Transformative Approaches to Teaching Students with ADHD

OPENING COMMENTS

Transformative Approaches to Teaching Students with ADHD Ari Tuckman, PsyD, MBA West Chester, PA Ari@TuckmanPsych.com adultADHDbook.com

Chris & Tommy Dendy Cedar Bluff, AL chris@chrisdendy.com www.chrisdendy.com Understanding ADHD Ari Tuckman, PsyD, MBA

INTRODUCTION & IMPACT

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UNDERSTANDING ADHD Ari Tuckman, PsyD, MBA West Chester, PA Ari@TuckmanPsych.com adultADHDbook.com

Understanding ADHD Ari Tuckman, PsyD, MBA

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What’s in a Name?

Report Card Comments

The current term is AttentionDeficit/Hyperactivity Disorder (ADHD) based on the three core deficits:

Inattentive presentation (aka ADD) Hyperactive-impulsive presentation Combined presentation

Hyperactive/impulsive kids get diagnosed younger.

Understanding ADHD Ari Tuckman, PsyD, MBA

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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Doesn’t perform to potential Must learn to pay attention Needs to put in more effort Doesn’t hand in assignments Disruptive in class Disorganized, loses things Needs to slow down, rushes Forgetful Understanding ADHD Ari Tuckman, PsyD, MBA

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

ADHD as an Important Population

School Functioning

Roughly 5% prevalence.

Probably more in certain schools.

School taps many ADHD weaknesses:

Large academic impact.

School is an excellent screening test.

High frequency of comorbid diagnoses.

Is there truly a greater likelihood?

Or is it that each processing bottleneck makes other limitations more obvious?

People like and expect consistency and predictability.

People infer our intentions from our actions— ADHD is a disorder of actualizing good intentions.

A parent probably also has ADHD.

Understanding ADHD Ari Tuckman, PsyD, MBA

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Weak executive functions (EFs) lead to forgetfulness, disorganization, procrastination, lateness, sleep deprivation, bad eating habits, etc.

People with ADHD use up their free passes.

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Homework is often a major struggle.

Chaos Begets Chaos

Understanding ADHD Ari Tuckman, PsyD, MBA

Also, under-functioning kids evoke overfunctioning from others.

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ADHD Affects Relationships

Children with ADHD require more oversight and tend to evoke more negative reactions.

Halo effect: marked strengths cause us to over-estimate someone’s overall abilities and miss weaknesses.

Understanding ADHD Ari Tuckman, PsyD, MBA

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Family Functioning

Students with ADHD seem to have a higher prevalence of LDs.

Understanding ADHD Ari Tuckman, PsyD, MBA

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Comorbid Learning Disabilities

Overall, they perform below ability and have far more behavioral problems.

LD and psychological.

Understanding ADHD Ari Tuckman, PsyD, MBA

Paying attention in class.

Keeping track of HW, books, pencils, etc.

Consistently completing HW (Achilles heel).

Resisting inappropriate impulses in class.

Creates an even more difficult situation to deal with.

Reducing chaos reduces the burden on the EFs so they can function at their best.

Understanding ADHD Ari Tuckman, PsyD, MBA

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

The Inconsistency of ADHD

Is the Problem Skills or Motivation?

Success comes from doing the right thing at the right time most of the time—and again and again.

ADHD is a disorder of doing what they know.

Inconsistency is a hallmark of ADHD. Success today does not equal success tomorrow.

Understanding ADHD Ari Tuckman, PsyD, MBA

Rewards and punishment increase motivation but not skills.

Success requires both.

A two-way street:

Confidence in one’s skills increases motivation.

Motivation to try something leads to experience which improves skills.

Understanding ADHD Ari Tuckman, PsyD, MBA

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Protective Pessimism

Kids do well when they can.

If at first you don’t succeed. . . then don’t get your hopes up.

Because doing well is always better than doing badly.

--Ross Greene, PhD Understanding ADHD Ari Tuckman, PsyD, MBA

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Anxiety, Overwhelm & Anger

Students with ADHD are more likely to be cognitively overwhelmed/frustrated.

Emotional self-control is also impacted by ADHD. This combination creates more frequent outbursts and meltdowns.

This has social implications with teachers and fellow students.

Understanding ADHD Ari Tuckman, PsyD, MBA

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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Optimism risks disappointment.

Trying and failing is seen as definitive proof of defectiveness—it’s better to blame failure on halfhearted efforts.

Pessimism, anxiety, and depression are reasonable feelings before ADHD is diagnosed.

Understanding ADHD Ari Tuckman, PsyD, MBA

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Understanding the Impact of ADD, ADHD, & EFD on Learning & Behavior!

Learning Difference & Innovation Summit Chris A. Zeigler Dendy, M.S. Athens, Greece chris@chrisdendy.com

Tommy Dendy, B.S. May 8-9, 2014 www.chrisdendy.com 18

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Children with ADHD are at Risk! for example at school…

90 % will struggle academically 25-50 % have learning disabilities More frequent days absent; more Ds/Fs 25-47 % will fail a grade 30-40 % drop out of high school 71 % suspended or expelled 70-90 % do not graduate from college Predictor of substance use & JJ issues

Succeeding in school is one of the

most therapeutic things that can happen to a child!!!

Chris A. Zeigler Dendy

Barkley

Common ADHD/EFD Struggles Underachievement!

What Every Educator Must Know About ADHD!!!!

Prevalence rate: 5-12 percent (11%)

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Smart, but not living up to potential Doesn’t use work time wisely Talks too much—but some are daydreamers Forgets things to do, assignments & big projects Difficulty memorizing facts Difficulty getting started; poor time management Does homework, leaves at home/forgets to turn in Late to school and work 21

3. Two distinct categories of ADHD 4. Brain: Three year delay in brain maturation 30 percent “developmental delay” (4-6 yrs, teens) Reduced brain chemistry makes hard work difficult

5. Coexisting conditions:

69 % CDC; Wolrich; Barkley

AD/HD predominately Hyperactive-Impulsive

Two Distinctly Different Categories of Attention Disorders

(6 of 9; age 17+ only 5) 1.

2.

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4.

5.

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7.

8.

9.

New DSM-V: Developmental Disorder

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Over/under-diagnosis? Miss gifted, girls, minorities 3-4 to 1 ratio boys more than girls; why increase?

2. A complex neuro-developmental disorder

Fact 2:

Dennis the Menace vs “the daydreamer”

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Fidgets or squirms in seat Can’t stay in seat Runs or climbs a lot (teenagers—restless) Difficulty playing quietly “On the go”; acts if “driven by a motor” Talks a lot Blurts out answers Can’t wait for turn Interrupts; butts into conversations or games 24

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

AD/HD predominately Inattentive (also called ADD--28% slow processing) 1 2 3 4 5 6 7 8 9

Inattentive (1994) (6 of 9; age 17+ only 5) Easily distracted Doesn’t pay attention to details; “careless errors” Doesn’t seem to listen Difficulty organizing tasks and activities Loses things necessary for tasks or activities Difficulty sustaining attention on tasks/activities Doesn't follow through or finish chores or schoolwork Avoids school work and homework Forgetful in daily activities (See DSM-V)

Students with ADD/I may have slow processing speed!

(28%) Accommodations: 1.

Extended time

2.

Shortened assignments

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ADD/ADHD Diagnostic Criteria

Fact 3:

Complex Neurobiological Disorder

If a student is punished for characteristics of ADHD he is being punished for his disability!

One example:

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Forgetful in daily activities (organizing, losing, finishing)

Instead…accommodate, give external prompts Visual reminders: computer, post-it note Verbal reminders: teacher, students

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Historic PET Scans of Brains Alan Zametkin, M.D. No ADHD

ADHD Smaller Brain Regions

ADHD

3-10% reduced volume in 5 brain regions :

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Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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Orbital-prefrontal cortex (mostly right side)

2.

Basal ganglia

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Cerebellum (mostly right side)

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Anterior cingulate cortex (underactivity)

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Corpus callosum (size of network correlates to degree of ADHD symptoms 30

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Fact 4:

“Interest Deficit”

Three Year Maturation Delay

Less activity in Nucleus accumbens & Caudate nucleus

In children with ADHD, the cortex reached peak thickness at age 10.5 years, compared with 7.5 years with normal children. The cortex thickening peaks during childhood, then starts to thin after puberty as unused neural connections are pruned.

Impact motivation & attention So not easily engaged, unless work is interesting/rewarding

Fewer dopamine receptors and transporters Explains why they play video games or skateboard, yet can’t focus on schoolwork.

Dr. Philip Shaw, NIH, NIMH (2007)

N. Volkow, J Swanson, JAMA, 9/2009 32

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DEVELOPMENTAL MILESTONES

30 Percent Developmental Delay AGES: Chronological vs Developmental

a set of age-specific tasks that most children can do at a certain age 6

vs. the reality of

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18 10

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ADHD 30% developmental delay

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4.2 5.5

7 8.4

9.8

11.2

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Barkley

Developmental Norms for Children & Adolescents

VS.

To paraphrase Dr. Russell Barkley…

An 18 year old is more like a 12 year old; if this student is to be successful, you must put the supports in place that you would for a 12 year old!

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Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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Sometimes… we forget that developmental norms are not carved in stone…

That children & teens do not master developmental steps at the same exact age.

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Fact 5:

Parents & teachers must provide “developmentally appropriate supervision”

Coexisting Conditions

That means we must give more support and supervision than for other students the same age…

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What Every Educator Must Know About ADHD!!!!

ADHD & Coexisting Conditions 2/3 have a coexisting diagnosis (ADHD+ -- 69 %)

SLD

25-50 %

Anxiety

37-65.8 %

Depression

28-69.6 %

Bipolar

12 %

ODD (oppositional)

40-61 %

Conduct Disorder

14-56 %

Substance Abuse

5-40 % (ADHD/CD)

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7. Executive function deficits

33-50% vs 89-98%

8. Inherited: runs in families

50-54 %

9. Medication works:

75-92 %

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MTA; CDC, Barkley, Biederman

People with ADHD are not all alike

Lifelong challenge: don’t outgrow ADHD

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MTA; Biederman; Smalley; Barkley 40

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Fact 6:

Attention Disorders are not all alike!

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Fact 8:

ADD/ADHD: Lessons Learned

Attention Disorders are inherited

May be very complex!

May be mild, moderate, or severe!

May coexist!

May include EF Deficits!

40-50% parents 32% siblings

May be a disability!

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What Lessons Have You Learned?

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Take home messages?

2.

Ah-ha moments?

3.

Implications?

4.

New information?

EXECUTIVE FUNCTIONS

Understanding ADHD Ari Tuckman, PsyD, MBA

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We Live in a Complicated World

Response Inhibition & Fundamental Strategies

The challenge is to do the right thing, at the right time, most of the time.

Need to filter out extraneous stimuli and thoughts and figure out what is most important in that moment.

Understanding ADHD Ari Tuckman, PsyD, MBA

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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Need to consider the past, present, and future.

The most important isn’t always the stickiest.

Understanding ADHD Ari Tuckman, PsyD, MBA

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Response Inhibition: It Starts with Stopping

Executive Functions

Highest level cognitive processes that help us manage the complexity of life and create a better future.

Often means not simply responding directly to stimuli or present opportunities.

They are actions we direct towards ourselves.

They allow us to do what we know.

Three places to inhibit a response:

Hold back a response to a new stimulus Interrupt an ongoing response to re-evaluate next steps Freedom from distractibility from outside events

Gives the EFs a space to work.

Tend to be subconscious, but we can become aware of them.

Understanding ADHD Ari Tuckman, PsyD, MBA

Understanding ADHD Ari Tuckman, PsyD, MBA

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It All Happens in the Pause

Work Around Response Inhibition

We use that moment of delay to sort through the options and decide what to do.

Fundamental strategies compensate for weak response inhibition.

People with ADHD often respond to the loudest, stickiest stimulus.

Stimulus/environmental management— control stimuli and thereby influence likelihood of responses.

Important stimuli are often quiet.

Their choices look like bad judgment, but there was no real time to judge (and thereby choose).

Understanding ADHD Ari Tuckman, PsyD, MBA

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More effective than relying on willpower.

Set students up for success.

Understanding ADHD Ari Tuckman, PsyD, MBA

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Fundamental Strategies: Inattention

Good teaching for students with ADHD is just good teaching.

Understanding ADHD Ari Tuckman, PsyD, MBA

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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Reduce the chances of attending to the wrong stimuli by reducing distractions.

Increase the chances of attending to the right stimuli at the right times by amplifying important stimuli.

Understanding ADHD Ari Tuckman, PsyD, MBA

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Inattention Strategies: Reducing

Inattention Strategies: Amplifying

Move distractible students away from distractions Reduce the number of papers in students’ desks, binders, etc.

Clear desk before transitioning to new activity Maintain quiet time when necessary Turn off TV, cell phone, etc. when studying

Understanding ADHD Ari Tuckman, PsyD, MBA

Move distractible students to front row Use reminders liberally Create a timeline for multi-part assignments Repeat important information Write out complex calculations Make eye contact when talking Allow students to use one binder for all classes Understanding ADHD Ari Tuckman, PsyD, MBA

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Fundamental Strategies: Hyperactivity

Student Examples: From the Specific to the General

Seek out situations that allow safe expression of hyperactivity.

Minimize situations that require more restraint than you can muster.

Understanding ADHD Ari Tuckman, PsyD, MBA

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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Hyperactivity Strategies: Minimize

Allow movement during activities Use hands-on teaching methods Encourage regular exercise, especially during breaks, gym class, and lunch Walk the kids around the long way back to class Ignore fidgeting if it isn’t disrupting others Create “individual field trips”

Understanding ADHD Ari Tuckman, PsyD, MBA

Understanding ADHD Ari Tuckman, PsyD, MBA

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Hyperactivity Strategies: Safe

Work on tolerance for repetitive or mundane activities, or (better) build in rewards.

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Break up long stretches of desk work with some activity Use multiple small rewards for progress along the way rather than one big one for completion Use praise liberally Re-direct off-task activity non-judgmentally (i.e., don’t take it personally)

Understanding ADHD Ari Tuckman, PsyD, MBA

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Fundamental Strategies: Impulsivity

Student Examples: From the Specific to the General

Create barriers to problematic actions by reducing tempting stimuli.

Set up cushions to reduce the damage done from impulsive acts.

Understanding ADHD Ari Tuckman, PsyD, MBA

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Student Examples: From the Specific to the General

Understanding ADHD Ari Tuckman, PsyD, MBA

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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Impulsivity Strategies: Cushions

Separate students who get each other going Skip over impulsively calling out Arrange for a keyword or a sign for when things are going down a bad path Partner impulsive students with more orderly (and flexible) ones

Understanding ADHD Ari Tuckman, PsyD, MBA

Work on self-control and forethought, to extent possible.

Understanding ADHD Ari Tuckman, PsyD, MBA

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Impulsivity Strategies: Barriers

Lead me not unto temptation. . .

Avoid situations that tend to get out of control Stop the student before the impulsive act is completed Point out impulsive acts non-judgmentally and give the student a chance to fix it Give a wound up student a chance to wind down before discussing the situation Understanding ADHD Ari Tuckman, PsyD, MBA

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Executive Functions

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Dealing with ADHD Ari Tuckman, PsyD, MBA

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Working Memory

Developing New Strategies Identify student's struggle or EF weakness Identify and teach a strategy Identify useful triggers Provide feedback on student use of strategy Fine-tune the strategy

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Working memory is the brain’s RAM—in the moment storage and processing.

Dealing with ADHD Ari Tuckman, PsyD, MBA

So maybe they are the same thing.

Distracted by new stimuli or thoughts Less reliable/efficient transfer into long-term memory

There is a constant flow of information through our working memory—the new replaces (or bumps out) the old.

Like water through a pipe.

Dealing with ADHD Ari Tuckman, PsyD, MBA

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Working Memory & ADHD

Working memory holds what we are paying attention to.

Dealing with ADHD Ari Tuckman, PsyD, MBA

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Working Memory & Attention

Takes information in Pulls information from long-term memory Processes it all together Holds information on deck Generates a response Transfers new information into long-term memory

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Facts Events

Lose things when forget where they were put down Reduced reading comprehension, retention and thereby enjoyment Dealing with ADHD Ari Tuckman, PsyD, MBA

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Working Memory Key Concepts

Make important tasks and items stand out more to make it more likely that your attention will stay focused on them.

The fewer distractions, the easier it is to stay focused on and remember what you should.

Write things down rather than try to keep it all in your head.

Dealing with ADHD Ari Tuckman, PsyD, MBA

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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Student Examples

Dealing with ADHD Ari Tuckman, PsyD, MBA

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Sense of Time & ADHD

Sense of Time

Some people’s internal clock ticks loudly, some softly.

Time is more fluid for ADHD folks—boring tasks take forever, interesting take no time.

Success in life requires the ability to manage time well:

Don’t do the right thing at the right time (run late and miss deadlines).

Predict how long an activity will take Monitor the passage of time during activities Notice the arrival of a particular time Re-adjust priorities and activities in relation to time as circumstances change Dealing with ADHD Ari Tuckman, PsyD, MBA

Don’t plan well (best case scenario planning).

Don’t accurately notice the passage of time.

They get lost in the moment when engrossed (hyperfocus), so time disappears.

Dealing with ADHD Ari Tuckman, PsyD, MBA

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Sense of Time Key Concepts

Supplement your internal sense of time with plenty of clocks and external reminders.

Use alarms and other limits to notify you that a specific time has arrived.

Use a schedule to plan out your time.

Dealing with ADHD Ari Tuckman, PsyD, MBA

Student Examples

Prospective Memory

Could be two seconds or two months.

It’s our mental to-do list.

Can’t write everything down.

Good intentions often falter here.

Dealing with ADHD Ari Tuckman, PsyD, MBA

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Do the right thing but at the wrong time.

Becomes increasingly important as we become adults as we manage a constant flow of intended activities and interruptions.

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Prospective Memory & ADHD

Remembering to remember at the right time and place (the point of performance).

Dealing with ADHD Ari Tuckman, PsyD, MBA

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Sometimes it is better late than never.

Sometimes it isn’t.

Don’t do the right thing at all (and are as disappointed as anyone).

Seen as unreliable (by others and oneself) when forgetting is seen as intentional or convenient.

Dealing with ADHD Ari Tuckman, PsyD, MBA

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Prospective Memory Key Concepts

Support your working memory by using external reminders to keep the task in your awareness.

Support your sense of time by setting up reminders and alarms that will trigger your memory at the right time and place.

Dealing with ADHD Ari Tuckman, PsyD, MBA

Student Examples

Emotional Self-Control Emotions color our experience and inform our decisions.

With maturity, we gain perspective on our emotions and are better able to separate feeling from thinking and acting.

They feel and express their (appropriate) emotions more strongly (poor poker face).

Behave spontaneously when strongly influenced by emotions.

We also get better at hiding or diluting our emotions.

This enables us to also see others’ perspectives.

Dealing with ADHD Ari Tuckman, PsyD, MBA

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Emotional Self-Control & ADHD

Dealing with ADHD Ari Tuckman, PsyD, MBA

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Seen as impulsive or irresponsible when react too quickly and it works out badly.

Can lose the big picture or another’s perspective.

Dealing with ADHD Ari Tuckman, PsyD, MBA

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Emotional Self-Control Key Concepts

Manage your stress.

The less strongly you feel an emotion, the easier it is to control it.

Own up to your reactions.

Dealing with ADHD Ari Tuckman, PsyD, MBA

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Student Examples

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Dealing with ADHD Ari Tuckman, PsyD, MBA

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Self-Activation

Starting and finishing enjoyable tasks is like riding a bicycle downhill—easy.

Internal vs External Pressure

The challenge is to get ourselves going on important but less enjoyable tasks before the last minute.

Life is full of uninteresting tasks that need to be completed on a regular basis.

The task itself is easy; the boredom is hard.

Procrastination creates external pressure.

Far-off deadlines or vague consequences don’t activate them.

A history of struggles adds psychological avoidance and lowers self-efficacy.

Dealing with ADHD Ari Tuckman, PsyD, MBA

Dealing with ADHD Ari Tuckman, PsyD, MBA

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Self-Activation Key Concepts

It takes more mental effort to self-activate on boring tasks.

Enjoyable activities require little internal pressure.

It’s easier to self-activate to work towards rewards than away from punishments.

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Self-Activation & ADHD

Kids rely more on external pressure.

Internal pressure = self-generated activity towards a goal (i.e., self-activation).

Self-activation comes out of emotional selfcontrol.

Dealing with ADHD Ari Tuckman, PsyD, MBA

External pressure = rewards, punishments, deadlines, nagging, etc.

Make the first step smaller and more manageable.

Visualize the rewards for starting and/or finishing (and create some if necessary).

Work on the task even if you don’t feel motivated.

Dealing with ADHD Ari Tuckman, PsyD, MBA

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Hindsight & Forethought

Student Examples

We use the past and the future to guide our decisions in the present.

Hindsight—using lessons from the past to guide behavior in the present (wisdom).

Forethought—using projected future outcomes to guide behavior in the present.

Dealing with ADHD Ari Tuckman, PsyD, MBA

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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Helps us avoid repeating mistakes.

We mentally play out possible scenarios and choose the best one.

Dealing with ADHD Ari Tuckman, PsyD, MBA

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Hindsight & Forethought & ADHD

People with ADHD are able to create good plans but don’t always do it.

They are pulled too strongly by the more obvious or intense aspects of the present and therefore don’t pause to consider the past or the future.

Don’t stop and access their knowledge.

Make the same mistakes (damn!).

Dealing with ADHD Ari Tuckman, PsyD, MBA

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Student Examples

Hindsight & Forethought Key Concepts

Intentionally pause before reacting and then consider your options.

Make a point of seeing how you’re doing occasionally and then adjust as needed.

Reflect upon lessons learned.

Dealing with ADHD Ari Tuckman, PsyD, MBA

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Understanding the Impact of ADHD & EFD: Academic Challenges

Dealing with ADHD Ari Tuckman, PsyD, MBA

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What Is Executive Function & Why Is It Important?

1. Critical cognitive skills that ensure school success!

2. Management skills (“CEO”) for completing school work.

3. EF Deficit involves delayed brain maturation.

4. Without strong EF skills… bright students will do poorly in school.

5. High IQ & poor performance baffle teachers.

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Executive Function Deficits coexist with ….

ADHD SLD Autism Aspergers Tourette Bipolar

Newsweek 2008, CAZD

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

EF Orchestra Conductor Controls…

Executive Function

Getting Started

Management functions of the brain in other words, the

“conductor of the orchestra!”

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Tom Brown, PhD 97

Attention & Achievement Center

Executive Function Components (components - Impacts School Work & Behavior)

Fact 7:

Is Executive Function the New IQ?

Working Memory is a better predictor of academic success than IQ scores!

Newsweek 2008

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Working memory & recall; predicts school success; Allows you to re-engage after being inattentive Alertness, activation, and effort (“getting started”) Reconstitution—analyze, problem solve, synthesize Internalizing language (self-talk) Controlling emotions – (emotionally immature) Shifting, inhibiting Organization/planning Organization of materials Monitoring (self-monitoring) Barkley, Brown, Gioia

Cognitive Counter Space Working Memory

ADHD limited working memory capacity

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Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

It is critical to‌.. reduce demands on limited working memory capacity!!

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Enhance Working Memory

Internal vs. External Reminders

Use effective teaching strategies

Reduce in demands on Working Memory

Teach memory strategies

Give water breaks; brain breaks; snack breaks

Consider medication

FYI-More difficult task; more movement is required

Encourage movement & exercise:

Increase # of neurotranmitters

Miracle Gro for brain cells Barkley, Ratey, Rappaport

(Internal reminders weak - Self-talk limited) External - Visual vs Auditory

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Limits of Working Memory

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Executive Function (Practical Impact) Executive Functions Impact Two Key Areas:

Time Limits -- ability to process intensely in WM

5-10 minutes for children

10-20 minutes for teens & adults

Academics

Writing essays & completing of complex math

Reading comprehension

Memorizing words, multiplication tables, languages

Difficulty completing long-term projects on time

Capacity

3-7 items for children (5 average)

5-9 items for teens (7 average)

Implications for Teachers:

Teach in shorter time chunks --maybe 20 min or so

Can’t teach too many new facts at one time

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Sousa

Zeigler Dendy 108

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Executive Function (Practical Impact) Academically Related Skills (EF skills) BEWARE of inaccurate perceptions!: (Looks like choice or laziness!)

Following directions Being organized Getting started and finishing work Remembering chores and assignments Analyzing and problem solving Planning for the future Controlling emotions

EFD may be the primary reason for school failure!

Not the ADHD symptoms 110

Zeigler Dendy109

Zeigler Dendy

Sometimes, we adults make moral judgments about EF Deficits because…...

The good news…

Executive function skills continue to mature until the early 30s or 40s!

children with EF deficits look like they have made a conscious choice to be lazy and unmotivated!

Russell Barkley, PhD & Martha Denckla, MD

111

112

Middle School (grades 6-8) and the “ADHD Brick Wall”

ADHD/Brain Challenges Summary from Morning

Increased demands for executive skills:

Organizational skills

Memory

Academic work more complex

Working independently

More homework (more teachers)

More complex routines (change classes/teacher)

113

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Delayed brain maturation (3-years) 30% developmental delay Executive function deficits Decreased blood flow, glucose absorption Smaller brain in 5 areas Reduced brain chemistry in “reward center” Untreated coexisting conditions Learning disabilities (up to 50%) Greater emotionality Undertreated ADHD or meds wear off

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Common Academic Problems 90% have academic problems Learning Disabilities—up to 50 percent ADHD/I – 28% slow processing speed Slow reading & writing (25-40%) (Slow color/letter/object fluency) Output: • Oral Expression • Written Expression – 65% • Math Calculation – (math - 26%) Spelling – 24% See Input: ADHD /EF • Listening Comp Articles at • Reading Comp. - 25-40% www.chrisdendy.com

Executive Function Deficits…

have a huge impact on

Memory!

Learning Pyramid

Tips to Improve Memory

Improve Memory Retention

(Deshler – make information meaningful) 1.

Linking episodic & semantic information improves LT memory Easier to remember episodic events/pictures Hands on activities also provide this link

117

Use effective teaching strategies

Reduce in demands on Working Memory

Teach memory strategies

Give water breaks; brain breaks; snack breaks

Consider medication

FYI-More difficult task; more movement is required

Encourage movement & exercise: Increase # of neurotranmitters

Miracle Gro for brain cells Barkley, Ratey, Rappaport

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Connection to prior knowledge

3.

Elaboration of information > LT memory

4.

Mnemonics (memory tricks) > LT memory

5.

Organization of information > LT recall Graphic organizers are helpful.

“Brain Break”

Enhance Working Memory

2.

Pick a stick

119

Machine gun feet Jumping jacks Head, Knees Toes “Simon Says” Dance to music March to music “The Doctor Says” Energizers!

Roser

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Key Word +Mnemonic

Math Foldables

Axis Powers - WWII (math graph) Axis

Mnemonic/acronym

JIG

Japan Italy Germany

Mastropieri, Zeigler Dendy

www.foldables.wikispaces.com

Foldables

Non-Math Foldables

Dinah Zikes McGraw-Hill

Dinah Zikes McGraw-Hill

Memory Bracelet

Behavioral vs.

Academic Challenges

Oriental Trading Company

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

where do you intervene first?

Academic interventions improve academics & behavior but…

With the academics?

The converse is not true!

or

Behavioral interventions do not always improve academic performance.

Combination of academic/behavioral is best!

If a student has behavior problems,

the behavior?

Marc Atkins, Ph.D.; George DuPaul, Ph.D.

No Magic Answers!!

Some experts say….

“Teach Executive Skills” It is NOT that simple!

Brain immaturity & inadequate brain chemistry are the culprits!

129

First, Identify Major Deficits

Practice without expectations for a miracle!

Compensate and Accommodate!

“Like throwing Jello against the wall & hoping something sticks!”

130

General Tips to Keep in Mind

Child will not need all accommodations.

Identify student’s challenges that cause school failure.

Prioritize

Provide accommodations only for most challenging!

Use technology!

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

top three challenges.

Identify

who responsible to address each one

Match 131

accommodation to challenges.

132

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Teacher PhD at top rated school:

“I’ve talked with Alex over and over again about paying attention in class, about turning in assignments… etc.

Don’t fight ADHD brain chemistry & delayed maturity…

“I have not been very successful getting through to him.”

Go with the Flow!!!

(Don’t punish; teach skills or accommodate)

“This is the third year I’ve had him and nothing has really changed much.”

9/3/13

Skeletons

“Going with the Flow!” (teaching tips)

“Wild & Wacky” vs “Same and Similar” Encourage movement/fidgeting; Give “brain breaks” Use “hands-on” interactive teaching strategies Give external prompts (visual or auditory cues) Give an alternative action for “ADHD behaviors” Teach missing skills (study, test taking, planning) Reduce demands on limited working memory Provide more supervision/structure/give choices Provide “point of performance/decision” interventions Dechler, Zentall, Levine, Ratey, Barkley, Jones, Rapport, Dendy

Heart Diagrams on Sidewalk/Parking lot

Layered Human Body

Abney & Zeigler Dendy

100 Point Spelling Contract Jonathan Jones, CEO, SOAR Camping Program

Dr. Billie Abney

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

20 20 20 40 20 40 40 20 20 20

Write words on flash cards.

Write words 5 times.

Type words times.

Use words in a sentence.

Write words in ABC order.

Write antonyms for words Write definitions for words.

Illustrate words.

Air write words Build words with letter tiles. (Scrabble)

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Study/Test Reviews

Teaching Methods (continued)

Give guided lecture notes/study guides (free)

Give Extra Help Paired learning Peer tutoring Teacher aides Private tutors

www.quizlet.com/flash cards, study games, variety/11M www.khanacademy.org/video, exercises; math/science/3k

Verbally emphasize key points “This is important”; “Remember this” Teach test taking skills Consider Games (move & discuss) 3 person teams; answer questions; earn points; winning team picks reward (state test) “Two truths & a lie” Text messaging answers; teams “You Tube”; skate board accidents/bones broken Record test reviews for IPod or Mp3 players

1.

Interactive Learning/Keep Class Active Group response Hands on learning Dry erase boards Games

2.

3.

4.

5.

BAA, CAZD, Linda Tilton

Executive Function Deficits… have a huge impact on

Writing Essays, Working Math Problems, & Spelling!

Chemistry Element Dating Abney, Zeigler Dendy

Improving Writing:

ADHD/EF Deficits & Written Expression

Limited working memory capacity

Unsophisticated ideation

Slow Processing Speed

Modify Assignments

Poor Fine-motor skills (handwriting)

(print, memory demand less - 26 sequences)

Written Language Production Problem

Organizational problems

Allow student to dictate report to scribe Cut and paste written work on computer

Allow Use of Spell & Grammar Check Substitute Creative Assign.

Levine

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Give Extended Time for Writing Reduce Amount of Written Work

Dictate report on a tape recorder Videotape the assignment

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Written Expression Specifics

Address Writing Challenges

Difficulty selecting a topic – indecisive

1.

Difficulty generating ideas

2.

Trouble finding words

3.

Hard to hold ideas in mind & write them

4.

Idea logjams

Difficulty knowing what to do/major steps

Difficulty ordering writing sequences

Shift topics in same paragraph

Brief simple writing – noun & verb

5.

Address Writing Challenges 7.

9.

“What I know” & “What I learned”

Allow a scribe, recorder, speech to text

6.

Dragon Naturally Speaking

Reduce Working Memory Demands

Draw sequential pictures – then describe

8.

Brainstorm ideas in class related to the topic Model essay writing – overhead/white board Facilitate selection of a topic/narrow to 3 Select a topic for them.

Make 2 columns: Brainstorm ideas, write

Graphic organizer provides visual cues.

Discussion will help, tell me what happened

Forbid use of “be” words – is/am/was/were (thesaurus may help) Use graphic organizers – for essay

Royal Order of Adjectives or Adverbs

Discuss - paraphrase for classmate 11. Put topic sentence on separate pages 12. Highlight finished paragraphs in color 10.

Masterpiece Sentences Jane Fell Greene

Prepare your canvas; base subject and verb.

1.

Paint your verb.

•

how? when? where? how much? how many? how often?

Move the verb painters around.

Paint your subject.

2.

3.

•

which? what kind of? how many?

Detail your words.

4.

•

birds--sea gulls, flew--soared

Apply finishing touches.

5.

•

Refine the wording. Move sentence parts. Ck sp. & punctuation

http://grammar.ccc.commnet.edu/grammar.

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Masterpiece Sentences

The birds flew.

At sunset, a thousand giant white sea gulls burst through the clouds with wings outstretched and soared above the thundering tide.

Remembering Two “F” Words:

Why Is Math So Hard?

Facts & Formulas

(Deshler - 2006 Presidential Commission)

(Difficulty with Math)

Math book shortcomings:

Too many concepts/too many pages in books. eg. 20 concepts first grade (limit to key topics each yr--maybe 150 pg/not 700) Focused coherent progression of skills

Introduces new concepts too fast Presentation of strategies not logical Instructional activities unclear Transition time from teaching to independent work too short.

Not enough content review.

Math Challenges Two key skills delayed in younger students 1. Number sense Takes longer to differentiate between values of two numbers Immature counting skills--finger counting 2. Fact fluency Mastery of basic math facts Difficulty memorizing math facts/letters/words (multiplication) Slow retrieval of facts Platt; Martinussen/Tannock; Swanson/Beebe-Frankenberger

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Four Strategies that Work Increase fact fluency by…

Small group tutoring (48 scripted lessons) Computer program practice (10 min.)

Focused instruction – Grade 1 focus on 3 things

mature counting, number sense, fact fluency

Stimulant medication

Increased mature counting & arithmetic strategies Decreased finger counting Increased productivity & efficiency Quicker retrieval of information Fuchs, DuPaul & Weyandt, Bennito-Nash, Martinsussen, Tannock, Platt

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Mastering Math:

Modify Teaching Methods

List steps for problem on board.

Copy steps from board Keep step-by-step problem on board.

Pair with another student. for answering questions for checking accuracy & assignments teaching each other Use peer tutoring; provide class time.

Teach math short cuts.

NovaNET.com, Khan Academy & msalgebra.com

WORD PROBLEMS John bought 7 boxes that contained 8 pencils each. He gave 6 pencils to Alex. How many pencils does he have left?

Algebra

Circle needed facts.

Mark out any unnecessary facts.

Underline the strategy word or phrase.

2-step problems:

1.

2.

3.

The real challenge‌‌..

4.

1.

2.

moving from concrete to abstract!

1 squiggly line under first step; 2 Squiggly lines under second step.

Four Parts

TREATMENT OPTIONS

Understanding ADHD Ari Tuckman, PsyD, MBA

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

161

Education to reduce guilt and increase likelihood of success with better strategies.

Medication to improve response inhibition and thereby reduce symptoms.

Coaching to develop better habits to create successes and build feeling of competence.

Psychotherapy to address effect of ADHD on self-image, self-efficacy, relationships, and secondary conditions.

Understanding ADHD Ari Tuckman, PsyD, MBA

162

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

More Successes, Fewer Struggles

The Magic Threshold

Goal of treatment is improved consistency:

Reduce the frequency of EF glitches.

Reduce the severity of the consequences (practical, social, and self-esteem).

Faster and better rebound afterwards.

Perfection is nice, but not necessary.

Sometimes even partial progress creates a significant improvement:

Change what you can, accept the rest.

Happiness requires both.

Therefore success is more achievable and motivation goes up.

Understanding ADHD Ari Tuckman, PsyD, MBA

Less late, less often.

More organized, fewer lost items.

Notice the partial successes.

Understanding ADHD Ari Tuckman, PsyD, MBA

163

164

Self-Knowledge Update

Educating Students about ADHD

Accurate self-knowledge is a key ingredient to success—for everyone.

After a lifetime of struggle, many with ADHD doubt their abilities—but diagnosing and treating their ADHD is a total game-changer.

Dealing with ADHD Ari Tuckman, PsyD, MBA

Strategies mean nothing if students don’t use them (or practice them in the first place).

A well informed teacher can help students feel better about themselves and more effective learners.

They rely on others being willing.

Explanations offer understanding for why something is happening and what one can do about it.

166

Approaching, Not Avoiding

Excuses lower expectations and are ultimately limiting.

Understanding their past differently creates a different future.

Dealing with ADHD Ari Tuckman, PsyD, MBA

165

Excuses vs. Explanations

This involves ADHD, but also other traits.

Knowledge is power, but the responsibility for change is on the individual to use that information.

Dealing with ADHD Ari Tuckman, PsyD, MBA

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

167

Approach problems, rather than avoid them.

Need to actively apply themselves (and their EFs) to be successful.

Dealing with ADHD Ari Tuckman, PsyD, MBA

168

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Some People Resist the Diagnosis

Improvement is Only Half the Battle

Some people feel bad enough about themselves already and see the diagnosis as official proof of their defectiveness.

Some kids and teens believe they’re doing better than they are.

Labels don’t change what one is, but they do change what one can do about it.

Even for people without ADHD.

Work on acceptance of remaining limitations and weaknesses.

Accepting the diagnosis is a step towards better things.

Dealing with ADHD Ari Tuckman, PsyD, MBA

Improve functioning by building skills, but there are limits to this.

This is easier if they value their strengths.

Suffering comes from expecting the impossible.

Not passive resignation, but active acceptance.

169

Dealing with ADHD Ari Tuckman, PsyD, MBA

170

Dealing with ADHD Ari Tuckman, PsyD, MBA

172

Resilience—Get Back on the Horse

Medication

Few successes are linear.

The unpredictable performance and frequent glitches of untreated ADHD make pessimism reasonable.

Expect setbacks—then keep going.

After a setback, work on acceptance without getting emotionally overwhelmed—address the problem actively and directly.

Dealing with ADHD Ari Tuckman, PsyD, MBA

171

Medication

Medications make the automatic more conscious.

Stimulants

Increase response inhibition.

They close the gap between intentions and actions.

Medication benefits academics and behavior.

Need to balance risks and side effects of both treating and not treating ADHD. Understanding ADHD Ari Tuckman, PsyD, MBA

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

173

Adderall XR, Concerta (Ritalin), Vyvanse.

Start working immediately.

Oldest, best studied, and most commonly used medication class for ADHD.

Can add in a second dose of a short-acting preparation after school to carry the effect a little further.

Understanding ADHD Ari Tuckman, PsyD, MBA

174

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Teacher Input on Medication

Side Effects

Prescribers are only as good as the information they get—teachers can be a valuable source of information:

Positive effects.

Side effects.

Variability over the course of the day.: early, middle, end.

Tend to improve with time or by lowering dose.

Most common:

Ari Tuckman, PsyD, MBA: Integrative Treatment for ADHD

There is currently no cure for ADHD— treatment means lifelong management.

Jury is still out on neurofeedback.

Maybe some benefit from mindfulness.

Exercise benefits attention and other mental processes.

Ari Tuckman, PsyD, MBA: Integrative Treatment for ADHD

Ari Tuckman, PsyD, MBA: Integrative Treatment for ADHD

175

Non-Traditional Treatments

177

Medication Works, but..

Effective for 70-92% Up to 55% of teens are on meds 50% on doses that are too low

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

176

Addressing Related ADHD/EFD Challenges Medication ADHD Education Trouble Shooting Tips Miscellaneous

Impact of Stimulant Medication

Fact 9:

(Getting it right isn’t easy!)

Appetite suppression Jitteriness Insomnia (take less or earlier) Feel flat or over-focused Irritability at end of dose

Increased

Decreased

Attention

Activity levels

Concentration

Impulsivity

Compliance

Negative behaviors

Effort on tasks

Physical & verbal

Amount & accuracy of school work

Speed of Learning

Hostility

Swanson; Bonci

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Medication Impact

ADHD Medications

Working memory, self-talk Verbal fluency, emotional control Ability to organize thinking Higher math & reading scores vs non-med Handwriting Motor coordination Self-esteem Acceptance by and interaction with peers Awareness of the game in sports Decreased punishment from others

Stimulants Ritalin, Ritalin SR, Ritalin LA Focalin, Focalin XR Dexedrine, Dexedrine SR Metadate ER; Metadate CD Adderall, Adderall XR, Vyvance Concerta Daytrana (patch) Quillavant XR (liquid-12 hrs) Non-stimulants Strattera Intuniv - guanfacine/tenex XR Kapvay (clonidine extended release) 182

Barkley; Scheffler, Hinshaw, etc.

Behavior Rating Scale (NIMH/MTA: Problems linked to meds too low) Initial Meds After Med Adjustment

184 Zeigler; Zeigler Dendy

Teachers are brain surgeons!!

They change … children’s brains!

Martha Denckla, MD, professor pediatrics, neurology & psychiatry Learning & the brain Reading disabilities Brain maturation & development Role of Executive function in ADHD

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

ADHD Brain on Meds Is More Mature When children are on medication their brains’ mature more than… non-medicated ADHDers’ brains!

ADHD brain on meds comes closer to hitting milestones of cortical thickness than non-med ADHD brain!

185

Medication affects the child’s experience, the experience affects brain maturation Makes children reachable & teachable!!!

Denckla

186

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Why is it so important to intervene early?

Identification of ADHD/EFD in First Grade is Critical!

If symptoms present, ADHD more severe.

Don’t ignore, huge struggles follow.

1st grade sets academic building blocks.

Otherwise, major gaps in learning occur.

Child will be behind/lower reading scores.

1.

Serious problems in preschool predict serious problems later— unless issues are addressed!

2.

3.

4.

5.

MTA Study; Hill Walker

Rabiner, 2013

Predicting Future Problems

PreK-3 ADHD/EFD looks like…

(More serious behaviors: Identify & Intervene)

Inattention/Impulsive Difficulty staying with group/disruptive Difficulty transitioning from one group to another Difficulty following directions: start & finish work Delayed maturity/language; may hit or bite May stammer, stutter, or poor pragmatics (45%) Talks a lot or may daydream; Poor social skills; alienates peers Delayed motor skills Poor fine motor & handwriting Memory deficits Difficulty remembering and following directions Difficulty memorizing numbers, letters, colors

Predicting Future Problems

Aggressive antisocial behaviors Explosive temper tantrums Physical aggression Fighting Intentional destruction of property Rare events Cruelty to animals Firesetting Bedwetting

Signs of Delayed Brain Maturation

(It’s critical to identify & intervene - cont.)

80% of boys arrested predicted by: 1. Early teacher ratings of social skills.

2. Total negative playground behavior.

3. Disciplinary contacts with principal’s office.

Age problems emerge makes a difference 1st graders with attention problems, lag behind for years afterward 2nd graders, less so (problems less severe) Walker, Rabiner

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

State of a child’s motor skills reflects on their learning readiness

No overlap--motor & prefrontal/cerebellar EF centers

But, “Like Smoke and fire;” state of one tells about other.

Prefrontal & frontal areas of brain Areas of brain for planning, organizing, controlling

“I shouldn’t have to remind you, you’re in middle school.”

Denckla

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Early ID of Delayed Maturation

Early ID of Reading Readiness

Immature Motor Coordination Is Key Boys should master by age 13; Don’t need EEG to ID.

RAN (Rapid Automated Naming)

Rapid naming of colors predictive of readiness to read!! but not true for rapid naming of letters or numbers

Not true for girls; must look for markers earlier, ages 4-7

Results: Variability in spacing of response Response preparation slower Predicts reading comprehension deficit Denckla

Brainwaves, John’s Hopkins, 2003

Reading high interest books nightly changes the brain!

194

Teach (Practice) Skills or Accommodate These students intuitively lack effective learning skills we take for granted!

Reading stories strengthen language comprehension regions by increasing connectivity between neurons in the brain.

Bern

Tips for Homework Completion

Avoiding the Dreaded Homework Battles

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Assignment Book Write Assignments Student Others (pairs ck.)

Row/team captain ck Teacher double cks Photocopy Assignts.

Stu. makes 5 copies Wk./mo. at a time

E-mail/fax to Parent

Teacher Web Page

Homework Pattern

Extra Book at Home

Phone # for Others

Weekly Report

Accept Late Work •

Develop plan

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Send Homework Tips to Parents

Give choice of a time to start & a location.

Prompt getting started (timer, verbal prompt)

Supervise work/at end get ready for next day

Call a friend, ask teacher homework (pattern), extra book at home, email teacher (save all old completed papers.)

Give structure/routine to homework time.

“Launch Pad” Near Door

Jump start your child (see tips) Know homework assignment—school website

Sit/work with your child or at least be in the same room Put back pack with finished work near the door

Manage homework time

Break the assignment into segments—10-20 minutes Give “brain breaks,” fidget toy, water, snack; fidgeting OK

Is Homework too Long?

Teachers may underestimate how long it takes for students with learning problems to complete homework!

Teacher and parents develop a plan

Teacher writes anticipated time for finishing

Sends note home/emails to parent with time

Student/parent write actual time required

Return note to school; compare times

If discrepancy, reduce assignments Zentall & Goldstein

Zentall & Goldstein

Completing Long-Term Projects

Modify assignments

Organizational support & supervision.

Avoiding Disaster with Long-Term Projects

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Break into 2-3 segments Give separate due dates and grades.

Prompt about the project due dates/ include in IEP. Notify parents; involve them in monitoring Monitor progress.

Teach to schedule time backward.

Provide a job card.

Provide a graphic organizer.

Show completed model projects or reports

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

LongTerm project

Test Taking Strategies Teach strategies--10 % increase in test scores www.ClassMarker.com on-line test maker $25

Try “brain dumping”.

Skim test, ck. back, ck points per section Don’t go back and change answers.

(Stick with first choice.)

Spend more time on part worth most points.

Mark out answers using absolute words – always, never, none, all, only.

T/F with these words are usually false.

Often, rarely, generally are usually true.

Matching questions; columns equal, use > once?

“Test-wiseness” Strategies (Deshler)

Start working ASAP. Skip items you don’t know; mark and come back.

Schedule time wisely.

Read directions very carefully.

Guess if it doesn't count off; or counts < right one.

Mark out obvious wrong answers; (absurd) Mark out if 2 options mean same thing.

Use stem-option; * similarities in root word; monglymatic/triglymatic acid * consonant/article agreement ; an…acid, not base

Pick obviously longer answers (3-4 words)

Deshler, Crutsinger, Rief

Homework Notification Free “Remind101” App No phone numbers are exchanged.

Educational Software

Remind Of Trip, Assignment, Test.

Abney

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Homework Notification “Infinite Campus” App Immediate Grade Reporting to Parents & Students

Reminder/Calendars Computer or Cell Phone

Working Memory—Concentration

Memory - Scribble Band

read,write,think.com;espn.go.com; funmatch.com Espn.go Concentration

$ 6.75

213

Tap WM Benefits of Video Games learningworksforkids.com Breaking New Ground—what ARE benefits?

Teach by trial & error 3. Must understand directions 4. Feedback given privately; not embarrassing 5. Games tap EF skills: organization, analysis, cognitive flexibility, self-control, time management, working memory & attention 100s Academic & regular video games rated/skills 1. Benefits: modest generalization in real world EF 2. Play together key: Talk during & after game; discuss strategy; ask if similar to academics

Interactive K ABC Match

Fine Motor Skills -- Dexteria

1.

2.

Kulman & Stoner

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Dexteria

Dexteria Jr

216

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Spelling

Quizlet Anatomy Flash Cards Spelling lists Test Teach Games 42,000 words Sentences definitions

Appendicular Skeleton: Study guide, review, test, games, sound, prints flash cards/names for all 19 bones as shown, bone highlighted

Clavicle (sound)

www.spellingcity.com

Khan Academy: math, biology, chemistry, physics, humanities, finance and history.

Quizlet.com

Times Tables the Fun Way

Age word problem:

New CD available

In 4 years, Ali will be 3 times as old as he is today. How old is Ali today? yrs InIn44years

3 times as old as he is today How old?

Circle underline key #s X + 4 = 3 X (Aliâ&#x20AC;&#x2122;s age in 4 years) 2X = 4

Learning Ally

AKA Recordings for the Blind & Dyslexic

Books on Tape, even texts for HS & college

$49 to join

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

WebQuest Maker www.Zunal.com WebQuest Menuâ&#x20AC;&#x201D;K-12 Art Music Business/Economics English/Language Foreign Language Health/PE Life Skills/Careers Mathematics Professional Skills Science Social Studies Technology User Profiles WebQuest Search

Science: 737 quests Blood types, viruses, volcanoes, ecosystems

Abney

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Writing: Brainstorm Ideas Inspiration Kidspiration K-5

Test Review

Popplet

Puzzlemaker Crisscross

(cheaper) Complete puzzle with partner.

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Neurology Drives Psychology

A STRONGER MINDSET

ADHD is a neurologically-based information processing disorder.

Pulling It All Together Ari Tuckman, PsyD, MBA

Interpretations of past events determine our current mindset. . . . . . which determines how we interpret current events. . . . . . which determines our future mindset. . .

Momentum can be your friend or your enemy.

Different people can interpret the same event differently.

The same person can interpret an event differently over time.

By changing our interpretations, we can change the psychological impact.

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Past, Present, Future

We interpret events and make meaning of them.

People with ADHD are more likely to have certain kinds of experiences which shapes their psychological mindset.

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Interpretations Determine Outcomes

Our busy, distracting world makes these weaknesses more obvious.

Even if the event stays the same.

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Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

A Better Future

They Kinda Make Sense. . .

By changing our interpretations, we can change an event’s psychological impact.

We can re-interpret the past in order to create a different mindset in the present. . . . . . which leads to a different future.

This is the power of an ADHD diagnosis—it changes a character defect into a treatable neurological condition.

Pulling It All Together Ari Tuckman, PsyD, MBA

Sometimes single or brief changes are not enough to turn the tide—need a critical mass:

This will persist if you never test it out.

You need to take a chance on new strategies with the hope of creating a different track record.

In order to succeed, you must be willing to fail.

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Change Enough Pieces

Or they carry a high price elsewhere.

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Negative self-fulfilling prophecies: if you expect a bad outcome, you put in minimal effort.

If they didn’t have some logic, we wouldn’t use them—that would be crazy.

Mindset traps offer some benefit, but it winds up being less than a more productive mindset would.

Turn the Momentum

Mindset traps have a certain logic to them, based on the person’s experiences and how other people interpreted those experiences.

Targeted strategies Medication, Cogmed Working Memory Training Therapy/coaching More organized/less chaos Better sleep, diet, and exercise

Then give it time to work!

Pulling It All Together Ari Tuckman, PsyD, MBA

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Avoidance is Tempting

Avoidance/Protective Pessimism

We all would like to avoid the things that are boring, make us uncomfortable, or tend to not go well.

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Pulling It All Together Ari Tuckman, PsyD, MBA

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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This is especially true when we are unclear about the methods to use or the task’s goals.

Neurology: people with ADHD have difficulties with self-activation.

Current benefits/costs are weighted over future ones.

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Track Record Expectations

Protective Pessimism

Due to previous struggles and failures, many ADHD folks avoid certain tasks.

There is a certain logic to this.

Pessimism, anxiety, and depression are reasonable feelings before ADHD is diagnosed and treated.

Psychology: rationalize bad choices by talking themselves into it with seemingly logical reasons.

Pulling It All Together Ari Tuckman, PsyD, MBA

Pulling It All Together Ari Tuckman, PsyD, MBA

Accept that risk is a requirement for success.

Work towards positives, not away from negatives.

Vividly think about the future benefits/costs in order to tilt the future over the present.

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But don’t put your entire self-worth on the line.

Separate feeling from acting—do it even if you feel anxious or uncertain.

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Solution: Accept Discomfort

Create more immediate rewards that are more motivating.

Optimism risks disappointment.

Trying and failing is seen as a character judgment—it’s safer to blame failure on halfhearted efforts.

But: avoidance and half-hearted efforts never show us what we are capable of.

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Solution: Bring the Future Closer

If at first you don’t succeed. . . then don’t get your hopes up.

Remind yourself that sometimes comfort comes after trying something, not before.

Treat anxiety and depression, if necessary.

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Solution: Just Try It

Figure out the specifics for vague projects/goals.

Re-think your standards/expectations—are they reasonable/likely?

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Run an experiment (in the name of science).

Try a previously avoided task using a new method, just to see what happens (whatever. . .).

Look for lessons learned and refine your method.

Pulling It All Together Ari Tuckman, PsyD, MBA

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Life at the Extremes

Black and white / all or nothing thinking oversimplifies the world: always/never, all good/all bad, only/every, etc.

The Extremes Are Costly Black and white / all or nothing thinking is demotivating because it sets too high a bar.

Anything in the middle needs to be rounded up or down in order to fit into one of two categories.

We need to distort reality in order to make it fit.

If success feels too unlikely, what’s the point of trying hard?

If you have a setback and can’t achieve your initial goal, then you may just give up entirely rather than set a new goal.

We are more likely to go black and white when we are emotionally fired up.

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Notice what went well or is positive, even in the worst experiences.

A Stronger Mindset for Life's Challenges

What did you do well?

What did others do well?

What parts of the task went well?

What did you learn from the experience?

Broaden your definition of success so you’re more willing to take a chance (and not feel like you failed).

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Solution: Re-Define Success

Solution: Look for the Grays

Approach challenges like a scientist—sometimes you need to try something to see that it doesn’t work. If you’re one step closer, then it isn’t a failure.

Moving on—don’t waste time wallowing in the extremes. Get moving!

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Self-Mistrust

Self-Mistrust

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Many people with ADHD suffer from selfmistrust, the belief that they can’t rely on themselves to do the right things at the right times.

A Stronger Mindset for Life's Challenges

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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Past: “Did I do everything I should have?”

Future: “Will I do everything I should?”

Unfortunately, their unpredictable and inconsistent track record justifies it.

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

The Cost of Self-Mistrust

Solution: Treat Your ADHD

Playing it too safe limits what we are capable of and the challenges that we take on.

Boring!

It can be used to justify avoidance because of self-doubt about how it would work out.

At a deeper level, it can affect their self-esteem so they don’t even consider trying certain tasks.

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Treatment and good processes mean little without good effort.

Notice your successes, not just your failures.

Processes are more sustainable.

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Break the self-fulfilling prophecies by giving your best effort.

You’ve already figured out the easy ones.

Faith comes from good processes, not from good intentions.

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Solution: Good Effort

Create better processes and systems—even (especially) the ones that don’t naturally fall into place.

(But still set realistic expectations.)

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Solution: Better Processes

Treatment changes the odds—addressing your ADHD makes new things possible.

Learn as much as you can about ADHD and good strategies.

If your current clinicians aren’t getting the job done, find new ones.

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Assess your performance—what is your actual batting average?

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Did I Do That?

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Locus of control: how much do my actions influence what happens in my life?

Many people with ADHD have an external locus of control.

A Stronger Mindset for Life's Challenges

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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Events seem (and may be) overly driven by others.

Partially due to distractibility, forgetfulness, procrastination, and poor planning.

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Others Run the Show

Freedom, At a Cost

Other people are more likely to get involved in the person with ADHD’s life and make things happen.

Can be driven by the other person’s need for anxiety management, based on ADHD-based inconsistencies (or not).

Can be driven by avoidance, entitlement, dependency, or feelings of inadequacy on the ADHD person’s part.

Blaming others for negative events offers some protection to self-esteem if you can dodge the bullet.

It also limits your future options by requiring assistance/generosity the next time.

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Solution: Strike the Balance

They don’t over-rely on others beforehand or externalize their troubles afterwards.

They don’t refuse appropriate help or get down on themselves for things outside of their control.

Instead, they actively address what they can and cut themselves slack when they need to.

A Stronger Mindset for Life's Challenges

What if the person is unwilling to help?

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Solution: Freedom, At a Better Cost

Research has found that those with ADHD who have the best self-esteem have a mixed locus of control:

But it carries a cost in the relationship and/or selfesteem to have to depend on others.

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Taking responsibility for what happened involves a temporary ego hit, but with responsibility comes the power to do better next time.

Today’s blame = tomorrow’s power.

This also gives you equal power in the relationship by eliminating over-dependency and resentment.

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Solution: Everyone Does Their Part

We are all the masters of our own happiness.

We need to be mindful of but not responsible for others’ happiness.

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Improving your track record puts you in a more credible position to push others to address their anxiety and issues.

We can’t expect others to do better or work harder than we do.

A Stronger Mindset for Life's Challenges

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Acceptance of Chaos

Some people with ADHD tend to live life two steps in front of the avalanche based in:

Chaos Is More Work

Neurology: primary weaknesses in executive functions.

Psychology: secondary psychological fallout as they avoid difficult habits/tasks.

Chaos feels inevitable so there is no point in trying to restore order.

Psychology: the goal of reducing chaos is that it makes it easier to accomplish your real goals—what are they?

Create enough order to get the job done.

Aesthetics come second.

Success feels more likely.

You no longer need to accept chaos.

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Solution: Focus on Function

Neurology: targeted treatment and strategies improve your effectiveness and make it easier to create and maintain order.

Order makes it easier to maintain order.

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Solution: Don’t Accept Chaos

So chaos begets more chaos. . .

Good news: reducing chaos can improve functioning.

Given their track record, this is a reasonable assumption.

Pulling It All Together Ari Tuckman, PsyD, MBA

Unfortunately, a chaotic situation makes our executive functions less reliable because the important items and tasks get lost in the chaos.

Maintenance is much easier than restoration.

Get back on the horse.

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Don’t make this into a moral issue (or let others do it).

Beyond small doses, guilt is de-motivating.

Bribe/pay someone to do it for you.

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Solution: Tolerate Discomfort

Identify what is most important to you—what do you need to do to accomplish this?

At the end of the day, what matters most is self-respect—did you act with integrity?

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Sometimes despite others’ bad behavior.

Doing the right thing often involves tolerating discomfort—but for a purpose.

Shame, confusion, boredom, fear, anxiety. . .

Pulling It All Together Ari Tuckman, PsyD, MBA

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Catastrophizing

Self-Fulfilling Prophecies

Because ADHD folks’ setbacks and failures are more obvious and/or frequent, it’s easy to catastrophize—make the current mole hill into a mountain.

The inconsistency of ADHD makes it harder to predict success or identify the factors that created it.

Strong reactions from one person tend to evoke strong reactions from others.

Polarizing—we each get more extreme in our positions.

A Stronger Mindset for Life's Challenges

Don’t believe everything you think or feel.

Identify what you actually know vs what you are assuming. Then prove it.

Easier to deal with setbacks because it is reasonable to expect a better outcome.

Makes it easier to stay motivated and bring your best in an enduring way.

It can help to talk it out with others.

Take a break before deciding—we gain perspective as our emotions fade.

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Life is messy and imperfect. Success is rarely a straight line.

Conflict Avoidance

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Solution: Stay with the Facts

Treating your ADHD improves your batting average and makes you more consistent.

Giving up prematurely guarantees a bad result.

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Getting diagnosed finally gives you a compelling (and workable) explanation for past difficulties.

Solution: Diagnosis is Liberating

Our emotions color how we interpret facts and even which facts we focus on.

Makes it easy to assume the worst.

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Solution: Persistence

Expect setbacks—then keep going.

Remember that a temporary setback does not equal failure.

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When feeling stuck, figure out your next step.

Stay with the options that are currently available.

Ignore the options that aren’t.

A Stronger Mindset for Life's Challenges

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Conflict Avoidance

People with ADHD may over-commit yet under-deliver:

It Goes from Bad to Worse

Neurology: don’t pause to evaluate before making commitments or lose track of them afterwards.

Psychology: promise too much with the hope of pleasing the other person.

Leads to increasing polarization.

Create successes elsewhere.

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Although good behavior on the other person’s part makes it easier for us to respond well, ultimately we are accountable to ourselves.

Bite the bullet in the moment, rather than pushing it into the future.

But at least it means we have some ability to improve the situation.

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Both people are happier with good expectations.

Solution: Personal Integrity

ADHD person needs to be honest, take the heat, be willing to fix the situation, and make amends.

Non-ADHD person needs to have reasonable expectations and respect honesty and react well to it.

Pulling It All Together Ari Tuckman, PsyD, MBA

One of the key struggles of ADHD is consistency, so don’t let them interpret one success as guaranteeing many more.

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We can’t expect others to behave better than we do or do more of the work.

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Expectation management—inform others about what you can reasonably and reliably deliver (and not).

Both people need to recognize their part:

There is no benefit of the doubt given and therefore little chance to rescue a situation.

Pulling It All Together Ari Tuckman, PsyD, MBA

Solution: Come to Center

Others may assume that the person with ADHD had no intention to follow through.

Both people feel justified in their position.

Pulling It All Together Ari Tuckman, PsyD, MBA

Unfortunately, falling short again only makes it that much worse.

Solution: Expectation Management

Cover-ups erode trust and reinforce angry reactions. . . . . . Angry reactions reinforce cover-ups. . .

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The Cover-Up Death Spiral

Before the ADHD is understood and treated, conflicts don’t lead to enduring solutions so it is tempting to avoid them—for both people.

Pulling It All Together Ari Tuckman, PsyD, MBA

It’s tempting to offer big promises in order to reassure the other person in the moment.

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Resist the temptation to wiggle out of a bad situation.

It’s better to disappoint early than late because there are more options available to fix it.

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Perfectionism

Perfectionism

Perfectionism involves striving for quality beyond the point of reasonable benefit.

Standards are in the eye of the beholder.

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The Psychology of Perfectionism

The task is a diversion to avoid another task or more difficult elements of the same task.

The high level of quality is an over-done protection against uncertainty or criticism.

Pseudo-perfectionism: ADHD hyperfocus can look like perfectionism (psychology) but it’s really about attention regulation (neurology)

A Stronger Mindset for Life's Challenges

Perfection Requires a Smaller Life

Quality and quantity are often in opposition— higher quality means accomplishing less.

Only some tasks deserve perfection.

By continuing to polish something, it is never completed and therefore up for evaluation.

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Solution: Identify a Reasonable Standard

A Stronger Mindset for Life's Challenges

Consider how this task ranks against others and your overall goals.

If relevant, seek input about others’ standards and expectations.

We like to be able to predict outcomes and avoid the discomfort of uncertainty, but there are limits to what we can know.

Being able to tolerate uncertainty allows us to pursue bigger goals.

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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More time and effort on this task necessarily comes at the expense of others.

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A high standard can make the task feel too daunting to start or finish.

Solution: Tolerate Uncertainty

Since time and effort are finite, there is an opportunity cost for everything that we do.

Sand the top of the table, but not the underside.

Extremes beget extremes.

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Mindset: those bigger goals are worth the discomfort.

There is always a next time.

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Solution: Tolerate Criticism

Their self-esteem is only as good as their last success or failure (black and white thinking).

Remember that our value goes beyond any one action.

This is easier if you value (remember) your strengths and other accomplishments.

A Stronger Mindset for Life's Challenges

Manage the Social Costs

Active expectation management can reduce the social costs of ADHD.

Intentions often count more than actions.

Re-interpret ADHD behaviors as unintentional and discourage over-reading of their meaning.

Tell people what they should and shouldn’t expect and give them permission to do certain things.

Both people benefit—it’s more than just a cover-up.

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Because people infer intentions from our actions, we sometimes need to actively manage their assumptions.

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Make ADHD Harder to Misinterpret

Manage the Social Costs

People with low self-esteem are especially vulnerable to every “failure” (defined broadly).

Resentment isn’t good for either person.

Free passes are earned with honesty.

Pulling It All Together Ari Tuckman, PsyD, MBA

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The Value of a Good Apology

A good apology requires the ability to first handle one’s own negative feelings.

A good apology contains:

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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ADHD & Executive Function Deficits…

Acknowledgement of the effect on the person An expression of remorse A promise to do better next time (or at least try)— focus on process, not effort.

Pulling It All Together Ari Tuckman, PsyD, MBA

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have a huge impact on

Emotions! (emotional immaturity)

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Emotions Impact Learning!

“Emotions are the ‘On-off switch’ to learning.”

Negative emotions like anxiety, fear, sadness, or anger produce cortisol in the brain that blocks learning--disrupts thinking, memory, and learning!

Chronic stress: causes dendrite atrophy & cell death!

Vail, Lawson, Ratey

Laughter is the best medicine!

Produces endorphins Increases nitric oxide Expands blood vessels Reduces blood pressure Increases blood flow & oxygen to brain 290

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Behavioral Strategies are NOT as effective for Students with ADHD! Linked to a difference in brain chemistry!

Remember, punishment will NOT..

1. Grow more white matter (connective tissue) 2. Increase neurotransmitters 3. Teach new skills

Point of Decision Three Tips for Maximizing Effectiveness of Behavioral Strategies!

Meet at locker at 3:00

1. Intervene at the Point of Performance!! (point of decision) 2. Give external prompts 3. Give an alternative behavior Russell Barkley, Ph.D.

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Externalize prompts!

Give visual or auditory cues

Internal vs. External Reminder Messages (Internal - Self-talk) External - Visual vs Auditory

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Alternative: Raise hand

Give an Alternative Behavior!

Post Picture of Desired Behavior

Students with ADHD are going to do something— Talk a lot, blurt, fidget,

So give them an alternative action!

Barkley; Zeigler Dendy

Tri-fold Prompt (impatient when waiting/may blurt)

Remember also…

Misbehavior often looks intentional… when in fact, it is often linked directly to the student’s ADHD, EF Deficits, or LD! www.reallygoodstuff.com

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Reward Good Behavior The behavior you attend to...

Write names of 5 students who listen, follow directions, and are on task: monitor, rotate to include all.

Send home a note with the child

will increase!

Ignore, give alternative or teach skill!

on the board or on a poster (keep track) Helpers Smiley face or a teddy bear stamp Encourage parents to brag on them, put on refrig.

Must keep name on board—can be erased

Explain specifically what they did & say a big thank you!

Kelly Smith, Alicia Solano

Dr. Jean Feldman

Foldables for Young Children

drjean.org --Free resources

Weighted Sweatshirt

“Magic Pebbles” Response Cost for Targeted Behaviors

Logan & Delores

For really difficult behaviors: Identify behavior of concern.

Discuss desired behavior with student.

10 magic pebbles given to start day.

If breaks rule, “bring me a pebble.”

If I have to come, I’ll take away two pebbles.

If have any pebbles, give a If 6-8 pebbles, smiley face + sticker.

8-10 pebbles, scratch ‘n sniff & smiley face.

Alicia Solano; Illles

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Play Oriented Environment of PreK-K Is Ideal!

“Quiet Mouse” Puppet

Hold quiet mouse to get attention.

Select a student to wear the puppet Students selects next “quiet” person for puppet.

Teacher may need to talk to parent, on phone, or send info to office.

Tolerant of & more patient with ADHD behaviors.

Provides optimum positive hands-on learning environment.

Allows more freedom of movement when child’s attention wanes.

Alicia Solano

“Jump Start” Students

Executive Function Deficits… have a huge impact on

Getting Started!

Review instructions

Call a friend for clarification

Break the assignment into segments

Simply begin working (becomes clear)

Draw a mind map or brainstorm

Use a graphic organizer

Trick himself; “I’ll read 15 min. & stop”

Start with physical activity; walk & read

Read during TV commercials; easy material

Executive Function Deficits… have a huge impact on

Being organized!

S. Weiss

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Chaos and Clutter

Study/Organizational Tips

Getting Organized at School Advice from Alex & Teen Experts:

2.

One colored folder for completed homework.

3.

Organize the locker.

1.

Buy a day planner/organizer.

Use notebook dividers.

Use different folders for each class.

4.

Put all books with homework on one shelf.

Give parents guidance for home-Go through papers with child at home.

Keep all old papers until semester's end.

Use Palm Pilot or iPAQ.

5.

6.

Meet a coach/friend/aide after school to organize assignments & take home all the right books.

Teach time management strategies--organizer.

Divide a large task into manageable sections.

Teach how to take notes; shorthand; notetaker; (discuss in pairs) Type on a computer to express oneself more quickly and clearly.

Use tools such as mechanical pencils or clipboards to work more efficiently.

A Bird’s-Eye View of Life with ADD & ADHD

Visual Timer (TimeTimer)

Executive Function Deficits…

Time is an abstract concept; Make it concrete!

Their internal time clock doesn’t work well; Make it external!

have a huge impact on

Awareness of Time!

Kinesthetic Clock

Impaired Sense of Time

(Time Machine)

(include accommodations in IEP)

Teach to compensate Use a wrist alarm Set an alarm in an IPAQ/Palm Pilot/computer Beep to remind of time Use a timer

Schedule backwards:

Give reminders for important meetings Utilize classmates/aides for prompts Get medication right

1. You have 5 marbles to finish work.

2. If quiet, can hear when time is up.

3. End of class, all balls roll to the bottom

Conley

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Practice time estimation; “how long will it take?”

Add in “get ready, travel and oops” time

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

ERO

“WatchMinder3”

(Impaired sense of time)

Event Required response Outcome

$69

If E, R, O are close in time, no problem.

65 messages, vibrates, repeats dialy, snooze alarm

(Write summary & turn in today.)

If add a time lag, you disable the child

(long-term project due in one month)

Barkley

Benefits of Physical Exercise

Executive Functions & ADHD Symptoms…

Are improved by

Increasing Activity Levels!

Reduced suspensions.

Better test scores & grades.

Remember facts better without interim testing.

Builds new brain cells.

So increase physical activity—30 minutes daily Fitness based PE programs

Our students need to be more active when work is harder & executive skills are needed!

Higher Test Scores after Exercise

Napierville IL; Hillman

Incorporate Movement Academic tasks--Group Response Thumbs up or down Yes/no cards

Stand up--yes/no

Dry erase boards

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Stand-up Desk; swinging footrest

Paired Learning & Dry Erase Boards

MaIwolf/Science Photo Library; dryeraseonline.com

Incorporate Movement/Fidgeting

GeoMotionTV.com

Fidget Toys

(flixercise)

Fidgetz

Tangle

“Brain breaks”: literacy, math, fitness videos Whole school, 25 mats: initial $800

Use velcro strip under desk Or on notebook or folder

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Ideas for Increasing Movement

Treadmills in classrooms

Exercise bicycle

During PE classes monitor heart rates

Use exercise balls for balance & attention

Double Dutch Jump Rope

Dance Dance Revolution

Stand-up desks; 2 wk. stations

“Brain Beaks”

Parents walk a tightrope (without a balance pole) Please be respectful of them!

Their job is NOT easy!…no job description!

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Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #

Parents/teachers juggle a balancing act, must constantly monitor progress and encourage child toward more self-sufficiency!

Please think twice before labeling…

“Overprotective…

Enabler…

Helicopter parent”

Can he or she do this without my help?

None of these terms are instructive!

They don’t tell parents what to do… and in fact they are judgmental and hurtful!

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Publications by Chris Dendy & son, Alex Zeigler Teenagers with ADD and ADHD, 2nd ed. (100,000)

If doing well…

Reduce involvement one small step.

If not successful, put support back in place!

The Books

Teaching Teens with ADD, ADHD, & EF Deficits, 2nd ed A Bird’s Eye-View of Life with ADHD (a teen survival guide)

New!!: Father to Father: Advice from the Experts!

Four dads give ADHD parenting advice!!

Real Life ADHD! (DVD) A DVD for children and teens by teens!!

ADD/ADHD Iceberg poster (11x 17, color) Available at bookstores and www.chrisdendy.com 333

Ari Tuckman, PsyD, MBA

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Workbook & Podcast

adultADHDbook.com Over 100 episodes & 1,000,000 downloads Information on the books Upcoming presentations Recordings of past presentations Cool ADHD events Handouts and articles

Ari Tuckman, PsyD, MBA

Ari Tuckman, PsyD, MBA adultADHDbook.com Ari@TuckmanPsych.com

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Chris A. Zeigler Dendy, M.S. View clips of Real Life ADHD! & Father to Father! at www.chrisdendy.com #