Cognition, LD, ID, & ADHD

ADHD paralysis - so paralyzed by the thoughts running through their head, they cannot act/behave properly, but it presents as laziness or indifference (often seen when a ADHD diagnosis is missed)

• More commonly seen in the inattentive type who have greater difficulty initiating a task

• using visual aids to plan steps/process to help initiate

Best Practices

• screen to understand the impact on occupational performance

• establish an occupational profile that outlines strengths & needs across multiple contexts

• explore environmental modifications, including movement breaks, headphones (quiet environment), dividers at desks (decreased visual stimuli), and flexible seating options to promote success

• provide opportunities to enhance executive functioning skills

• allow opportunities for self-regulation, social emotional learning, & coping skills to be developed & practiced

DSM Criteria

• when there are deficits in both intellectual functioning & adaptive behavior & functioning skills

  • Adaptive behavior - life skills/ADLs

  • Adaptive functioning - similar to IADLs, communication, etc.

• The WISC is commonly used for diagnostics done by psychologist, psychiatrist, maybe neurologist to determine IQ - 

  • IDEA & DSM seeks to deemphasize the reliance on IQ scores for diagnosis

  • Does not always indicate someone's ability to learn

  • An individual cannot get state assistance unless there is a diagnosis of ID (must be on file that there is an IQ <70)

• If a diagnosed with ID, the employer is able to to pay them below minimum wage through the Fair Labor Standards Act

• Mild ID: may be independent, but social & IADL difficulties

• Moderate ID: communication, ADL, & IADL issues

• Severe/Profound ID: level of dependency with ADLs & IADLs

Comorbidities

• Sedentary lifestyles & social determinants of health can cause comorbid conditions including:

• Obesity

• Sleep disorders 

• Arthritis

• Gastrointestinal disorders

• Diabetes

• High blood pressure

• Cardiovascular disease

• Greater risk of sexual abuse & online sexual victimization

SODH that impact condition:

• poor socioeconomic status

• education level

• physical environment (places & spaces)

• social supports

• access to healthcare

Best Practices

• consider not just the now, but the plan for the client's future (including transition planning)

• explore health promotion for this population & their families

• advocate for inclusion to provide opportunities for social-emotional skill learning & practice

Stages of Learning

1. Acquisition

• trial & error

• needs cues & prompts

2. Maintenance

• can perform task in familiar settings & with familiar materials

3. Fluency

• rate or speed is equivalent to peers (what is necessary for function)

4. Generalization

• can apply what was learned to all environments/situations

5. Transfer

• Can develop new ways to do things based on past experience

Cognitive Approaches

• Performance-based - see how you perform first, then determine plan as we go

• Top-down - take the big picture and break down into smaller details

• Development of strategies (to be used when they are on their own to generalize learning to other situations/settings)

  • Mnemonics - memory aid helps with storage & retrieval of info (acronyms/visuals)

  • Chunking - putting into categories to help w/ memory & understanding

  • Self-monitoring/evaluation

  • Goal-setting

Ways to Intervene

• controlling task difficulty - accommodations/modifications of task

• controlling the environment - accommodations/modifications to environment

• direct instruction - explicitly teach how to do something

• cognitive strategy instruction - explicitly teach how to think about doing something

• scaffolding - breaking down tasks & communicating (aloud) the process to complete the task successfully

  • build's children's internal dialog

  • difficult with children that do not respond well to multiple verbal cues

  • supports skills in:

    • understanding task demands

    • problem-solving

    • coping with failures

• metacognition - learning about one's own learning

  • wants to always encourage within a child

  • child evaluates own performance - identifying strengths/weakness

  • child empowered to create own goals based on the weaknesses

  • leads to:

    • goal commitment

    • improved performance

    • intrinsic motivation

• instrumental enrichment: helping children to generalize new learning to real life activities

  • good for children with good processing skills/metacognition

  • techniques:

    • questioning - what they learn

    • bridging

    • comparison/describing

    • modeling

    • challenging - just right challenge/grading

    • elaborated feedback

CO-OP (Cognitive Orientation to Daily Occupational Performance)

• Cognitive intervention protocol

• problem-solving approach

• focused on strategy use

  • Child chooses what to work on

  • OT teaches strategies to work on these goals

  • generalization of acquired skills to other settings

  • transfer of skills to other occupations

• used guided discovery

• Key features

  • goal identification

  • dynamic performance analysis (DPA)

  • use cognitive strategies (Goal-plan-do-check)

  • guided discovery (to develop strategies)

  • enabling principles

  • caregiver/parent involvement

  • intervention format

Generalization & Transfer

• Keep the child motivated & part of the process! Make it fun!

  • most difficult part for children with ID

• Work directly on the real-life task

• teach the process of problem-solving

• consider intervention models

  • push in model works best!

  • pull-out - use stimulated tasks with relevant activities/materials

• Adapting the environment

  • Goals:

    • enable child to participate

    • develop skills to engage in environment

• Motivation

  • child generated ideas

  • Choice & control