ADHD Treatment In Rhode Island
“Consult with the experts on Child and Adolescent Evidence-Based ADHD Pyschotherapy and Psychiatry”
ADHD is a neurological and behavioral disorder that affects not only the person diagnosed, but the entire family. ADHD can affect children, teens and adults. It is the most commonly diagnosed neurobehavioral disorder in children. Adult ADHD is estimated to occur in approximately 4-5% of adults.
At Quality Behavioral Health of Rhode Island, 160 years of experience treating ADHD and co-existing disorders by a staff of Board Certified Child, Adolescent, and Adult Psychiatrists, a Developmental Pediatrician, and prescribing Nurse Practitioners.
Contact with patients is immediate and services provided within one week.
ADHD and Executive Functioning at QBH
A NEW UNDERSTANDING OF ADHD IN CHILDREN AND ADULTS
“For over 100 years, ADHD has been seen as essentially a behavior disorder. Recent scientific research has developed a new paradigm which recognizes ADHD as a developmental disorder of the cognitive management system of the brain, its executive functions.”
Thomas E. Brown, PhD, Associate Director of the Clinic for Attention Disorders, and Clinical Professor of Psychiatry, Yale University School of Medicine.
According to Russell Barkley, Clinical Professor of Psychiatry and Pediatrics at The Medical University of South Carolina, ADHD is a disorder of Executive Functioning. Executive Functioning is comprised of a set of mental skills that help the brain organize and act on information. These skills enable us to plan, organize, remember things, prioritize, pay attention, and get started on tasks. The ADHD/Executive Functioning Program at Quality Behavioral Health will address the mental skills that effect learning and behaviors and that help parents, students, and educators develop a customized educational curriculum to help children increase their self-awareness of the way they learn, and to actively participate in the learning process.
According to Barkley “executive functions are things we do to ourselves in order to change behaviors. By employing executive functions effectively we hope to change our future for the better”.
A key component of the program will be the introduction to a number of EF APPS, carefully vetted by Randy Kulman Ph.D. of LearningWorks for Kids, accompanied by suggestions for implementation. An article describing the apps programs, 5-Must Have Apps for Improving Executive Functioning is attached. Apps that support planning, working memory, organization, and time management, will be demonstrated to parents and children by in-house staff.
Included in the program will be the option for NUTRITIONAL COUNSELING. Psychiatric Nurse Practitioners will be available to provide nutritional guidelines. The best foods for children who have ADHD are the same as those for children who do not have the condition. All children need lots of healthy unprocessed food and generous amounts of fruits and vegetables.
Consideration is being given to the incorporation of Occupational Therapy services to address sensory processing difficulties and to and to help children adapt to varying learning environments.
ADHD and EXECUTIVE FUNCTIONING PROGRAM at QUALITY BEHAVIORAL HEALTH
Licensed Mental Health Counselors and licensed Social Workers will conduct psychoeducational and therapeutic sessions for parents and children designed to develop an understanding of the etiology, signs and symptoms of EF deficits. Informal, traditional and on-line assessments may be administered in order to identify problem behaviors and EF deficits. You may find an on-line assessment for EF at www.kandmcenter.com. Individual plans will then be developed to address those deficits by selecting age and developmentally appropriate activities to be used in both home and school settings.
The initial assessment will identify the child’s strengths, weaknesses, and skill deficits. A schedule and learning goals will then be developed. Individual learning and practice activities will be then be assigned for use during both the therapeutic session and at home.
ORGANIZATION of EXECUTIVE FUNCTIONS
The executive functions will be organized into 5 general clusters as proposed by Russel l A. Barkley, Clinical Professor of Psychiatry and Pediatrics at The Medical University of South Carolina.
The ability to hold things in mind, how we can picture things mentally
PROBLEMS OF EMOTIONAL REGULATION:
Self-directed attention, the ability to manage one’s own emotional state
Self-directed attention, self-inhibition
PLANNING AND PROBLEM SOLVING:
Self-play, or how we play with information in our minds to come up with new ways of doing something, planning solutions to our problems
DIFFICULTIES WITH TIMING:
The ability to look into the future and contemplate goals, taking goal-directed actions
EXAMPLES OF AGE AND DEVELOPMENTALLY APPROPRIATE ACTIVITIES
After assessment for EF functioning, and determination of functional deficits, skills development activities can be selected and taught at the appropriate level of the child’s ability. It should be noted that impairments or deficits in one area of functioning will often overlap with other areas or clusters.
These EF skills can be taught systematically and at the appropriate level of the child’s functional ability. Three to five-year olds need support in learning rules and structure, and a goal might be to gradually shift from adult reliance. A five to seven year old might benefit from more challenging tasks and games with more exacting rules. Teenagers need to operate in multiple contexts, managing their own extracurricular activities.
Examples of EF Treatment
The following examples are drawn from a research article available at developingchild.harvard.edu The article contains numerous developmentally appropriate activities and strategies for improving EF skills, and will provide an importance bank of resources to participants in the QBH/ADHD and Executive Functioning Program.
Six-year old exhibiting difficulty with-self-regulation and lacking concentration
At this age children start to enjoy games that have rules but do so with varying levels of interest and skills. Games like Go Fish, Old Maid, Uno, can be played, initiated by the parent but with gradual withdrawal allowing more freedom, responsibility, and decision-making practice by the child. The activities can then be graduated to more fast-paced games, challenging attention and inhibition. Eventually Parcheesi, Checkers, Minecraft, Dungeons and Dragons….
Seven to Twelve Year Olds
For children of this age it becomes important to steadily increase the complexity of games and activities. Card games exercise working memory and promote mental flexibility. Any games requiring strategic thinking and planning such as gin rummy, mahjong, or fantasy games like Minecraft or Dungeons and Dragons. Physical activities, music, singing, puzzles, and brain teasers draw on a wide range of skills.
Teenagers need to successfully complete more abstract and complicated projects. Self-regulation is required in any goal-related activity. Identifying goals, planning, monitoring progress, and adjusting behavior in social contexts become increasingly important. Teens need to be helped to develop plans, take on larger social issues, use self-talk, understand the motives of others.
Age and developmentally appropriate activities will be chosen for the following:
5-7 year olds
7-12 year olds
Should you as a parent, teacher, or caregiver feel that your child is experiencing difficulties managing behaviors related to Executive Functioning please feel free to assess their behavior on-line at www.kandmcenter.com or contact Quality Behavioral Health to schedule an appointment for individual assessment.
Medical management services are available by a team of Board Certified Psychiatrists, Developmental Pediatricians, and Psychiatric Nurse Practitioners.
Guide to ADHD Treatment and Executive Functioning