Copyright Dr. Carrie McMillin, LLC 2018...Override the desire to quit or do anything else that’s...

Copyright Dr. Carrie McMillin, LLC 2018


About me● Naturopathic physician (ND)● Specialize in helping adults, children, and families

manage ADHD and anxiety● Private practice in both Seattle and Issaquah● Began education at medical (MD) school in

Detroit, switched to attend Bastyr University● Published research scientist- sleep medicine● Background in laboratory medicine, medical

education, medical writing, pharma● Spouse and mother of some amazing people with

ADHD


Understanding Executive Function Deficits

(and how to overcome them)


What is ADHD

Three types:

● Primary inattentive● Primary hyperactive● Combined type

These are all technically called ADHD


What is ADHD

● Executive function deficit disorder● Disorder of self-regulation, more

than attention● Inability to engage in self-directed

actions that are beneficial to the future


What are executive functionsSet of brain functions that affect self-control, self-regulation, and the ability to achieve goals● Inhibition● Flexibility● Emotional control● Task initiation● Working memory● Planning/organization/prioritization● Self-monitoring● Time management

Variation of list proposed by Drs. Gerard A. Gioia, Peter K. Isquith, Steven C. Guy, and Lauren Kenworthy


Executive function: Inhibition

The ability to stop your behavior at the appropriate time

● Stopping actions and thoughts

● Ignoring distractions

● Resisting temptations


Executive function: Inhibition

“Hyperactivity” of ADHD (not a restlessness)

Don’t notice distractions more, but react to them

more

Self-control is not learned


Executive function: FlexibilityThe ability to move freely from one situation to another● Thinking flexibly in order to respond

appropriately to the situation● Being able to think about something

in more than one way● Hyperfocus


Executive function: Emotional controlAbility to adjust emotional responses based on logical reasoning

● Managing emotional reactions in order to perform a task ● Resisting temptation in order to get a larger reward● Ability to self-soothe


Executive function: InitiationThe ability to begin a task or activity

● Self-motivation● The ability to independently

generate ideas, responses, or problem-solving strategies


Executive function: Working memoryThe capacity to hold information in mind and then use it to complete a task

● What was I doing?

● What was the goal?● Can lead to information

overload and results in tuning out


Executive function: Planning/organizationThe ability to manage current and future-oriented task demands

● To bring order into work, play, and storage spaces

● Foresight/hindsight● How to eat an elephant


Executive function: Self-monitoringThe ability to think about what you are doing and to measure it against some standard of what is needed or expected● Internalized speech● Notice challenges, pause, think about options, and put things into context● Central to solving problems


Executive function: Time managementCapacity to estimate:

● How much time there is to complete a task/project

● How much time a task will take ● How to allocate time correctly● How to stay within time limits

The longer the task takes, or the more time that exists between now and the deadline, the more difficult it will be to manage time accurately


Skills Related to Executive FunctionProcessing Speed

● The reflection process needs to occur quickly and efficiently to solve problems on time

● Affects how well executive skills can be used to solve problems and achieve goals


A note about diagnosis


Overcoming Executive Function Deficits

Helping ADHD kidsEmpathy and understanding

View struggles in the context of a disorder instead of purposeful misbehavior or lack of effort

Assist in self-understanding and

acceptance

Believe they can do it


Reward, reward, rewardFrequent, positive feedback/encouragement● Must be specific● Must be genuine

Give breaks!

Helping ADHD kidsCreate a routine

Model organization

Calendar- one week at a time


CommunicationEngage as many senses as possible

Incorporate verbal, auditory and even tactile cues if you can

● Give both written and verbal instructions

● Use “props”

Homework and choresHelp break things into reasonable tasks

● Put them on a list● 2-4 items

When they begin the task, the end should be in sight (or the break)


EngagementSome kids with ADHD do well with rapid, competitive exercises

● Utilize a timer● Pair with incentives● Consider a challenge of time to beat or other marker

For kids with anxiety, usually better to structure this as looking for improvement trends in timing, number completed, etc.


Pomodoro techniqueSet timer for short periods of time followed by short break

After 3-4 of these cycles, a longer break is earned

Example:

15 min work

5 min break

15 min work

5 min break

15 min work

15 min break


Incentive chartsMake sure the difficulty of the task is appropriate

Positive reward only

Talk with your child to decide on a

reasonable and desirable reward


Helping with initiationOverride the desire to quit or do anything else that’s preferable● Consider the next smallest step to move forward● Make first step easy enough and immediately follow with reward

To build this skill

● Gradually increase amount of effort needed to achieve the reward○ Increase task demand

○ Increase amount of time child must work


Helping with initiationAre you doing what you need to be doing right now?

Do you need my help or someone else’s help? Or do you think you can do this yourself?

I will come back and check on you in case you change your mind and need extra help


Transitions

Transitions can often be difficult for kids with ADHD (flexibility)

● Overview of expectations ● Give a “5 minute warning” when a transition is approaching

○ (Maybe a 10 minute warning)


Fuel interests

Best strategy:

interest-guided learning● Support their interests● When possible, have kids help

to choose activities


Improving executive functions

A good general rule:

Only offer amount of support needed, and for as long as needed


Be your child’s cheerleader


Thank you


Mindfulness


What is mindfulness?State of mind

Focus on the present moment

Witness the sensations of body/environment

No judgement

Therapeutic breathing


MindfulnessImproved attention

Better emotional regulation● More engagement when emotions activated● Less emotional reactivity

Increased compassion● Self● Others

Stress reduction

Decreased anxiety

Increased neuroplasticity

www.mindfulschools.org


MindfulnessBe a mindfulness model

● Morning, evening● Brief moments throughout day● Examples:

○ Belly breathing

○ 4-7-8 breathing

○ Sensory scan- what do I hear, feel, smell, taste


MindfulnessApps:

● Headspace● Insight Meditation Timer● Stop, Breathe, and Think● Smiling Mind

UCLA Mindfulness Awareness Research Center

http://marc.ucla.edu/mindful-meditations


Mindfulness in the classroomIdeal time: mid-morning

Essential to teach kids why

Mindful Breaks

Attention check

● Is your attention here?● Where is your mind wandering?

http://leftbrainbuddha.com/teaching-mindfulness-to-teens-5-ways-get-buy/


Mindfulness in the classroomResources:

www.mindful.org

www.mindfulteachers.org

www.mindfulschools.org

www.leftbrainbuddha.com


Objectives Revisit● Develop a concrete understanding of executive functions● To make the connection between deficits in executive functioning and the

behavior we see in students with ADHD● Ways to support students with ADHD in the classroom● Techniques for strengthening executive functions● How to incorporate mindfulness into the learning environment


OrganizationWork folder

● Simplify it to one for things that go home/need to be worked on○ Student must review every night

○ Empty every morning

● Master binder with folder for each subject○ Prioritize eliminating what is not needed


OrganizationOrganization

● Always model organization● Include one page agenda

○ Can be a checklist

○ Test, assignments, materials needed, etc.

● Day at a glance on desktop ● Encourage use of a calendar- one week at a time


Improving executive functionsCreate organized classrooms

Provide framework for learning executive function skills

Some students do not fully develop their executive function capabilities, even with

these approaches.

● Make sure to eliminate the “I can’t” mindset

● Students must believe they will be successful for these skills to become

internalized

Copyright Dr. Carrie McMillin, LLC 2018...Override the desire to quit or do anything else that’s...

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