the facts: regulatory disorders adhd, ocd, tourette syndrome · general facts •it is one of the...

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10th Annual SoutheastRegional ADHD Conference ADHD Myth Information:

Separating Fact from FictionJanuary 27, 2018

Sheryl K. Pruitt, M.Ed., ET/P

The Facts: ADHD, OCD, Tourette Syndrome

© Sheryl K. Pruitt, M.Ed., ET/P 2018

Attention Deficit Hyperactivity Disorder

Sensory Defensiveness

TouretteSyndrome

Anxiety Disorders

ObsessiveCompulsiveDisorder

Mood Disorders

© Sheryl K. Pruitt, M.Ed., 1999

Regulatory Disorders

SleepDisorders

AutisticSpectrum Stuttering

The Basal GangliaThe Basal Ganglia

Language Disability

Learning

Disabilities

Executive Dysfunction

© 1999 Sheryl K. Pruitt, M.Ed

Non-Regulatory Disorders

Visual-Motor Disability

Memory Disorders

Slow Processing

Speed

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Hallmarks of ADHD

© Sheryl K. Pruitt, M.Ed., Warren Walter, Ph.D., 1992

• Distractibility

• Dysregulation of Attention

• Impulsivity

• Hyperactivity (optional)

• Impersistence at a Boring Task

• Arousal Difficulties

• Difficulty Initiating

Sleepy

Underarousal Overarousal

Arousal Curve

Memory for complex, unfamiliarinformation and behavioral control

Optimal Arousal

Hyperactivity

Arousal

Tests

Storms

Couch Potato

© Teaching the Tiger, pg. 18, 1995 © Sheryl K. Pruitt, M.Ed., 1991

© Daniel and Sheryl Pruitt, M.Ed., 1989Teaching The Tiger pg. 53

This is what your brain looks like “ON” ADHD.

Who turned out the Lights?!

Photo Source: Zametkin et al., 1990© 1999 Leslie E. Packer, Ph.D.

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Slow processing speed is reported by researchers to exist in one-fourth to one-half of students with ADHD-Inattentive Type.

©Tigers, Too, 2009

Carlson, Mann,2002, Goodyear, Hynd1992Nigg,Blaskey,Huang-Pollock,Rappley, 2002,Weiler, Bernstein, Bellinger,Waber, 2000, Barkley, 2006

Slow Processing Speed(Sluggish Cognitive Tempo)

• Sustained Attention• Executive Functions• Memory• Academic Achievement• Behavior• Social Competence

©Tigers, Too, 2009 ©Dornbush, M.P. and Pruitt, S. K., 2009

Processing SpeedInfluences:

Treatment for Sluggish

Cognitive Tempo or Slow

Processing Speed Disorder

The Fast ForWord® Program

Image: www.cerescanimaging.com/

• Intrusive, repetitive unwanted thoughts (obsessions), and/or

• Repetitive or ritualized behaviors (compulsions)

• Some compulsions may not be observable (such as counting)

Obsessive-Compulsive Disorder (OCD)

© 2011 Challenging Kids, Inc.

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CommonObsessions

• Symmetry and Order• “Just Right Feeling”• Doubting and Worrying (leads to indecisiveness)• Perfectionism (work, words, people, appearance)• Need to experience sensations (burn, cuts)• Dirt, germs, cleanliness, contamination• Counting or lucky numbers or words• Aggressive thoughts or images (sexual or gruesome)• Dangerous or terrifying thoughts• Religious or moral scrupulosity

© L.E. Packer, S.K. Pruitt, C.I. Wang, 2000© Teaching The Tiger, pg. 14

Obsessions are intrusive, repetitive, unwanted thoughts, and can provoke profound anxiety.

Common Compulsions

© S.K. Pruitt & C.I. Wang, 1999

Compulsions are repetitive, ritualistic behaviorsfrequently associated with obsessions.

I am not obsessing …I am not obsessing …I am not obsessing...

• “Just Right Syndrome” (e.g. objects, responses)• Ordering, counting, arranging, evening up, checking• Touching, fiddling• Cleanliness, smelling objects • Superstitions• Doing what is forbidden• Needing to finish or ask same questions• Stuck/perseverating, repeating, erasing, rewriting• Picking, nail biting, pulling hair (Trichotillomania)

© Teaching The Tiger, pg. 15

A Real Balancing Act…

Getting OCD Off My Land!

Dr. John Marsh

Exposure Response Prevention Therapy


Anxiety may cause a “fight or flight” response and lead to school avoidance or refusal.

Image courtesy of Silicon Valley Brain Spect Imaging, Inc.

Non-OCD Anxiety Disorders

• Separation Anxiety

• Generalized Anxiety

• Specific Phobias

• Panic

• Post-Traumatic Stress

• Social Anxiety

• Selective Mutism


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The Hallmark of Tourette Syndrome

© Sheryl K. Pruitt, M. Ed., 1992

Motor Tics Vocal Tics Sensory Tics

• Tics are brief, purposeless, repetitive involuntary movements or sounds that usually occur in bouts.

• Tics may be simple or complex and are often confused with allergies, habits, or misbehavior.

Tourette Syndrome


Not All That Tics is Tourette

• Chronic Tic Disorders

• Transient tics

• Medication-inducedtics

• Tics due to trauma

© Leslie E. Packer, Ph.D., 2000

General Facts

• It is one of the most common neurological disorders of childhood. It is vastly under diagnosed. It knows no cultural or racial boundaries.

• 1:100 prevalence

• Average onset 3-9 years

• 10% for all tic disorders

• Is passed from generation to generation and can be affected by internal or external stressors in the environment

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Symptoms or Misbehavior?Symptoms or Misbehavior?

• touching

• echopraxia

• copropraxia

• echolalia

• coprolalia

• palilalia

• touching

• echopraxia

• copropraxia

• echolalia

• coprolalia

• palilalia

© L.E. Packer, S.K. Pruitt, C.I. Wang, 1999© L.E. Packer, S.K. Pruitt, C.I. Wang, 1999

Mood Disorders

• Dysthymia

• Depression

• Bipolar Disorder

• Cyclothymia

“When I am depressed, I feel so blue!”


Depressed Recovered

NIMH, 2009

Signs of Mood Disorders

© L.E. Packer & S.K. Pruitt, 2000

Too serious

Hallucinations(voices)

Excessive guilt

Sleep disturbance

Appetite disturbance

Down mood

Feels worthless

Agitation

Concentration impaired

Energy loss

Suicidal thoughts

News Flash: Depression

Students AT RISK!!!_______________________________________________________________________

• Approximately 3.4 million children in the U.S. suffer from depression. Less than half receive treatment.

• 5% of adolescents will experience major depression.

• Suicide is the third leading cause of death in youth aged 15 - 24.

_______________________________________________________________________


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Features of Mania/Hypomania

• Euphoria or marked irritability.

• Grandiose thoughts.

• Impulsivity and/or disruptive behavior.

• Hallucinations (severe cases).

• Change in sleep pattern: insomnia + excessive energy may indicate mania.

• Racing thoughts, rapid speech.

• Highly distractible.


PediatricAutoimmuneNeuropsychiatric DisorderAssociated withStrep

© modified from L.E. Packer and S.K. Pruitt, 1999 Raymond A. Cattaneo, 2011

PediatricInfectionTriggeredAutoimmuneNeuropsychiatric Disorder

PediatricAcute-onsetNeuropsychiatric Syndrome

PANS, PITANDS, and PANDAS,

Oh my!

Autism Spectrum DisorderKey Features

• Social Interaction Difficulties

• Communication Deficits

• Narrow Interests

• Inflexibility and Repetitive Behaviors

• Comprehension Deficits

© Sheryl K. Pruitt, M.Ed., ET/P, 2017

• Impaired attention and memory

• Increased hyperactivity and impulsivity

• Bullying and aggressive behaviors

• More accidents• Depressed mood• Long-term memory

deficits

Sleep Problems

“Just five more minutes!”


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• Takes place from infancy through childhood. A child usually matures and is well integrated by 8-10 years of age, but sensory processing continues to be refined throughout life.

• Occurs on an unconscious level, whereas thinking and cognition are more conscious processes.

• Is developed and/or enhanced by sensory experiences.

SensoryIntegration

© 1997 Parkaire Consultants

• Smelling

• Seeing

• Tasting

• Hearing

• Touching

• Pain*

• Proprioceptive

• Vestibular

Photo Credit C. Wang

Sensory Defensiveness

“Make the firm alarm bell stop!”

© 2011 Challenging Kids, Inc.* Added by Pruitt

Hey, you forgot

Oppositional Defiant

Disorder!!

© L E Packer S K Pruitt C I Wang 1999

Did Not!!!!

The Executive Functions Are the Cuing of the Executive Skills!

©Sheryl K. Pruitt, M.Ed., ET/P, 1995

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The “Dreaded Book Bag Diagnostic

Test”

Photo credit, Colleen Wang

© Sheryl K. Pruitt, M. Ed., 1995

CLUECLUE© Sheryl K. Pruitt, M. Ed., 1995

“He is such a good boy. I just don’t know enough things to tell him not to do.”

- Ferrell Sams

EXECUTIVE SKILLS

• Set Goals

• Initiate

• Prioritize

• Pace

• Plan

• Sequence

• Organize

© D.G. Pruitt, S. K. Pruitt, L.W. Walter, M.P. Dornbush, L.E. Packer, 2008

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EXECUTIVE SKILLS

• Shift

• Use Feedback

• Inhibit

• Self-Monitor

• Problem Solve

• Execute

• Generalize


EXECUTIVE SKILL

Set Goals


Friends

FamilyWork


EXECUTIVE SKILL

Initiate


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• Routines with checklists• Verbal or visual cue to

start• Work with peers • Break up tasks • Activity before starting • Provide model work sample• Teach brainstorming • Pick topics of interest


INITIATEINITIATE EXECUTIVE SKILL

Prioritize


• Divide the assignment into small parts with a definite time schedule.

• Show them what a finished product will look like.

• Monitor progress towards intermediate deadlines.

Written Expression and ProjectsWritten Expression and Projects


EXECUTIVE SKILL

Pace


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Now!Or

Not Now!


EXECUTIVE SKILL

Plan


Planning involves anticipating the outcome of your strategy before selecting it.

.

Plan Your Work and Work Your Plan


Two-Step Process

+P.L.A.N.Problem defined!

Lay out options!

Act on one!

Now evaluate!

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EXECUTIVE SKILL

Sequence

© D.G. Pruitt, S. K. Pruitt, L.W. Walter, M.P. Dornbush, L.E. Packer, 2008© Teaching The Tiger, 1995


THE SEQUENCE OF LONG DIVISION

VERBAL CUE

Daddy, Mother, Sister, Brother

VISUAL CUE

COGNITIVE CUE

Dirty Marvin Smells Bad(Divide) (Multiply) (Subtract) (Bring

Down)

EXECUTIVE SKILL

Organize


Organizing Materials: Do’s

Have A Stash of Supplies


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EXECUTIVE SKILL

Shift


You announced a change in plans. She’s handling it quite well, isn’t she?

(Pre warnings give them

a head start to change)


EXECUTIVE SKILL

Use Feedback


Executive functions have beenthe “hidden curriculum.* ”

© Leslie E. Packer, Ph.D., 2002* Richard Lavoie

It’s time to explicitly teach them.

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EXECUTIVE SKILL

Inhibit


• Put your hand in front of your mouth.

• Write your question on a piece of paper so you can wait without forgetting.

© Sheryl K. Pruitt, M.Ed, Bob Rogers., 2002

Blurt Blockers

EXECUTIVE SKILL

Self-Monitor


This isn’t it!


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Pictoral Editing Strip

© Tigers, Too 2009 © Sheryl K. Pruitt, M.Ed., 1992

Memory Functioning

Short-Term MemoryImmediate Memory

Long-Term Memory

Declarative MemorySemantic MemoryEpisodic Memory

© Sheryl K. Pruitt, M.Ed., ET/P, L. Warren Walter, Ph.D., 1997

Spared Memory

Memory Functioning

© Sheryl K. Pruitt, M.Ed., ET/P, L. Warren Walter, Ph.D., 1997

Impaired Memory

Short-Term MemoryWorking Memory

Long-Term Memory

Procedural MemoryProspective MemoryMetamemoryStrategic Memory

© Marilyn P. Dornbush, Sheryl K. Pruitt, M. Ed., Tigers, Too, 2009©Tigers, Too, 2009

Memory Functioning

Word Retrieval

Is A

Memory Look Alike

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TEACHER FROM HELL

A B C D E N O P Q R

I J K L M W X Y Z

© S.K. Pruitt & C.I. Wang, 1999

Prepare the child for the path….

Not the path for the child!


Credits….

Thanks go to Leslie Packer, Ph. D. for her constant support and contributions for several of the power point slides used here today.

Thanks also to Marilyn Dornbush, Ph.D. and Warren Walter, Ph.D. for their contributions and support to several power point slides today.

Thanks especially to my husband, Daniel G. Pruitt, PCC, SCAC, who has been my supporter, partner in our clinic, my publisher, and a contributor to this presentation.


This program is cheerfully dedicated to the author’s family, who have cleverly managed to have almost every problem described. Any problem my husband and I did not have I gave birth to. They are my first, and best, teachers.

Dedication

© Shari Zellars Photography, 2009


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Sheryl K. Pruitt, M.Ed., ET/P

www.parkaireconsultants.com

the facts: regulatory disorders adhd, ocd, tourette syndrome · general facts •it is one of the...

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