Learning and Attention Disorders in Adolescence and Adulthood

Assessment and Treatment

Sam Goldstein, Jack A. Naglieri, Melissa DeVries, Sam Goldstein, Jack A. Naglieri, Melissa DeVries

• Publisher: Wiley
• Year: 2011
• ISBN:
  9781118061923
• Edition: 2
• Topic: Psychology
• Subtopic: Education in Psychology
• Index: Psychology

Fully revised coverage with the most current diagnoses and treatments for adolescents and adults living with learning and attention disorders

Reflecting the most recent and relevant findings regarding Learning Disabilities (LD) and Attention-Deficit/Hyperactivity Disorder (ADHD), this Second Edition of Learning and Attention Disorders in Adolescence and Adulthood provides practitioners in the fields of education and mental health with a set of practical guidelines to assist in the assessment, diagnosis, consultation, and treatment of adolescents and adults struggling with LD and ADHD. The new edition includes:

• An emphasis on working from strengths—adapting to disabilities and dealing with them successfully on a daily basis
  
  

• New coverage of the causes and long-term implications of LD and ADHD in adolescents and adulthood
  
  

• New chapters on treatment effectiveness; building resiliency and shaping mindsets; cognitive therapy; and strategic life coaching to help guide individuals with LD and ADHD
  
  

• Contributions from leading researchers, including Noel Gregg, Russell Barkley, Kevin Antshel, and Nancy Mather
  
  

Drawing on evidence-based techniques to meet the pragmatic demands for intervention, the Second Edition guides school psychologists, counselors, and educators in promoting positive change for adolescents and adults with LD and ADHD as they strive for success in school, work, and home settings.

PART I

Background

CHAPTER 1

The Changing Face of LD and ADHD in Late Adolescence and Adulthood

Sam Goldstein

Melissa DeVries

INTRODUCTION

Although in the Bible, God did not completely abandon Job, the proverbial Job’s law has been extrapolated to conclude that if someone experiences a single problem, he or she is likely to develop second, third, or fourth problems. There appear to be a large group of adolescents burdened with histories of multiple developmental, behavioral, emotional, and temperamental problems as they begin their transition into adulthood. These numbers appear to be increasing each generation. For this reason, the second edition of this volume is even more important and critical than when initially published nearly 12 years ago.

This second edition begins by providing background information about the childhood and adolescence of people with histories of Learning Disabilities (LD) and Attention-Deficit/Hyperactivity Disorder (ADHD). As child is the father to man, an understanding of the current research regarding childhood and adolescent problems is essential to appreciate the effects of these problems in adulthood. At the time the first edition of this volume was printed, many readers working with the adult population were not too aware of the extensive childhood literature available on LD and ADHD, especially in contrast at the time to the minimal adult literature on these subjects. In the first edition of this volume, it was noted that between 1971 and 1994, nearly 3,000 peer-reviewed studies were published about ADHD. Of these, only 80, or approximately 3%, dealt with adult issues (Resnick & McEvoy, 1995). This percentage appears to be increasing over time, however. For example, between 2005 and 2009, 29% of the peer-reviewed articles published in the Journal of Attention Disorders were focused on ADHD-related issues in adults. For this reason, Chapters 2 and 3 provide a revised overview of the available literature on the history, presentation, definition, comorbidity, evaluation, and treatment of ADHD and LD in childhood. Chapters 4 and 5 review current knowledge about adult outcome for individuals with histories of these two problems.

This second edition then deviates significantly from the original volume. Chapters 6 through 10 provide a framework for assessment. Chapter 6 provides a neuropsychological framework for evaluating the cognitive and related problems experienced by individuals with ADHD and LD. Chapters 7 and 8 provide overviews of academic and psychiatric assessment in these populations. Chapter 9 provides a model for data integration, through sample reports and case studies. The assessment model is based on a neuropsychological, functional framework. Readers are guided through a process that focuses on evaluating the individual and using the resulting assessment data to help guide important life, vocational, and educational decisions. Finally, Chapter 10 provides an update and overview of the legal rights and qualifications for individuals with these conditions in our society today.

The closing 10 chapters of the book are focused on treatment, beginning with an overview of current research on the medical, nonmedical, and educational interventions directed at adults with histories of LD and ADHD. Treatment chapters then continue and include a resiliency model, a framework for cognitive therapy, classroom and instructional strategies, medications, vocational problems, and lifestyle issues. Also included is a chapter focusing on the increasing application of life coaches to guide individuals with LD and ADHD, particularly through challenging educational and vocational experiences.

It has been 12 years since the publication of the first edition of this volume. During this period of time, there has been an increased emphasis on assessing the effectiveness of schools to prepare all students, not just those with LD and ADHD, to transition successfully into independent living and competitive vocation. This push has led not only to increasing emphasis on high-stakes testing and high school exit examinations but also to an awareness that social/emotional dimension of a child’s life must equally be attended to (Cohen, 1999). Strengthening a student’s sense of self-esteem and emotional well-being, particularly for students with LD or ADHD, is now recognized as an essential part of the curriculum. The self-confidence and resilience of students with LD and ADHD provides a supporting foundation for enhanced learning, motivation, and self-discipline. Schools must now provide social and emotional interventions for students with LD and ADHD hand in hand with academic education (Merrell, 2002; Weist, Evans, & Level, 2003). In fact, a sustainable school environment must be capable of meeting the social, emotional, and academic needs of all students (Elias, Zins, Graczyk, & Weissberg, 2003). The second edition of this text reflects our renewed interest and commitment to maintaining this focus into the adolescent and adult years for individuals with LD and ADHD. This charge is increasingly important as children’s medical, mental health, and general adjustment continues to be eroded by the pressures of our society, making it increasingly more difficult for children to negotiate everyday life successfully and thereby lay a firm foundation for transition into adulthood. As Seligman (1998a, b) has pointed out, attending to those issues that are preventive and create a resilient mindset and wellness will require a significant paradigm shift in mental health professionals and in the educational community. It is the intent of this second edition to introduce and advocate for the implementation of a life span model of effective prevention and positive social and educational science throughout the life span for individuals with ADHD and LD.

LD AND ADHD IN LATE ADOLESCENCE AND ADULTHOOD

Thirty years ago, LD and ADHD were defined as problems of childhood. Yet approaches to remediating these conditions in childhood typically led to minimal if any positive impact in the adult years. (For review, see Goldstein & Teeter Ellison, 2002; Gregg, 2009.) Therefore, it is not surprising that these two conditions have come to be recognized as lifetime phenomena. LD and ADHD affect people across the life span as well as of all socioeconomic classes, ethnicities, cultures, and levels of intelligence (e.g., Faraone, Sergeant, Gillberg, & Biederman, 2003; Morris, Schraufnagel, Chudnow, & Weinberg, 2009). In 1989, Levine referred to the growth and adult LD research as “the early adulthood of a maturing concept” (p. 1). The number of peer-reviewed research studies dealing with LD and ADHD issues in adulthood is growing at an exponential rate. The lifelong nature of these conditions is increasingly well recognized although not always observed as these individuals are no longer in school. Life in many areas, including the workplace, continues to be a struggle for many. Nonetheless, it is still the case that a thorough understanding of the implications these conditions have in the adult years is not well understood. Some researchers suggest that individuals with LD and ADHD have difficulty in adulthood in a broad range of areas beyond just the workplace, including making appropriate choices and decisions, using efficient strategies on a daily basis to assess their functioning, transferring learning from one activity to another, breaking tasks into smaller parts, and overall making good life decisions (Hill, 1984).

The symptom constellation referred to as Attention Deficit Disorder or Attention-Deficit/Hyperactivity Disorder (APA, 2000) has become one of the most widely researched areas in childhood and adolescence with increasing interest throughout the adult life span. In clinic-referred settings, males outnumber females 6 to 1; in epidemiologic studies of community-based settings, the ratio is 3 to 1 (Barkley, Murphy, & Fischer, 2008). The incidence of diagnosis continues to increase with a 70% increase in the diagnosis of children and nearly a 100% increase in the diagnosis of adults with ADHD between the years 2000 and 2003 (Centers for Disease Control [CDC], 2005). It is now estimated that between 4% to 8% of the general population has received a diagnosis of ADHD (CDC, 2005; Cuffe, Moore, & McKeown, 2005). Females are the fastest-growing group (Medco, 2005). Broad-based definitions of ADHD find epidemiology of nearly 16% in adults; narrower definitions report an incidence of 3% to 4% (Faraone & Biederman, 2005).

In addition to examining the adult impact of these conditions, researchers have begun to question the validity of using childhood constructs to diagnose, evaluate, and treat adults suffering from LD and ADHD (Patton & Polloway, 1992). Some of the theories, ideas, beliefs, and strategies used with children are suggested as inappropriate for adults (Lieberman, 1987). Further, although the literature suggests that some people with histories of these conditions may learn to compensate and succeed in adulthood (Adelman & Vogel, 1990; Polloway, Schewel, & Patton, 1992; Weiss & Hechtman, 1993), it is likely that the majority of individuals with these conditions do not fare as well as the normal population (Gerber et al., 1990; Gregg, 2007; Mannuzza et al., 1993; Newman, Wagner, Cameto, & Knokey, 2009; Wagner, Newman, Cameto, Garza, & Levine, 2005).

Individuals with LD and ADHD do not have an intellectual disability. They fall on a normal curve for intellectual abilities but are typically weak in one or more specific abilities necessary for academic and vocational achievement. Given their deficits, however, it is not surprising that a common misconception among the public, and still to some extent among mental health and educational professions, has been that LD, ADHD, and intellectual disability are variations of the same phenomenon. They are not. Even more perplexing has been the relationship between LD and ADHD (e.g., Bonafina, Newcorn, McKay, Koda, & Halperin, 2000; Preston, Heaton, McCann, Watson, & Selke, 2009). Attention problems were long considered part and parcel of LD. In fact, some researchers suggested that the majority of children with ADHD experienced LD (Safer & Allen, 1976). It is now known, however, that while groups of individuals with diagnoses of LD and ADHD respectively may overlap by as much as 40%, the majority of each group does not experience the other problem (Barkley, 1990, 2005). In fact, weaknesses in the underlying intellectual and neuropsychological abilities that may be responsible for each condition likely do not overlap (Naglieri, Salter, & Edwards, 2004). The majority of individuals with LD typically experience problems with sequential or simultaneous processing while those with ADHD typically experience problems with planning or attention processing. However, failure to practice for proficiency, a problem typically associated with ADHD in academic settings, leads to the commonsense conclusion that inattentive individuals may not perform well and thus fall behind in school, possibly leading to an LD classification (Schnoes, Reid, Wagner, & Marder, 2006). In this volume, LD is considered primarily as a problem of faulty input. That is, a number of specific weak abilities hinder the acquisition of the knowledge necessary to become competent in reading, writing, spelling, arithmetic, and other basic academic skills. ADHD is considered a performance or output problem. Thus, individuals with ADHD typically know what to do but, because of their poor planning, limited attention to detail, and/or impulsive responding, typically do not do what they know efficiently. It quickly becomes apparent that individuals with both conditions are significantly compromised in nearly all walks of life.

According to the preponderance of available data, outcomes for young adults with histories of LD or ADHD are not good (Spencer, Biederman, & Mick, 2007). Members of this group typically are under- or unemployed, struggle to achieve vocational skills at a rate commensurate with others or, for that matter, with their basic intelligence, and do not achieve at a rate commensurate with their personal or academic potential (Gregg, 2007; Newman et al., 2009; Smith, 1992). In 1982, for example, it was reported that 36% of all juvenile delinquents, a group made up disproportionately of persons from low-income families, suffered from LD (Dunivant, 1982). It is still the case that young adults with LD and ADHD are overrepresented in the penal system (Rutherford, Bullis, Anderson, & Griller-Clark, 2002; Shelton, 2006). The educational, employment, personal, and emotional lives of these individuals appear to demonstrate the nearly irreversible effects of their childhood experiences and struggles.

Individuals with LD appear to constitute the largest disability group (Interagency Committee on Learning Disabilities, 1987; SRI International, 1990; U.S. Department of Education, 2002). It is likely that more than half of individuals with disability experience LD, ADHD, or both of these conditions. Traditionally, the focus in dealing with these conditions in late adolescence and adulthood has been primarily on transition—that is, helping these individuals successfully make the move to independent living and...