risk, resilience and adhd - · pdf filerisk, resilience and adhd sam goldstein ph.d.!...
TRANSCRIPT
![Page 1: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/1.jpg)
Risk, Resilience and ADHD
Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor of Psychology! George Mason University!
www.samgoldstein.com
![Page 2: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/2.jpg)
Relevant Disclosure
• Editor in Chief of the Journal of A:en;on Disorders
• Author of a number of textbooks and trade books about ADHD
• Compensated Speaker
• Clinician
![Page 3: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/3.jpg)
Goals for This Presenta;on
• Discuss current knowledge and research about ADHD e;ology, conceptualiza;on, diagnosis and treatment.
• Discuss current knowledge and research about resilience as a clinical phenomenon.
• Integrate these two areas to appreciate and apply a strength based model in the treatment and educa;onal guidance of ADHD.
![Page 4: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/4.jpg)
What is self‐regula;on/self discipline?
![Page 5: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/5.jpg)
Self-discipline can be understood as a vital component of a sense of ownership and responsibility
for one’s behavior.
![Page 6: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/6.jpg)
The need to develop and effectively harness self-discipline at an early age, while critical
in any culture, may take on greater importance in a society filled with complex demands, challenges, and stresses. The possession and ability to effectively utilize self-discipline paves a successful road into
adulthood.
![Page 7: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/7.jpg)
It is not surprising that in our fast paced, seemingly chaotic world, children capable of implementing self-discipline at young ages appear to negotiate the maze of family, school, friends, and community
more successfully than those who struggle with this ability.
![Page 8: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/8.jpg)
Effective self-discipline implies that a child has internalized a set of rules so that
even without the presence of a parent or other caregiver, the child will act in a
thoughtful, reflective manner.
![Page 9: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/9.jpg)
What happens to children when they struggle to keep pace in the
matura;on of their self‐discipline?
![Page 10: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/10.jpg)
We fail to appreciate that children are gene;cally endowed with certain
pa:erns of behavior and thought.
![Page 11: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/11.jpg)
What Are These Traits?
The drive to help. The drive to mastery. Altruism.
Self-discipline Social connections. Instinctual optimism. Intrinsic motivation.
![Page 12: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/12.jpg)
The experience of growing up with ADHD absent oNen steals away
opportuni;es to develop a resilient mindset.
![Page 13: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/13.jpg)
Children with educa;onal vulnerability driven by un‐ or
undertreated ADHD become failure avoiders when the well meant
efforts of parents and teachers fail.
![Page 14: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/14.jpg)
14
Defining ADHD
![Page 15: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/15.jpg)
15
What is ADHD?
ADHD is a biopsychosocial condi;on characterized by core symptoms of ina:en;on, hyperac;vity and impulsivity leading to/interac;ng with specific cogni;ve/neuropsychological deficits causing impairment in all walks of life.
![Page 16: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/16.jpg)
16
What is ADHD?
• ADHD appears to primarily involve the basal ganglia, cerebellum and variably the frontal lobes, depending on associated learning difficul;es.
• Comorbidity with ADHD probably confounds findings from different study groups. (Hendren et al, 2000)
• The symptoms of ADHD lead to a nearly infinite number of consequences
![Page 17: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/17.jpg)
17
ADHD is a condi;on stemming from inefficient self‐regula;on.
![Page 18: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/18.jpg)
18
Self‐regula;on
• The ability to inhibit • The ability to delay • The ability to separate thought from feeling • The ability to separate experience from response
• The ability to consider an experience and change perspec;ve
• The ability to consider alterna;ve responses
![Page 19: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/19.jpg)
19
Self‐regula;on
• The ability to choose a response and act successfully towards a goal
» The ability to change the response when confronted with new data
• The ability to nego;ate life automa;cally
• The ability to track cues
![Page 20: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/20.jpg)
20
Children with ADHD aren't Clue‐less
They are unfortunately oNen cue‐less!
![Page 21: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/21.jpg)
21
Poor Self‐regula;on
• Poor self‐regula;on is synonymous with
– poor self‐control • Poor self‐regula;on leads to
– impulsive behavior
![Page 22: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/22.jpg)
22
Ina:en;on
• Condi;ons under which ina:en;on is observed – Repe;;ve – Effor`ul – Uninteres;ng – Not chosen
![Page 23: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/23.jpg)
23
Consequences if ina:en;on
• Condi;ons under which problems with consequences are observed – Delayed – Infrequent – Unpredictable – Lacking saliency
![Page 24: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/24.jpg)
24
Is there a broader conceptual model to understand, explain, evaluate and
treat ADHD?
![Page 25: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/25.jpg)
25
Execu;ve Func;oning (EF)
EF is comprised of internal and/or external procedures necessary to engage in purposeful behavior and
achieve goals.
![Page 26: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/26.jpg)
26
What is Execu;ve Func;oning (EF)?
• Absent in nearly all of the literature on EF is any truly opera;onal defini;on of the concept itself
– One typically finds a vague general statement of EF (e.g., social intelligence, goal‐directed ac;on, cogni;ve control, top‐down inhibi;on, effor`ul processing, etc.)
– Or a ba:ery of tests believed to assess EF – Or a lis;ng of the constructs subsumed by the term
• e.g. Inhibi;on, Nonverbal and Verbal Working Memory, Planning, Problem‐Solving, & Goal‐Directed Ac;vity, Strategy Development and Execu;on, Emo;onal Self‐Regula;on, Self‐Mo;va;on
![Page 27: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/27.jpg)
27
1. An intention to act. 2. Formulation of a goal of action. 3. Formulation of a plan of action.
4. Temporally sequencing the chosen plan of action. 5. Executing the plan smoothly from step to step.
6. Evaluating and re-evaluating the outcome in light of the objective.
7. When successful move on – if failed rethink from step #3.
Execu;ve Func;oning Requires:
![Page 28: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/28.jpg)
28
EF is comprised of internal and/or external procedures necessary to engage in purposeful behavior and achieve
goals. EF comes online when one or more of these condi;ons are present:
1) when a cogni;ve task is new as opposed to familiar or prac;ced;
2) when a cogni;ve task is difficult as opposed to easy; 3) when the condi;ons of the task vary as opposed to
remaining stable and predictable; 4) when behavior is not automa;c; and 5) when a quick response is required.
![Page 29: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/29.jpg)
29
The frontal lobes in combina;on with mid‐brain structures in the
basal ganglia and the cerebellum are key to efficient EF. Their inefficiency is in part responsible for ADHD.
![Page 30: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/30.jpg)
30
Just as intelligence is more than the sum of certain intellectual processes, so to is EF more than just the sum of certain func;ons. As such to understand EF one must be able to
quan;fy an outcome, not just a set of hypothe;cal func;ons.
![Page 31: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/31.jpg)
Processes Controlled by Frontal Opera;ons
• A:en;on • Decision Making/Problem Solving • Flexibility • Impulse Control • Emo;onal Control • Ini;a;on • Memory • Organiza;on • Persistence • Perspec;ve Taking • Self/Performance Monitor
![Page 32: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/32.jpg)
Flexibility – (adaptability). The capacity to make appropriate responses to changed or changing situa;ons; the ability to modify or adjust one’s behavior in mee;ng different circumstances or people.
![Page 33: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/33.jpg)
Emo;onal Control: A process of restraining one’s affec;ve responses Ini;a;on – voluntary exer;on to begin
goal‐directed ac;vity; planning, launching, and ini;a;ng goal‐directed
ac;vity.
![Page 34: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/34.jpg)
Organiza;on: The structure discovered in or imposed upon a set of items in order to guide memory performance; coordinated mental processes or
behaviors.
![Page 35: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/35.jpg)
Persistence: Con;nuance or repe;;on of a par;cular behavior, process, or ac;vity despite cessa;on of the
ini;a;ng s;mulus; quality or state of maintaining a course of ac;on or keeping at a task and finishing it despite the obstacles or effort
involved.
![Page 36: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/36.jpg)
Perspec;ve Taking: Looking at a situa;on from a viewpoint that is
different from one’s usual viewpoint.
![Page 37: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/37.jpg)
Performance/Self Monitoring : Communica;on with the self or a meta‐awareness of one’s ac;ons
allowing for error detec;on, changing response pa:erns, etc.
![Page 38: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/38.jpg)
So is ADHD an EF Disorder?
![Page 39: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/39.jpg)
Should we re‐label ADHD as EFDD?
![Page 40: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/40.jpg)
40
ADHD Characteris;cs • ADHD “results from a failure in self‐control” (Barkley, 1998, p. 66)
• Symptoms: – problems with inhibi;on of prepotent responses which limits control of behavior
– lead to poor planning and an;cipa;on – poor organiza;on – impaired verbal problem solving and self‐directed speech, poor rule governed behavior
– problems developing, using and monitoring organiza;onal strategies;
– (Barkley, 2003).
![Page 41: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/41.jpg)
Is this a just another tool to measure ADHD?
![Page 42: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/42.jpg)
A New Paradigm
• Intelligence comprises abili;es needed to solve problems.
• Knowledge is all acquired informa;on employed selec;vely to solve problems.
• Self‐discipline/control is essen;al to inhibit sufficiently to solve problems.
• Mo;va;on is the interest/drive the individual possesses to persevere.
• EF is the efficiency needed to manage all of these components successfully. It is the proverbial “grease for the gears”
![Page 43: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/43.jpg)
43
ADHD Characteris;cs
• Children with ADHD may have difficulty with some but not all ‘execu;ve func;ons’.
• Shared deficits may be related to frontal lobe deficits.
• If ADHD is a failure of self‐control within the context of prefrontal lobe func;ons (see Goldberg, 2001) ‐
• Then a connec;on between the disorder and the PASS theory described by Naglieri and Das (2005) based on A. R. Luria’s work can be made.
![Page 44: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/44.jpg)
44
ADHD Characteris;cs
There is considerable research that suggests that children with ADHD have a specific profile of abili;es on the Planning, A:en;on, Simultaneous, Successive (PASS) theory of Luria.
Dehn, 2000; Paoli:o, 1999; Iseman, 2005; Naglieri, Goldstein, & Iseman, 2003; Naglieri, Salter & Edwards, 2004; VanLuit, Kroesbergen &
Naglieri, 2005
![Page 45: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/45.jpg)
They Struggle With Planning
ADHD
ASD
SLD
![Page 46: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/46.jpg)
ADHD acts as a catalyst fueling other developmental and environmental risk factors.
![Page 47: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/47.jpg)
The Consequence Is Worse Than the Symptom
NEGATIVE REINFORCEMENT
![Page 48: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/48.jpg)
Five keys to successful support of people with ADHD
• Make tasks interes;ng • Make payoffs valuable
• Adjust expecta;ons for change • Allow more trials to mastery
• Focus on assets/resilience
![Page 49: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/49.jpg)
Resilience is a process focusing upon strengths/assets to overcome
adversity.
![Page 50: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/50.jpg)
Resilience
• A process leading to good outcome despite high risk
• The ability to func;on competently under stress
• The ability to recover from trauma and adversity
![Page 51: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/51.jpg)
“I’m not afraid about my girlfriends and myself, we’ll squeeze through somehow, though I’m not too certain
about my math.”
Anne Frank June 21, l942
![Page 52: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/52.jpg)
“I have lots of courage, I feel so strong and as if I can bear a great deal,I feel so free and so young! I was glad when I first realized it, because I don’t think I shall easily bow down before the blows that inevitably come to everyone.”
Anne Frank July 15, 1944
![Page 53: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/53.jpg)
Person A:ributes Associated With Successful Coping*
• Affec;onate, engaging temperament. • Sociable. • Autonomous. • Above average IQ. • Good reading skills. • High achievement mo;va;on. • Posi;ve self‐concept. • Impulse control. • Internal locus of control. • Planning skills. • Faith. • Humorous. • Helpfulness.
* Replicated in 2 or more studies
![Page 54: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/54.jpg)
Environmental Factors Associated With Successful Coping*
• Smaller family size. • Maternal competence and mental health. • Close bond with primary caregiver. • Suppor;ve siblings. • Extended family involvement. • Living above the poverty level. • Friendships. • Suppor;ve teachers. • Successful school experiences. • Involvement in pro‐social organiza;ons.
*Replicated in 2 or more studies.
![Page 55: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/55.jpg)
The pathways that lead to posi;ve adapta;on despite high risk and adversity are complex and greatly influenced by context therefore it is not likely that we will discover a
magic (generic) bullet.
![Page 56: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/56.jpg)
Resilient children are not simply born that way nor are they made from scratch by
their experiences. Gene;c and environmental experiences loom large as protectors against a variety of risks to healthy development ranging from resistance to bacteria and viruses to
resilience to maltreatment and rejec;on.
Kirby Deater-Deckard
![Page 57: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/57.jpg)
Diagnosis may be a simple ma:er of coun;ng symptoms however
assessment is not.
![Page 58: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/58.jpg)
ADHD brings with it increased vulnerability.
• Mood disorders. • Anxiety disorders. • Personality disorders. • Academic failure. • Substance abuse and addi;on. • Obesity and health risks. • Rela;onship problems. • Voca;onal problems. • Financial problems.
![Page 59: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/59.jpg)
Assessment Requires
• Detailed history. • Observa;on direct and indirect. • Diagnosis. • Cogni;ve, academic, emo;onal and neuropsychological data.
• Apprecia;on of available resources. • Considera;on of addi;onal diagnoses. • Treatment formula;on.
![Page 60: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/60.jpg)
Treatment Plan For ADHD
• Educa;on • Thorough assessment • Medica;on • Behavior management • Educa;onal support • Long term perspec;ve • Build success • Focus on resilience
![Page 61: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/61.jpg)
If great men and women suffered from ADHD their achievements were
despite not because of ADHD.
![Page 62: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/62.jpg)
S;mulant Trends
![Page 63: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/63.jpg)
Pills will not subs;tute for skills
But they will relieve symptoms
![Page 64: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/64.jpg)
Psychosocial Interven;ons for ADHD
• Environmental manipula;on of the physical plant
• Environmental manipula;on of consequences
• Modifica;on of cogni;ve func;on
![Page 65: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/65.jpg)
Symptom relief is not synonymous with changing long term outcome.
![Page 66: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/66.jpg)
What Quali;es Define the Best School for Students With ADHD?
![Page 67: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/67.jpg)
What Quali;es Define the Best Teacher For Students With ADHD?
Quali;es That Define the Best Teacher For All Students!
![Page 68: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/68.jpg)
Some Quali;es of Good Teachers
• Empathic
• Communicate Well • Seek the best in every student • Focus on strengths not weaknesses • Make children feel welcome in the classroom
• Educate enthusias;cally • Seek to understand before being understood • Change methods not students
![Page 69: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/69.jpg)
“Make the work interes;ng and the discipline will take care of itself”
E. B. White
![Page 70: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/70.jpg)
What teachers want from children with ADHD
• TO THINK • TO START • TO STOP in concert with all students
![Page 71: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/71.jpg)
“The secret of educa;on lies in respec;ng the student”
Ralph Waldo Emerson
![Page 72: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/72.jpg)
The Essen;al Mindset For Youth With ADHD
• The world makes sense. • I can control myself. • I am part of a community. • I can solve problems and learn from mistakes. • I feel loved and appreciated. • I am intelligent.
![Page 73: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/73.jpg)
The Essen;al Mindset For Youth With ADHD
• If I’m willing to try a different way I can be successful.
• Hopeful and op;mis;c.
• I can make a contribu;on.
• I am worthy.
• The world is fair.
![Page 74: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/74.jpg)
Adopt a learning to ride a bicycle mindset!
![Page 75: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/75.jpg)
Stress Hardiness
• Commi:ed to finding a meaningful purpose in life.
• A belief that you can influence your surroundings and outcome of events,
• A belief that you can learn and grow from both posi;ve and nega;ve life experiences.
![Page 76: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/76.jpg)
Focus on Well Being!
• COMPETENCE in academic, social and voca;onal areas
• CONFIDENCE or a posi;ve iden;ty • CONNECTIONS or healthy rela;ons • CHARACTER or posi;ve values, integrity, and values
• CARING and compassion
(Lerner et al, 2000, 4-H Study)
![Page 77: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/77.jpg)
An Example of Five Strategies To Foster a Resilient Mindset
• Teach empathy by prac;cing empathy.
• Teach responsibility by encouraging contribu;ons. • Teach decision making and problem solving skills that foster self‐discipline.
• Offer encouragement and posi;ve feedback. • Help children deal with mistakes.
![Page 78: Risk, Resilience and ADHD - · PDF fileRisk, Resilience and ADHD Sam Goldstein Ph.D.! Assistant Clinical Professor of Psychiatry! University of Utah! Affiliate Research Professor](https://reader030.vdocuments.net/reader030/viewer/2022020411/5a9dbc897f8b9aee528bde74/html5/thumbnails/78.jpg)
www.samgoldstein.com [email protected]