have a hard time asking for help and think they always have to be present. And unfortunately, many parents are not aware of the resources available that are designed to give them a break. Respite is a service designed to provide care for the child of the caregiver by an individual who is knowledgeable and trained to care for the child’s needs. This service also provides parents a break from the day to day intensive care they provide their child.

Respite care typically falls into two categories – traditional and specialized. Traditional respite is focused on taking care of personal needs and in-home activities such as washing, using the toilet, or having a meal. Specialized respite provides these same basic services but goes a step beyond. With specialized respite care, staff members are in the home to teach, supervise and actively engage while the parents go shopping, do errands, or just take some time away. These care teams are trained in step-by-step behavior analysis and goal-based treatments. They collaborate with the applied behavior analysis (ABA) service provider to follow the individual’s specific behavior support intervention plan, which spells out consistent responses to behavior problems.

The best respite care services will rotate staff members in the home so that children grow accustomed to meeting a variety of people. This makes it easier for them to transition into outside programs for more training, and eventually help them prepare to live as independently as possible. That is the ultimate goal, especially for parents of adult children who worry about who will take care of their adult children when they are no longer around. It is a relief for them to see their children make progress. Parents are happy to see how care teams can help their children develop and thrive.

Everyone needs a break sometime. And parents need not feel that they are alone. If you think you need help, contact a respite care provider to arrange a meeting to learn more about how they can offer assistance. Respite is a very valuable resource that can help prevent caregiver burnout . . . and might be just what you need.

Learn more about respite care available through 360 Behavioral Health.