Intervento sui Disturbi da Deficit di Attenzione e Iperattività (ADHD ) Prof. Cesare Cornoldi

Dimensione: px

Iniziare la visualizzazioe della pagina:

Download "Intervento sui Disturbi da Deficit di Attenzione e Iperattività (ADHD ) Prof. Cesare Cornoldi"

Faustina Ferrara
8 anni fa
Visualizzazioni

1 Lab.D.A. Laboratorio sui Disturbi dell Apprendimento Galleria Berchet, 3 Padova Direttore: Prof. Cesare Cornoldi Intervento sui Disturbi da Deficit di Attenzione e Iperattività (ADHD ) Prof. Cesare Cornoldi

2 NICE Guidelines Marzo 2009 Criteri per la considerazione di un lavoro sul trattamento: gruppi randomizzati e comparabili (lo studio MTA era tale per cui il gruppo di controllo, per due terzi, aveva il farmaco e il gruppo a trattamento psicologico no)

3 Studies involving participants with a mean age of 8 or 9 looked at the effects of work with both the child and the parents or family (BLOOMQUIST1991; FEHLINGS1991;PFIFFNER1997; TUTTY2003) or just the child (ANTSHEL2003; GONZALEZ2002).

4 The analysis conducted here therefore suggests that CBT interventions for ADHD can have beneficial effects whether delivered in the absence of medication or as an adjunct to continued routine medication for ADHD

5 Four studies were found that demonstrated positive effects of psychological interventions on core ADHD symptoms together with ratings of conduct, social skills or self-efficacy (FEHLINGS1991; LONG1993; PFIFFNER1997; TUTTY2003). The interventions studied were either mixed CBT/social skills interventions delivered to groups (PFIFFNER1997; TUTTY2003) or predominantly CBT interventions (FEHLINGS1991; LONG1993).

6 FEHLINGS1991 involved teaching children CBT techniques to improve behaviour in home settings. Time was taken to teach problem-solving techniques, which included identifying the problem, goal setting, generating problemsolving strategies, choosing a solution and evaluating the outcome. Active learning methods were used including modelling and role play. Homework assignments were set and related to individual problem situations at home. Learning gains were reinforced with reward strategies such as tokens and so on. As in TUTTY2003 and PFIFFNER1997, separate parent sessions were also held. Parents received education about ADHD and training in CBT techniques that they were then encouraged to use to reinforce target behaviours in individual homework tasks given to each child participant

7 According to the findings of the economic analysis, the group clinic-based programme was the dominant option among the three parent-training/education programmes, as it provided the same health benefits (same clinical effectiveness) at the lowest cost (total intervention cost per family was 629 for the group clinic-based programme, 899 for the group community-based programme, and 3,839 for the individual home-based programme).

Parent training (NICE) November 18, 2008 NICE guidelines on ADHD Parental training and psychological interventions are at the heart of new National Institute for Health and Clinical Excellence (NICE)

8 Parent training (NICE) November 18, 2008 NICE guidelines on ADHD Parental training and psychological interventions are at the heart of new National Institute for Health and Clinical Excellence (NICE) guidelines on the diagnosis and management of ADHD, published in September. Specifically, drug treatment is not recommended for pre-school children with suspected ADHD, nor for older children and adolescents with moderate ADHD. Instead, the parents of children and adolescents with ADHD should be offered a group training programme based on the principles of Albert Bandura's social learning theory. There should also be the option of group psychological treatment or social skills training for the child or young person, and the option of individual psychological therapy should be considered for older adolescents. The new guidelines do recommend drug treatment as the first line intervention for children and young people with severe ADHD and for adults with ADHD. However, such treatment should always form part of a comprehensive care package that includes psychological and educational components. In particular, adults who don't want a drug treatment should be able to access psychological help instead. Other notable aspects to the new guidance include: a call for multidisciplinary specialist ADHD teams and/or clinics to be established; a recommendation that teachers with necessary training should provide behavioural interventions in the classroom; an unequivocal statement that dietary fatty acids are not recommended; and a recommendation that GPs do not initiate drug treatments for ADHD, although they may continue prescribing and monitoring such treatment once started by a suitably qualified expert

9 Efficacia training cognitivi ADHD Atten Deficit Hyperact Disord. 2012;4: NEUROCOGNITIVE TRAINING FOR CHILDREN WITH AND WITHOUT AD/HD. Johnstone SJ, Roodenrys S, Blackman R, et al. There is accumulating evidence that computerised cognitive training of inhibitory control and/or working memory can lead to behavioural improvement in children with AD/HD. Using a randomised waitlist control design, the present study examined the effects of combined working memory and inhibitory control training, with and without passive attention monitoring via EEG, for children with and without AD/HD. One hundred and twenty-eight children (60 children with AD/HD, 68 without AD/HD) were randomly allocated to one of three training conditions (waitlist; working memory and inhibitory control with attention monitoring; working memory and inhibitory control without attention monitoring) and completed with pre- and post-training assessments of overt behaviour (from 2 sources), trained and untrained cognitive task performance, and resting EEG activity. The two active training conditions completed 25 sessions of training at home over a 4-5-week period. Results showed significant improvements in overt behaviour for children with AD/HD in both training conditions compared to the waitlist condition as rated by a parent and other adult. Post-training improvements in the areas of spatial working memory, ignoring distracting stimuli, and sustained attention were reported for children with AD/HD. Children without AD/HD showed behavioural improvements after training. The improvements for both groups were maintained over the 6-week period following training. The passive attention monitoring via EEG had a minor effect on training outcomes. Overall, the results suggest that combined WM/IC training can result in improved behavioural control for children with and without AD/HD..

10 Cenni di TRATTAMENTO Il trattamento ha senso solo se coinvolge i più importanti contesti di vita del bambino. Quindi il trattamento coinvolgerà: La famiglia (Parent training) La scuola Il bambino

11 L intervento può sperare di avere una certa efficacia se: 1) coinvolge più fronti 2) si inserisce su un contesto motivazionale e attribuzionale appropriato

12 Circolare (dott. Cutolo)

13 Possibili Mediatori per gli Interventi a scuola (DuPaul & Power, 2000) Insegnanti Strategie di istruzioni; Rinforzo coi gettoni Genitori Tutoring ai genitori; Rinforzi a casa Pari Tutoring dei compagni della classe Computer Esercitazioni guidate Sè stesso Auto-monitoraggio; Auto-gestione

14 Interventi a Scuola per ADHD(cont.) Manipolare le conseguenze (Reattiva) Rinforzo coi gettoni Rimproveri verbali Costo della risposta Time Out dai Rinforzi Positivi Auto-gestione

15 Esempi di Strategie Mediate dall Insegnante

16 Tecniche di insegnamento per prevenire problemi comportamentali Ricordare agli studenti le regole Mantenere il contatto visivo con gli studenti Ricordare agli studenti il comportamento atteso Muoversi per la classe per monitorare/dare feedback Usare indizi non verbali per reindirizzare Mantenere un ritmo veloce di istruzioni Assicurarsi dell avvenuta comprensione dell attività Controllare che i momenti di passaggio avvengano in maniera ben organizzata Comunicare le proprie aspettative rispetto all uso del tempo in classe

17 Componenti di un programma di comunicazione scuola-famiglia efficace Obiettivi giornalieri/settimanali specificati in maniera positiva Includere sia obiettivi accademici che comportamentali Pochi obiettivi per volta Dare un feedback quantitativo rispetto alla performance Feedback forniti dagli studenti o dalle lezioni Comunicazione su base regolare (sia giornaliera che settimanale) Contingenze a casa legate alla performance (sia a breve che a lungo termine)

18 Esempi di Strategie mediate dai Pari

19 Classwide peer tutoring Dividere la classe in coppie Fornire schemi accademici Tutoring a turni Dare immediatamente feekback e correggere errori Monitorare i progressi e fornire punti bonus Registrare i punti e delineare i progressi Cambio settimanale delle coppie

20 Effetti del CWPT sull ADHD (DuPaul et al., 1998) 18 b. con ADHD & 10 studenti di controllo (dal 1 al 5 anno) CWPT aumenta l iniziativa riducendo I comportamenti off task 50% degli ADHD miglioramenti scolastici Effetti positivi per i soggetti di controllo Alto livello di soddisfazione di studenti e insegnanti

21 Strategie di intervento sugli ADHD Le linee prevalenti di intervento sugli ADHD (v. linee guida NICE, 2012) insistono sulla necessità di associare agli interventi autoregolativi anche interventi centrati sulle abilità sociali

22 Tra le tecniche di insegnamento con mediazione sociale proposte coi bambini ADHD ritroviamo: Cooperative Learning Interdipendenza positiva Interazione diretta costruttiva Abilità sociali Responsabilità individuale Valutazione del lavoro di gruppo. Peer tutoring Peer collaboration

23 Peer tutoring

24 Individuale vs gruppo Van Manen (2004) ha trovato che il lavoro di CBT individuale è più efficace di quello di gruppo nelle misure a breve termine, ma meno nelle misure a lungo termine. Una spiegazione potrebbe risiedere negli effetti immediati di un rinforzo individuale e negli effetti più profondi del rinforzo sociale P. Muratori e la sua equipe hanno raccolto risultati nella stessa direzione

Documenti analoghi

Strategie di intervento a scuola per bambini e adolescenti con disturbo di attenzione e iperattività (ADHD)

Strategie di intervento a scuola per bambini e adolescenti con disturbo di attenzione e iperattività (ADHD) George J. DuPaul, Ph.D. School Psychology Program Lehigh University Bethlehem PA 14 May 2009