On January 15, The Cove School hosted an Annual Professional Development Workshop. This year’s guest lecturer was Dr. Russell Barkley, Clinical Professor of Psychiatry at the Medical University of South Carolina. Dr. Barkley presented the following topics: Executive Functioning and its Impairment in ADHD: What Teachers Need to Know; Recent Advances in ADHD Diagnosis, Etiology and Management; and The Other Attention Disorder: Sluggish Cognitive Tempo and ADHD.
Over 190 participants from a variety of professions, from school districts and private practice, as well as the entire Cove staff, attended the full day event.
The first topic Dr. Barkley addressed was titled “Advances in Diagnosis, Etiology, Theory and Management of ADHD,” defined Attention Deficit Hyperactivity Disorder as neurological, developmental impairment of adaptation. Dr. Barkley put to rest misunderstanding of ADHD as immaturity, as separate from ADD, as a learning disability, psychopathology, or as a performance or skill deficit. Among the symptoms of ADHD are impulsivity that may be manifested as poor inhibition in multiple domains: motor, verbal, cognition, motivation, emotion. ADHD is a deficit of executive functioning, working memory and self-monitoring that encompasses poor persistence toward goals/tasks, distractibility, deficient task-reengagement once distracted. Dr. Barkley reviewed some of the extensive research, including genetic and neurological imaging, that shows that about 35% of ADHD is acquired, while about 65% of ADHD is inherited. Three neural networks are associated with ADHD, each of which includes the brain’s frontal lobe. Acquired ADHD is due to injury or insult to the frontal lobe, usually associated with a number of prenatal risk factors, including premature birth. As an inherited disorder, ADHD is the most genetically regulated disorder of all psychiatric disorders. Research has identified underdevelopment of the “gray matter” of frontal lobe and associated regions, as well as “white matter” structural circuitry aberrations. ADHD may present various profiles, or changes in behaviors over time, especially from childhood to adulthood. While some ADHD symptoms may be present over a lifetime, it is only when the behaviors interfere with everyday functioning – academic, social, interpersonal, independent – that it is considered an impairment. When ADHD does interfere with a person’s performance, adaptation or survival, it is identified as a disorder that requires treatment. Psychosocial interventions may be helpful for supporting executive functioning, but have not yielded generalization when the supports are faded. In contrast, pharmacological management may be both helpful in reducing severity, concomitant stressors and comorbid problems, and possibly also neuro-protective in so far as normalizing some features of brain structures.
Dr. Barkley’s second lecture was titled, “The Other Attention Disorder: Sluggish Cognitive Tempo vs. ADHD.” Acknowledging the unfortunate implications of the label (suggestive of “slow thinking/dim-wittedness” even though it is unrelated either to cognition or to slow processing), he presented evidence supporting SCT as distinctive from ADHD and not simply as ADD, an attention disorder without the component of hyperactivity. Among the distinguishing characteristics of SCT are: its manifestation does not change over time or setting; day dreaming or inattention; difficulty with initiation; over-aversion to risk-taking; passivity and extreme self-inhibition; slow response pattern; deliberative focus/orienting/selection behaviors. In contrast to persons with ADHD who likely exhibit difficulty with work production, persons with SCT may complete their work, but with errors, due to weak attention to important details. ADHD may be associated with deficits in reading, handwriting and reading comprehension, while SCT may be associated with dyscalculia and math learning disorders. The impulsivity of ADHD may lead to self-endangering situations; persons with ADHD statistically have a lower-than-average life expectancy. However, SCT is not associated with parenting stress or to high-risk behavior because of an overriding self-inhibiting response; life expectancy is not statistically aberrant. Nonetheless, both ADHD and SCT present challenges for persons impaired by either disorder in school, social and work settings.
Dr. Barkley’s third lectured, “Executive Functioning in Typical and ADHD Students,” described executive functioning (EF) as arguably humanity’s highest function It is the basis for self-regulation, which is fundamental to survival. EF encompasses self-awareness and inhibition. It may be defined as any self-directed action that is intended to change a future event or consequence. Developmentally, the Vygotsky construct of speech progressing from outward to inward self-talk, can be applied to executive functioning. With neurological maturation, humans become increasingly able to self-initiate and self-direct solutions to problems encounterd, large and small, in the moment or over time. We learn from experience, the hindsight becomes foresight, we off-load the problems-solving processes from working memory into the realm of automatic functioning. Well-developed EF allows for delayed gratification, anticipation of the future, internalized motivation and “privatized” or mental self-direction. Neurologically, these functions require brain maturation, particularly of the frontal lobe and associated regions. Full brain maturation may not occur until 30 years of age. Therefore, admonishing children and adolescents with underdeveloped brains who are struggling with executive functioning behaviors to simply “try harder,” would likely be unhelpful. Moreover, teaching skills (e.g., organizing strategies) is insufficient for addressing EF problems. Rather, providing environmental modifications and external scaffolding at the “point of performance” are key for supporting persons with EF challenges. EF deficits are usually developmental, not social or cultural. Medications may be of use, but restructuring settings, externalizing cues and motivators, chunking task loads and replenishing one’s “resource pool” such as with breaks between segments, are highly beneficial.
We are pleased to continue to offer programs like this free of charge as an expression of our gratitude to the community, and to all those who serve students with special needs.