ADHD Q&A with Dr. Ronald T. Brown — Questions

I work at a school district with students K-8. Currently there is a lot of tolerance and accommodation for ADHD symptoms with students in grades K-5, but as students get older and academics get more rigorous teachers are less accommodating. What accommodations are reasonable and functional to ask of teachers in grades 6-8?

I’d love you to speak to the idea of diet modification in relation to ADHD/ADD, as well as the idea of caffeine intervention! These are ideas I have heard parents request/attempt/research and I would love to have a response. I am actually a child of the Feingold diet in the 1970’s and my mother swears it changed everything for me. I always advocate healthy eating to families, but would love to hear your take on these ‘interventions’!

Is it typical for the symptoms of ADHD to change over time as students age?

What is your opinion on neurofeedback for ADHD kids? Does it work or help with ADHD symptoms?

Are there any specific behavioral interventions that have been shown to be more effective with children who have ADHD (i.e. antecedent vs. consequence-based interventions, token economy, behavior contract, etc.)?

I am a BCBA supervising an RBT who provides 1:1 ABA services to a student in a mainstream 4th grade classroom. The student is diagnosed with ASD, ADHD and anxiety. The biggest problem we run into is impulse control. We will clearly lay out contingencies, prime him on expectations, practice role plays, and provide intrusive prompts to help ensure his success, but when the moment comes in real life to practice the skill, the reinforcement of following the impulse of the moment far exceeds the reinforcement contingency we have created. Do you have any suggestions of how to best approach training impulse control?

In the literature review webinar, it was mentioned that short bursts of attention/focus on an activity and then allowing breaks is likely more effective than requiring attention for very long durations of time. What is recommended duration for these short bursts of focus?

Are there certain medications that have been validated for use for either type of ADHD?

Is there insurance coverage for behavior therapy for children diagnosed with ADHD? What is the recommended intensity of behavior therapy to teach skills to replace symptoms?

I am a mom of 2 with ADHD and a BCBA.  Can you speak to the anxiety/ADHD inattentive subtype connection? Example:  A student with ADHD is attempting to take notes, has trouble managing multiple streams of sensory info simultaneously (audio, visual, memory, textual, etc), by the time they tune back in, the teacher is 5 bullet points down, causing anxiety which compounds the situation.  How common is ADHD and anxiety common?

How do different cultures resist or accept the diagnosis?

What is the most common concomitant functional deficit for people with ADHD?  working memory? processing speed?

Is there correlation between sleep deprivation and ADHD (worsening of symptoms/behaviors)?(or not)

For the “best outcome” children with autism who had intensive ABA at a very young age for years and were able to enter regular school without any support and no longer needs supports or ABA and no longer meet the criteria for autism (“best outcome group”), they may display symptoms of ADHD/ADD. What is your stance/feelings about a child in such a case? Would you recommend children to seek a physician to be evaluated for ADHD/ADD? Or if it is not impacting their life in a negative way in the grand scheme of things…?

I would like more on how to support students with ADHD in speech therapy and how to help justify the need for speech therapy in the schools to work on social learning, even when they are doing okay in their academics.

I currently work with children from birth through adolescents with a diagnosis of ADHD, and many have co-morbid diagnoses of Autism Spectrum Disorder, and/or mood disorders. I also have several clients who metabolize stimulant medications rapidly. These are the two issues I would be most interested in discussing with other experts.
 Is it still only diagnosed based on behavioral observation, and could there be an overdiagnosis, and over-use of pharmacological interventions, when behavioral interventions may be enough?

How can I help my own older children and help ensure other families have a good start so they aren’t still struggling in their late teens and early 20’s.

What tools and strategies do people with ADD/ADHD day help them function and focus best?