Dr. Dianne Olvera's New Address Jan. 1, 2010
2816 Northview Ave. Arroyo Grande, CA
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Newsletter Center For Educational Therapy
Many of you have asked for more information regarding
attention deficit and the role executive
function plays in facilitating the attentional process.
Therefore, I'm including some information since I just returned from a great conference and the guest speaker
was Dr. Russell Barkley, Ph.D.,
Clinical Professor of Psychiatry Medical University of South Carolina,
Charleston, SC and Research Professor, Dep't. of Psychiatry SUNY
Upstate Medical University, Syracuse, NY.
He followed 158 children, ages 4-11, diagnosed as hyperactive child syndrome
from 1978 - 1980, - currently
considered ADHD.
His group also contained 81 control children from the same
schools and neighborhood and were matched with his research group by age.
These children were reevaluated at age 15, 21, and currently, 27 years of age.
The groups consisted of 83 - 94% males and his findings were quite
interesting - even contrary to what current information suggests.
Given the in-depth
information Dr. Barkley presented, I will share my notes on the initial portion of his talk
and will use subsequent newsletters to continue this discussion.
I would welcome any feedback and comments as we distribute this information.
Also, if you find the information contained informative, please feel free to share it with others.
With warm regards,
Dr. O
The Nature of ADHD: The Executive Functions and Self Regulation
Notes from Dr. Barkley's Presentation:
It should be noted that Dr. Barkley prefaced his talk by noting the the comments he made, were general statements,
and a child, or person, does not have to have all indicators in order to be diagnosed as ADHD.
However, many of the characteristics are played out in ADHD cases because it is a disorder of executive functioning.
In the last newsletter email, you recall, is that executive function involves the problem solving part of the brain
and is instrumental in inhibiting behavior. Executive function plays
a fundamental role in the self regulation of a person's ability to plan, to organize, to hold information
in working memory, as well as, to hold that information in mind to regulate emotions.
Neuroimaging has helped shed light on the purpose of the executive
system which:
☞ Promotes the ability to regulate ones' behavior for extended periods of time, even when
there is a long delay between the behavior and the consequences for that behavior.
☞ The reason this system came on line is to help us function in social situations.
☞ When the executive system is working at the age appropriate level, humans are able
to engage in social situations such as cooperating with peers, attaining reciprocity, forming friendships, and taking
part in social competition.
✎ Dr Barkley notes that the current clinical view of ADHD is considered, "A disorder of age inappropriate behavior involving
inattention, hyperactive and impulsive behavior."
A person is considered hyperactive – impulsive when he/she:
▸ has poor verbal, or, motor inhibition;
▸ is impulsive in making decisions and usually can't defer gratification
▸ Is not able to realize the future consequences of their actions
▸ Is often squirming, fidgeting and moving
▸ Is restless
▸ Is emotionally impulsive with emotions welded into everything
they think, say, and do.
A person is considered inattentive when he/she has;
▸ "poor persistence toward tasks (the future)
▸ impaired resistance in responding to distractions
▸ deficient task reengagement, following disruptions
▸ difficulty remembering what is to be done"
Since ADHD is a disorder of executive functioning, it consists of two
major components:
1. Inhibition (cognitive, verbal, motor, emotional), and self regulation
2. self regulation (working memory, planning/problem solving, & emotional self regulation).
When inhibition is highly involved in a person's case, ADHD related to hyperactivity and impulsivity is often diagnosed.
However, when self regulation is the main area of concern, ADHD attributed to inattention, is often diagnosed.
The statement that Dr. Barkley made, really resonated with me because he noted,
"What I think, affects what I feel." Since I am interested in what the impact of our internal and external words have on a person's
ability to improve their executive function, I found this to be a powerful statement that should be kept in mind when working with
people who have been diagnosed with executive function disorders. People with inattentive issues find the aforementioned items
difficult to achieve when compared to their peers because that part of their brain has not developed at the
same rate as their peers.
He made a side note that the frontal lobe is sensitive to hormones and we lose some of the aforementioned abilities
due to aging when we reach middle age. (He could have waited until the end to mention that statement - being of advanced
age, myself. I didn't need to know my future executive functioning may be on the downhill slope!)
Developmental Progression Of Behavior
Dr. Barkley noted that a child's language system takes over the motor system. He quoted
Vygotsky's Concepts of externalized
and internalized speech systems and noted that from:
▸ birth, to about three years of age, a child's behavior is directed toward others
▸ about three to five years of age, the child talks out loud to himself and is often heard describing their actions
▸ when the child turns from five to seven years of age, their language starts to turn inward and takes
the form of inner speech with occasional leakage of words called "telegraphic" speech. At
this time, their language intentions go from description to prescription of behaviors.
When a child hits these specific time frames in their lives, they use
their words to help them define their behaviors and use their thoughts to help them negotiate
time frames, planning, organization of materials, facilitate socialization, and learn from their mistakes.
Children who fail to attain these behaviors, when compared with peers of the same age,
are, possibly, experiencing executive function problems. Dr. Barkley's Theory demonstrates
how these five daily life activities play out:
▸ Inhibition; can't self-stop in the areas of cognitive, motor, verbal, and emotional output
▸ Sensing to the self; (Imagery) - self management to time and future
In other words, a person can't control their ability to inhibit their responses
because they don't self manage their current, or, future perspective of time by
using self speech to help in their own self organization or problem solving.
Results of these inabilities often create emotional problems such as lack of self motion and they are not able to analyze (take apart a situation that happens)
or synthesize (pull information from a variety of experiences, or, resources), to help
them learn from their mistakes.
They don't use the experiences they have had to help themselves create new, and more successful events,
when confronted with similar events in the future.
This drives some of the parents and teachers who work with me, crazy! Many will think the child is willfully
trying to sabotage their life, or, their family values.
However, if you read Dr. Barkley's books and articles, you will see that this disability is real, and,
the more we learn and understand it, the more we are able to help these people become more successful
in life.