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“What is it with this Kid? What can I DO?”

Sabrina Schuck, Ph. D.Assistant Clinical Professor, Pediatrics, Psychology & Social Behavior

Executive Director, Child Development Center School

UC Irvine

Identifying children “at-risk” in your classroom and finding strategies that work

Struwwel-Peter(Slovenly Peter)

Is it a Duck or a Goose?Key Components of EF are Attention, Inhibition & Working 

Memory (Lyon &Krasnegor, 1996)

Attention Deficit Hyperactivity Disorder  Hallmarks Difficulties with inhibition Difficulty initiating and maintaining mental set

Autism Spectrum Disorders (ASD) Hallmarks Difficulties with shifting mental set (perseveration) Difficulties with social relationships (inflexibility)

What’s in a Label?Does identification really help better indicate intervention?

Mental Health Diagnoses of Childhood

ADHD

The Autism Spectrum Disorders (formerly PDD, Asperger)

Learning Disorder (dyslexia, dysgraphia, dyscalculia)

Anxiety  & Mood Disorders

Low IQ/Intellectual Deficiency/brain insult/injury

• Educational Designations for Special Education•Other Health Impaired•Autistic Like•Learning Disability•Emotionally Disturbed•etc…

Disorders in which co‐occurring mild to moderate academic impairment is common

ADHD 20‐35% of children with ADHD present with Reading 

Disorder

Anxiety & Mood Disorders

Autism Spectrum Disorders

Sunohara G, et al. J Am Acad Adolesc Psychiatry. 2000;39:1537-1592.Giros B, et al. Nature. 1996;379:606-612.

Molecular Genetics and Risk

Specific genes associated with poor self-regulation Dopamine receptor D4 gene (DRD4) on

chromosome 11 Dopamine transporter gene (DAT1) on

chromosome 5 D2 dopamine receptor gene Dopamine-beta-hydroxylase gene Uncertain about the association of

noradrenergic genes

There are several genes involved and their effects are cumulative

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UC Irvine Molecular Genetic Studies of the DRD4 Receptor

• Swanson et al. (2000) Neuroscience &BiobehavioralReviews

• Swanson et al. (2001) Proceedings of the National Academy of Science

• Ding et al. (2002) Proceedings of the National Academy of Science

• Grady et al. (2003) Molecular Psychiatry

• Leung et al. (2005) American Journal of Medical Genetics

Kilpatirick& Cahill, 2001 & Phelps, 2006

Empirical evidence suggests that there is a bio-mechanism involved in determining the strength of the link between what we feel and what we do

Phelps & Le Doux, 2005

Deficits of the nucleus accumbens give rise to deficits in arousal and self-regulation

Link between Emotion & Motivation

Motivation Deficit

Volkow et al (2009) article suggest the concept of "motivation deficit disorder", and thus provides some rationale for behavioral/motivational interventions

.

Low D2/D3 in the “reward” pathway of impaired children when compared

with non-impaired peers

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“Boring” Elicit Motivation

Or…..

Cognitive ImpairmentDifficulties inhibiting impulses

Poor motor planning

Difficulties sustaining mental engagement during effortful or

non-preferred tasks

Cognitive inflexibility

Social Impairment

Intruding, Blurting out, Interrupting & Excessive talking

Careless mistakes & poor attention to detail

Not following directions & not completing tasks/projects

Poor accepting & difficulties with transitions

Impairment common to EF disorders

Core Impairment

Compliance

Productivity

Relationships

Replacement BehaviorsFollowing Directions &

Following Rules

Staying on Task

& Completing Work

Assertive, Serious Student

Cooperation & Good Sportsmanship

What it looks like in the Classroom Setting

Punitive Focused Response/Cost Models

Demerits (without Merits)DetentionsSuspensionsOffice ReferralsPeg systems

Lose, Lose, Lose

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Low Internal Locus of ControlShift your Perspective

Provide specific rules

1) Keep your hands and body to yourself

2) Use appropriate words at school

3) Raise your hand to speak during a quiet time

4) Follow Directions right away

5) Ask permission before touching things

6) Ask staff before leaving the room

Typically we see rules thatstate what NOT to do

We prefer rules that tell kids what TO do…

The UCI

Token Economy ClassroomGetting Started

Following Directions

Staying On Task

Getting Along

Following Rules

Cleaning Up

Compliance * Productivity *Relationships

FrontloadCommunicate and review the plan with the kids

- Describe the schedule

- Describe the expectations

- Empathize with them (if necessary)

- Let them know what they can earn for being helpful/ staying calm or accepting

Clear, Concise Directions Effective use of prompts and cues “ You have a direction to_________”

Keep the directions short and direct

Be sure to express what TO do

Focus on one direction at a time

(once mastered you can add more)

Verbal or Silent Countdown Prompt younger children with verbal indication of 5

second duration to initiate and complete a task

Works well with younger children/inattentive children “- 5…4…3…2…1…positive praise as reward to

reinforce desired behavior

Cautions with older/mood disorders

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Operant Conditioning Basic Skinner

Behavior Modification 101 Positive reinforcement The presentation of a stimulus which increases the behavior

that preceded it

Negative reinforcement The removal of a stimulus which increases the behavior that

preceded it (avoid/escape)

Punishment I (Positive Punishment) Add an aversive stimulus to decrease the behavior that

preceded it

Punishment II (Negative Punishment) Remove a rewarding stimulus and decrease the behavior

that preceded it (Time Out)

Time Out from………Anyone? Anyone?

Time Out is only as effective as the positive reinforcement program from which a child is removed

Create a Reinforcement MenuClassroom

Helper privileges

Praise

Special pencil

Special chair or seat

Class bucks

Coupons

Picture taken (model)

Computer time (a few minutes)

Front of the line

Getting excused first

Feeding the class pet

Sharpening the pencils

Home: PraiseTV timeComputer timeOutdoor play timeSpecial snacksStay up laterFront seat of the car privs (if old enough)Choose the radio stationGame with parentsTrip to the parkMovie night (popcorn and movie rental)PJ party (whole family)

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A Preliminary Examination of a School-Based Intervention for Children with Neurodevelopmental Disorders

Chung, Kim, Abdullah, &Schuck, 2013

z = -2.00, p = .045n = 21

z = -2.49, p = .013n = 21

z = -0.45, p = .651n = 21

z = -0.31, p = .975n = 16

z = -1.49, p = .137n = 10

z = -0.93, p = .350n = 10

At intake/upon enrollment

9-15 months into participation

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Designing an iPad app to monitor and improve classroom behavior for children with ADHD:iSelfControl Feasibility and Pilot Studies

Kimberley D. Lakes, HadarZiv, Natasha Emmerson, Penelope Collins, Jose NewkirkMark Warschauer, & Sabrina Schuck

Designing an iPad app to monitor and improve classroom behavior for children with ADHD:iSelfControl Feasibility and Pilot Studies

Kimberley D. Lakes, HadarZiv, Natasha Emmerson, Penelope Collins, Jose NewkirkMark Warschauer, & Sabrina Schuck

Method

Results

Introduction

There is a great deal of evidence that self-regulation – the ability to monitor, evaluate, and control one’s behavior to achieve short-and long-term objectives –is just as critical to educational and social success as is academic content knowledge. People with poor self-regulation are unable to persist when faced with challenges, focus their attention, and avoid distractions and delays in pursuing their goals (Diamond, 2012). Researchers (e.g., Moffit et al., 2011) have noted that intervention to promote self-regulation is warranted as it can lead to more positive developmental trajectories. Our objective was to study a web-based application (iSelfControl) that we designed as an intervention to improve children’s self-regulation.

There is a great deal of evidence that self-regulation – the ability to monitor, evaluate, and control one’s behavior to achieve short-and long-term objectives –is just as critical to educational and social success as is academic content knowledge. People with poor self-regulation are unable to persist when faced with challenges, focus their attention, and avoid distractions and delays in pursuing their goals (Diamond, 2012). Researchers (e.g., Moffit et al., 2011) have noted that intervention to promote self-regulation is warranted as it can lead to more positive developmental trajectories. Our objective was to study a web-based application (iSelfControl) that we designed as an intervention to improve children’s self-regulation.

Discussion

In a laboratory school setting, we conducted a pilot study with a class of 11 5th grade children with ADHD. Students and teachers used iSelfControl in the classroom for six weeks. Every 30 minutes of the academic day, students monitored and evaluated their behavior and teachers evaluated students’ behavior individually, allowing for a comparison between teacher and student ratings.

Results demonstrated the potential for iSelfControl to provide useful information to children and their teachers that could be applied to individualized intervention to promote self-regulation among children with ADHD. Our next steps include programming iSelfControl to deliver pre-emptive warnings to students prior to the periods where they exhibit the most difficulty regulating their behavior as well as to provide feedback that helps students improve the accuracy of their self-perceptions. Moreover, iSelfControl will be modified to encourage students to compare their ratings to the ratings made by their teacher and to reflect on reasons for discrepancies in their ratings through the use of customized messages, in order to increase the accuracy of their self-evaluations. In the pilot study, improvement in self-regulation was not documented; this may be because the intervention was very brief, and for children with behavioral problems severe enough to warrant placement in a clinical school setting, a longer intervention is likely needed to show substantial behavioral change. Our future research plans include further development of iSelfControl and the evaluation of a long-term intervention in special education and public, general education settings

iSelfControl was well received by both teachers and students and was consistently used in the classroom over a 6-week intervention period. iSelfControl illustrated unique trends for individual students through out the academic day. Results demonstrated differences in student self-perceptions that have implications for intervention. For example, some students consistently rated themselves very highly, demonstrating little insight into their behavior. Others rated their behavior more harshly than the teacher did. After about one week of intervention, some student self-ratings were consistent with teacher ratings. Overall behavioral improvement across the 6-week intervention was not noted.

1) iSelfControl will be perceived by teachers, parents, and students as a beneficial tool to monitor behavior and promote individualized intervention in the classroom.

2) iSelfControl will provide data that could inform individualized intervention.

3) iSelfControl will promote self-regulation by prompting students to self-monitor, self-evaluate, and self-correct

Hypothesis

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TeacherAMMean

StudentAMMean

One student’s morning mean score, over 28 days, shown as rated by both the teacher and student.

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UC Irvine Child Development SchoolA model laboratory school environment for children with neurodevelopmental differences

Discovernew ways for children with ADHD and related learning differences to reach their academic and social potential; Discoverbest practices in teaching and progressive curriculum models for children with ADHD; Discover the talents and strengths of each child, and explore ways to maximize their potential; Discovernew ways of supporting our students’ families, so that the progress made at the school extends to the home and to the community as a whole.

Teachchildren how to access curriculum, interact socially in various environments, and develop their strengths; Teach University students, educators, physicians, psychologists, and other professionals how to identify and successfully address the symptoms of ADHD and related learning differences, based on proven methodologies of diagnosis and positive reinforcement programs.

Healchildren by rebuilding their self-esteem, reduce their symptoms of ADHD and increase positive behaviors in their classrooms and at home; To Heal families by providing a safe, positive environment for their children, while concurrently teaching parents successful strategies to address attention and behavior concerns at home and at school.

Big Deals to: Dave Agler, Nicola Byford-McEachin, Carolyn

DeVoy, Megan DeVoy, Rachelle Eng, Mary Gonzalez,Monique Gonzalez, Molly Ha-Hong, NasHariri, Rose Holland, Sue Keir, Laura Murillo, Erica Nguyen, Jose Newkirk, Jacqueline O’Hagen, Carol Reed, Laura Rocha, Sandra Ruiz, Rhonda Weaver, Tina Wippler

And a Special Privilege to Ron Kotkin

ADHD and Reading Comprehension Difficulties Short versus Long Passages (Brock & Knapp, 1996)

ADHD group more impaired in reading comprehension from long passages

ADHD group did not differ in comprehension of short passages ADHD group revealed relative difficulty with effortful processing

but not automaticity

Oral versus Silent Passages (Schuck, 2008) ADHD group impaired comprehension compared to non-affected

peers when they read silently ADHD group the same as non-affected peers when they read orally Children with ADHD read more slowly than their peers when they

read silently but not when they read orally suggesting impaired automaticity

Contribution of Executive Function to Reading Comprehension

Key components of Executive Function (Lyon & Krasnegor, 1996) Attention, Inhibition, and Working Memory

Hallmark of ADHD is deficits in tasks of EF (Barkley, 1997)

3rd to 5th grade the most difficult time for children with ADHD because they are asked to read for meaning

Executive Dysfunction MeasurementClassically measured by skills of: Verbal Working memory (eg. digit span tasks)

Fluid Reasoning (eg. matrix reasoning tasks)

Cognitive Flexibility (eg. Problem solving tasks)

Reading difficulty and cognitive overlaps with ADHD and Autism

Key Components of Reading Disorder include poor phonologic awareness, verbal working memory, and verbal automaticity

Reading Disorder HallmarksPoor letter-sound associationPoor rhymePoor digit span recall (working memory)Poor ‘naming’ skills (automaticity)

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Automaticity & Fluency

Perfetti, 1985 The more quickly or automatically words are

read, the more processing energy is available for acquiring new vocabulary and comprehending text

Attentional resources less stressed, allowing more availability of Working Memory

Accuracy AND

Comprehension

Broadly, Perfetti, Landi, and Oakhill, 2005 Reading requires the synthesis of:

1) identification of words

2) the assembly of words into messages

Autism and Reading Comprehension Difficulties Hyperlexia, or word reading accuracy skills in advance of reading

comprehension, is associated with autism (Grigorenko, Klin, Pauls, Senft, Hooper, &Volkmar, 2002)

Poor integration of contextual information and a stability overtime of difficulty with homograph identification when given the context of a sentence (Frith&Snowling, 1983; Frith, 2003)

Adequate single word reading but below average phonologic awareness (Gabig, 2009)

Demonstrated good automaticity and phonological awareness independent of word reading accuracy suggests young children with Autism are unlikely to be identified as poor readers requiring early intervention

Hidden Language Impairment at age 8

Nation, Clarke, Marshall, & Durand, 2004 Despite fluent and accurate reading and normal non-verbal ability,

impaired reading comprehension

Phonological abilities intact

Superficial reading appears normal

SLI undetected

ASD’s and specific reading skills Nation, Clarke, Wright, and Williams, 2006 Word, non-word, and text reading accuracy were

average but comprehension was impaired

Considerable within group differences, but all but one child showed at least 1 SD lower comp than word reading

Reading Comprehension across the Autisms

• Jones, et al., 2009

• Relative impairment in reading comprehension is the most prevalent ability-achievement discrepancy in children with ASD and most relevant to diagnosis, prognosis, and intervention

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Intervention-focused assessment indicated for young children at-risk for ASD and ADHD

High risk for poor reading comprehension skills

Poor education outcomes for children with poor reading comprehension

Risk unlikely to be identified through screening methods currently employed in school districts

Risk unlikely to be identified from clinical diagnostic measurements alone

Ideal ScreenTools designed to identify population-specific

risk are most likely to identify risk for poor reading achievement that may otherwise go undetected in emerging readers difficulty shifting and maintaining set difficulty identifying anaphores poor comprehension from reading silent

connected text without visual clues

Evidence-Based Reading Interventions and ASD

Review of the literature (Whalon, Al Otaiba, & Delano, 2009) Children with ASD will benefit from reading instruction offered

in the general education curriculum but because many learners with ASD will have greater difficulty developing reading comprehension skills, Interventions should focus on building reading comprehension

Anaphoric CuingO’Connor & Klein, 2004

Anaphoric Cuing significantly increased passage comprehension

Anaphoric Cuing resulted in students resolving most anaphors correctly

The number of correctly resolved anaphors correlated with total passage comprehension

Anaphoric cuing was more beneficial for students with lower grammatical abilities

Anaphoric cuing outperformed pre-reading comprehension questions and cloze facilitation

Changing teacher expectations through community education: Don’t be foiled by the “little professor”

Mature spoken grammatical structure

Advanced vocabulary

Abundant factual knowledge

Intense interests in non-fiction or reference books

Interventions in children with Right Hemisphere Challenges

Working memory deficits for both ADHD and ASD impact reading comprehension skills

ADHD Oral Reading strategies improve fluency and comprehension by freeing

up more attentional resources for making meaning out of text

ASD (particularly HFA/AD) Anaphoric Cuing improves contextual meaning, facilitating more fluid

reading and freeing up more attentional resources for making meaning out of text