Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Working with Scouts with ADHD University of Scouting 2013

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Introduction Dr. Charles Pemberton, LPCC –Past President KCA – ACA Chair - Taskforce on DSM 5 –Ed.D. in Educational Counseling –20+ years in Counseling and Mental Health –SR-989, Cubmaster, Member of Review Board –PARENT –Adjunct Professor – Graduate University of Louisville Undergraduate –KCTCS –Private Practice – 80% children and families

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Today’s Schedule Diagnosis and Identification Meeting interventions –Behavioral Strategies Tools and Resources Questions Won’t get a plan that works Everywhere with Everyone

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Causes of ADHD Biological Disorder –Neurological – dopamine/norepinephrine –Genetic Toxins Head injuries Immunizations No evidence: –Sugar –Food additives –Allergies

Hyperactivity Impulsivity Inattention Characteristics of ADD/ADHD The Tip of the Iceberg Hidden below the surface

Characteristics of ADD/ADHD Hyperactivity Impulsivity Inattention PhysiologicalFactors Weak “Executive Functioning” SleepDisturbance Impaired Sense of Time DelayedSocialMaturity Not Learning Easily From Rewards and Punishment CoexistingConditions LearningDifficulties Low Frustration Tolerance Hidden below the surface

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Major Features Often will not complete tasks Easily distracted by minor stimuli Work often messy and completed w/o thought Forgetful in day-to-day activities Impulsive (interrupting others, cannot wait turn, etc.) Fidgetiness Excessive talking

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: ADHD SCOUTS HAVE GREAT ATTRIBUTES TOO! Engaging Bright Excited Creative Happy-go-lucky Enthusiastic Exceptional Inquisitive Spontaneous Clever Unique Eager Energetic Carefree

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Medication – parents’ info If your Scout takes medication to help him focus at school, it may help him focus better during Scout activities as well. You may want to discuss this issue with your Scout’s physician. Make sure your Scout knows that medication is to help him focus, not make him “be good.”

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Medication Prescription medication is the responsibility of the Scout taking the medication and/or his parent or guardian. A Scout leader, after obtaining all necessary information, can agree to accept the responsibility of making sure a Scout takes the necessary medication at the appropriate time, but BSA policy does not mandate nor necessarily encourage the Scout leader to do so. Also, if state laws are more limiting, they must be followed.

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: How to help Get trained Complement They are all individuals Clear expectations Talk to Parents about what works –Meetings –Day trips –Weekends –Week long

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: How to help Set a schedule (mental/physical) –Know what is expected –Use daily/weekly forms for planning –Use color codes –Limit time –Give Breaks –Provide review –Provide Transition time Minimize spaces/distractions Organize

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: How to Help Put it in writing Set smaller/reachable goals Divide into smaller segments Reward all completions Review for ‘hasty’ errors Work on discovering what is really happening – (i.e. Forgetting)

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Forgetting 1- Need to notice 2- Need to write/record 3- Need to bring home 4- Need to look 5- Need to understand 6- Need to start/finish 7- Need to store 8- Need to turn-in

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Movement Offer opportunities for purposeful movement, such as –Leading cheers –Performing in skits –Assisting with demonstrations This may –Improve focus, –Increase self-confidence, and –Benefit the troop as a whole

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Warning Signs Be aware of early warning signs, such as fidgety behavior, that may indicate the Scout is losing impulse control. When this happens, try a Private, nonverbal signal or Proximity control (move close to the Scout) to alert him that he needs to focus.

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Warning Signs During activities, games and transition times, be aware when a Scout is starting to become more impulsive or aggressive.

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Helping a child control his behavior Minimize distractions Give choices Limit Choices Teach problem solving Use calm discipline - distraction

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Redirecting When you must redirect a Scout, Do so in private, in a calm voice, unless safety is at risk. Avoid yelling. Never publicly humiliate a Scout. Don’t “sandwich” a correction between two positive comments. –Good, bad, good

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Time out If it has not been possible to intervene proactively and you must impose consequences for out-of-control behavior, use time-out or “cooling off.”

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Keep Cool Don’t take challenges personally. ADHD Scouts (should be “Scouts with ADHD”) want to be successful, but they need support, positive feedback, and clear limits.

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: EDGE Through systematic Explanation, interactive Demonstration, and Guided practice, Scouting Enables Scouts with Scouts to discover and develop their unique strengths and interests.

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Excuses Expect the Scout with ADHD to follow the same rules as other Scouts. ADHD is NOT an excuse for uncontrolled behavior.

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Some bad Examples We A fair trial often includes assessing the scout's behavior on camping trips or other activities both on and off his medication. If you choose to have your son take no medication for 1-2 events and he is unable to focus and benefit from the experience, it is reasonable to then medicate him for 1-2 events to determine if the medication actually yields any benefit. If the scout clearly does better on medication than off, it is expected that he will remain on medication for all activities longer than 2-3 hours.

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Suggested Strategies We Tell the Scouts in advance what they will learn Provide a combination of visual, written and oral instructions since these help the Scout to focus and remember the key parts of a learning activity. Repeat instructions often Break large tasks into a set of smaller tasks or steps and monitor for completion of each step Make a written list of these steps and allow the Scout to cross off each step as it is completed. This method may also be used for any number of tasks. Work on one step at a time.

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Suggested Strategies We Allow for extra time for some Scouts to compete certain steps Have different (and adjustable) activities for faster and slower learners Try to provide a quiet area with limited distractions. Create a routine and expectations for each meeting. Plan short breaks Provide an area or time where the Scouts can move around and release excess energy. Establish a clearly defined and posted system of rules and consequences for behavior.

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Suggested Strategies We A card or a picture may serve as a visual reminder to use the right behavior, like raising a hand instead of shouting out, or staying in a seat instead of wandering around the room. Accept and praise each boy’s best effort in keeping with the Scout Oath. Never make comparisons. Help everyone to understand that while fair means giving everyone what he need, it is not necessarily equal. (Weinstein, 1994)

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Summing it up Don’t Spoil Me. I know I should not get all I ask for. I am only testing you Don’t be afraid to be firm with me. I prefer to know where I stand Don’t use force with me. It teaches me that power is all that counts. I respond better to examples of what I should do

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Summing it up Don’t be inconsistent. You’ll just confuse me and make me try harder to get away with anything I can Don’t make promises you can’t keep. I will learn not to trust you Don’t let me provoke you. If I say or do things to upset you, don’t blow up or I may do it again. I don’t mean it. I just want you to feel sorry for me.

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Summing it up Don’t me feel smaller than I am. I’ll just make up for it by acting like a big shot. Don’t do things for me that I can do myself. This only makes me more dependent. Don’t give my bad habits a lot of attention. This only encourages me to keep showing these to you

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Summing it up Don’t correct me in front of others. It is better to correct me quietly and in private. Don't discuss my behavior in the heat of conflict. I don't hear or cooperate well at this time. Do what needs to be done, but save the words for later. Don't preach to me. You'd be surprised how well I already know what's right and wrong

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Final Word Scouts with ADHD are generally energetic, enthusiastic, and bright. Many have unique talents as well. Help them use their strengths to become leaders in your troop.

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: Tools/Resources Working with Scouts with Disabilities – Teenagers with ADD: A Parents’ Guide

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: References The ADD/ADHD Iceberg adapted by permission of Chris Dendy, Teaching Teens With ADD and ADHD: A Quick Reference Guide.

Dimensions Family Therapy 2302 Hurstbourne Village Dr. Suite 300 Louisville, KY Phone: Fax: References American Academy of Pediatrics. Diagnosis and evaluation of the child with attention- deficit/hyperactivity disorder. Pediatrics. 2000;105: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. DSM-IV-TR. In: Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence: Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder. Washington, DC: American Psychiatric Association; 1994: National Institute of Mental Health. National Institutes of Health. Attention deficit hyperactivity disorder. Available at: Accessed April 19, U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Available at: Accessed April 19, Dulcan M. Practice parameters for the assessment and treatment of children, adolescents, and adults with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 1997;369(suppl): American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. DSM-IV-TR. In: Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence: Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder. Washington, DC: American Psychiatric Association; 1994: National Institute of Mental Health. National Institutes of Health. Attention deficit hyperactivity disorder—questions and answers. Available at: Accessed April 19, American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, Fauman, M. A. (2002). Study Guide to DSM-IV-TR. Washington, DC: American Psychiatric Publishing, Inc.