Discussion Naomi Steiner MD DevelopmentalBehavioral Pediatrics nsteinertuftsmedicalcenter org

Discussion Naomi Steiner, MD Developmental-Behavioral Pediatrics nsteiner@tuftsmedicalcenter. org Institute of Educational Science June 29, 2010

Conflicts of Interests o Naomi Steiner Has NO relevant financial relationships to disclose or Conflicts Of Interests to resolve.

Attention o Attention skills are complex n o Attention affects learning n o Different areas of the brain affect other areas Early attention problems in kindergarten poor reading outcomes Attention is a developmental process n Brain plasticity

Target Population Study Target Population Two models of preschool training All children in a Head Start classroom Computer attention training in 1 st graders Students with inattentive symptoms Response-to. Students with treatment paradigm in executive function 2 nd graders deficits

Attention training to preschoolaged children o ALL child-parent dyads in Head Start n o harmless, cost-effective intervention Specifically in this generation (fastpaced information processing) n n Affecting attention in ways we do not yet fully understand Affecting future ability to attend to lengthy academic assignments

Attention deficit as a spectrum? o o Attention spectrum disorder Enrolled children with attention symptoms as per Conners’ Teacher Ratings Inattentive Scale Children who scored at least 1. 0 standard deviation above the sample mean Subgroup analysis in children with 6 or more symptoms

Executive Function in 2 nd graders o o Executive function affects in the complex process of writing. Support interventions: students with writing difficulties and executive function deficits issues will react differently

Support services o o o Should we be thinking of attention issues for all students with academic difficulties? The role of assessments Break down learning into smallest steps to identify the true deficit

Age Study Age Two models of preschool training Preschool age Computer attention training in 1 st graders Response-to 2 nd graders treatment paradigm in 2 nd graders

Age o o Attention development starts in infancy Is there a minimal age to start to train attention functions in children?

What is going on developmentally? o o o Children with SLI have deficiencies in selective auditory attention Gestalt: A deficit in one area associated with a deficit in another Plasticity: with improvement in speech and language do the auditory channels of attention also improve?

Work using different angles o Courtney Stevens: Indirect n n o o Teach the parents how to support their children’s development Teacher mediated interventions to support positive classroom behavior and learning Desiree Murray: CAT and CAI Steve Hooper: support services

Shortcomings of medication therapies for ADHD o o Short term Helps students get their work done in the moment does not help learn how to focus long term or develop executive functions/ organization Need for other techniques to teach children with attention issues

Conclusion: ADHD affects learning o o ADHD is not a trivial diagnosis The presentation is complicated n o o o Multiple co-morbidities Affects academic learning Students with ADHD may struggle in regular education activities Positive interventions early on and throughout their school carriers

Take home message o o o Importance of research on how students with ADHD learn General education classroom: how to help students with ADHD adapt Individualized interventions: identify what kind of specific and individualized interventions work best for students with ADHD

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