Upload
david-nowell
View
436
Download
2
Embed Size (px)
Citation preview
David D Nowell PhDwww.DrNowell.com
www.DrNowell.com
DavidNowell
DavidNowellSeminars
Overview
• Perspectives• Curious compassionate nonjudgmental evaluation• ADHDetc
– SPD– CAPD– ADHD/ADD
• Ask 2 questions• Strategic behavioral inquiry (HËDŸDT)• Tools you can use now• 75 strategies that just might change your life
Overview
• Perspectives• Curious compassionate nonjudgmental evaluation• ADHDetc
– SPD– CAPD– ADHD/ADD
• Ask 2 questions• Strategic behavioral inquiry (HËDŸDT)`• Tools you can use now• 75 strategies that just might change your life
www.slideshare.net/dnowell
PERSPECTIVES
Avoiding the most common diagnostic error
What’s wrong with this brain model?
What’s wrong with this brain model?
What’s wrong with this brain model?
What are our data sources?
• Record review• Interview• Collateral interview• Checklists• Mental status examination • Test scores
CURIOUS COMPASSIONATE NONJUDGMENTAL EVALUATION
Curious Compassionate Nonjudgmental Evaluation
• Skillfully eliciting the chief complaint• HËDŸDT?• Forming a diagnostic impression• Defending your diagnosis / impression
Skillfully eliciting the chief complaint
• Too much of what? Or too little of what?• Invoking the Pediatric Fairy (or the Psychiatric
Genie)
HËDŸDT?
• How exactly did you do that?– Everybody’s doing the best he/she can– Every behavior problem is either• Skills deficit• Contingency problem
Forming a diagnostic impression
• Where do you see it the most? And where do you see it the least?
• Two disorders = two stories
Documenting and communicating your conclusions
• The footprints in the butter• Defend your diagnosis
ADHDETCSPD, CAPD, ADD/ADHD, SCT
SENSORY PROCESSING DISORDERADHDetc
Sensory Processing Terminology
• Sensory detection• Sensory discrimination• Sensory modulation• Sensory integration– Performing a developmentally appropriate task in
a multi-sensory environment
Who doesn’t love a wedding?
Who doesn’t love a sensory deprivation tank?
Sensory Processing Disorder
• Persistent atypical over-responsivity or underresponsivity to sensation
SENSORY PROCESSING DISORDER
Sensory modulation
disorder
Over-responsive
Under-responsive
Sensation seeking
Sensory discrimination
disorder
Sensory-based motor disorder
Postural disorder Dyspraxia
Interventions for Sensory Processing Disorders
Interventions for Sensory Processing Disorders
• Top down– Normalizing– Patient and family education– Environmental interventions– Self-esteem / success experiences– Treating comorbidities
The Sensory Defensive Adult
Consider your own self-stim strategies
• Applying lotion• Clicking pen• Sewing machine leg• Gum• Whistling
Instant study carrel
Time “in”
Place the student with tactile defensiveness at the edge of the group
Provide multiple cues for transitions
• Verbal “two minute warning” • Visual schedule• Changes in lighting• Nonverbal cues
Heavy work
CENTRAL AUDITORY PROCESSING DISORDER
ADHDetc
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
58
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
59
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
60
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
61
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
62
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
63
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
64
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
65
• Auditory discrimination (same/different)• Auditory localization (locate source of sound)• Auditory performance with degraded acousticsignal• Auditory figure-ground (perceiving sounds inbackground noise)
Central auditory processes
Central Auditory Processing Disorder
• Difficulty processing auditory information
despite normal hearing– With functional impact– Observable by SLPs, teachers, and parents
CAPD: what we notice
• Poor communicator (terse, telegraphic)• Hears better when watching the speaker• Problems when I speak to rapidly to him• She interprets words too literally• Memorizes poorly
CAPD: what we notice
• Often needs remarks repeated• Difficulty sounding out words while reading• Confuses similar-sounding words• Difficulty following directions in a series
CAPD
• the research challenge of “supramodal influences”
CAPD or ADHD?
• Where do you see it the most? Where do you see it the least?
Interventions for CAPD
• Bottom up– Auditory integration training and similar programs– Environmental modifications• FM transmission• Train the speaker to face her listener, and check for
understanding• Preferential seating• Untimed testing• …..and…..
Interventions for CAPD
• Bottom up– Auditory integration training and similar programs– Environmental modifications• FM transmission• Train the speaker to face her listener, and check for
understanding• Preferential seating• Untimed testing
• Increased use of visual cues
Interventions for CAPD
• Bottom up– Auditory integration training and similar programs– Environmental modifications• FM transmission• Train the speaker to face her listener, and check for
understanding• Preferential seating• Untimed testing• Increased use of visual cues
True or False?
• Sensory Processing Disorder will be included in the DSM5
• Only individuals on the autistic spectrum engage in self-stimulating behaviors
• Speech Language Pathologists formally diagnose CAPD by way of screening tests
• CAPD and ADHD can be co-occurring conditions in some clients
Interventions for CAPD
• Top down– Metalinguistic strategies including schema
induction, context-derived vocabulary building, phonological awareness, and semantic network expansion
Interventions for CAPD
• Top down– Metalinguistic strategies including schema
induction, context-derived vocabulary building, phonological awareness, and semantic network expansion
– Metacognitive strategies including self-instruction, cognitive problem solving, and assertiveness training
Skillfully eliciting the chief complaint
• Too much of what? Or too little of what?• Invoking the Pediatric Fairy (or the Psychiatric
Genie)
HËDŸDT?
• How exactly did you do that?– Everybody’s doing the best he/she can– Every behavior problem is either• Skills deficit• Contingency problem
Forming a diagnostic impression
• Where do you see it the most? And where do you see it the least?
• Two disorders = two stories
Documenting and communicating your conclusions
• The footprints in the butter• Defend your diagnosis
Adults with Auditory Processing Challenge
Strengths and Weaknesses Checklist(Sensory Processing Problems)
Appendix A
ATTENTION DEFICIT HYPERACTIVITY DISORDER
ADHDetc
The Executive Functions
• Nonverbal working memory• Verbal working memory• Self-regulation of affect/motivation/arousal• Reconstitution
Barkley, RA, Murphy, KR., Fischer, M (2008). ADHD in Adults: What the Science Says . New York, Guilford Press.
The Executive Functions
• Sensing to the self• Speech to the self• Emotion to the self• Play to the self
Barkley, RA, (2012)
The Executive Functions
• Making movies in your head
• Talking to yourself
• Being your own boss
• Thinking and creating “what could be”
Arenas of Involvement
• Intrapersonal• Interpersonal• Environmental• Academic / symbol system
(McCloskey & Perkins, 2013)
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
99
1. 1-step errands
2. Chores with cues
3. Basic inhibition
Age-appropriate ExpectationsPreschool
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
100
1. 2-3 step directions
2. 20-30 minute assignments
3. Follow rules/inhibit/no grabbing
Age-appropriate ExpectationsKindergarten -2nd Grade
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
101
1. Simple shopping list
2. Keep track of variable daily schedule
3. Inhibit and regulate even without teacher present
4. Simple delayed gratification (phone)
Age-appropriate Expectations3rd-5th Grade
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
102
1. Complex chores
2. Organizing system
3. Time management
4. Self soothe
5. Manage conflict
Age-appropriate Expectations6th – 8th Grade
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
103
1. Independent with assignments
2. Make adjustments based on feedback
3. Inhibit reckless behavior
4. Say “no” to fun activity if other plans already made
5. Take others’ perspective
Age-appropriate ExpectationsTeenage-mid 20’s
Knock 3 years off his age
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
105
Age-appropriate ExpectationsLending Your Brain
Model and discuss attending
• Broad versus narrow• Internal versus external• Passive and active
ADHD and Brain Development
ADHD
Inattentive Hyperactive Combined
Appendix B
DSM-V Changes
• Age of onset (12 years rather than 7)• Adult criteria (5 symptoms rather than 6)• Additional symptom examples provided• Strengthening of cross-situational
requirement• Provision of comorbidity with autism
ADHD and Brain Imaging
Environmental Influences
• Screens • Second-hand smoke• Toxic exposure• Sleep deprivation
Environmental Influences
• Screens • Second-hand smoke• Toxic exposure• Sleep deprivation
Functional impact of core symptoms
• Arousal / alertness• Mental effort• Determination of saliency• Focal maintenance
Sleep hygiene
• Strict bedtime• Use bed only for sleep• No caffeine after mid-afternoon• No activating media after 7pm
Establish bedtime routine
Fidget supports
Functional impact of core symptoms
• Arousal / alertness• Mental effort• Determination of saliency• Focal maintenance
Premack Principle
Reward small units of effort
Functional impact of core symptoms
• Arousal / alertness• Mental effort• Determination of saliency (what’s in it for me?)• Focal maintenance
There’s no such thing as procrastination
• “There’s just choosing….and choosing again…”
procrastinators-anonymous.org
Functional impact of core symptoms
• Arousal / alertness• Mental effort• Determination of saliency• Focal maintenance
EZ-C Reader
Functional impact of core symptoms
• Satisfaction control (“post-synaptic dopamine insensitivity”)
• Inhibition• Tempo control• Self-monitoring and correcting
DRO
Differential Reinforcement of Other
Fail-proof desk activities
Appendix C
Daily report card
Appendix D / E
Meet with your ADHD employee for regular ongoing feedback
Functional impact of core symptoms
• Satisfaction control• Inhibition• Tempo control• Self-monitoring and correcting
There’s no such thing as “disinhibited”
The “talking stick”
Functional impact of core symptoms
• Satisfaction control• Inhibition/Self-Regulation– Arousal– Motivation– Mood• ADHD or Bipolar Disorder?• Too much “push” or too little “pull”?
• Tempo control• Self-monitoring and correcting
ADHD is notFRED-PG13
• Flight of ideas• Racing thoughts• Euphoria• Decreased need for sleep• Periodicity • Grandiosity• Age of onset
Functional impact of core symptoms
• Satisfaction control• Inhibition• Tempo control• Self-monitoring and correcting
1 hour 1 day 1 week 1 month 1 year
Time Horizon
Functional impact of core symptoms
• Satisfaction control• Inhibition• Tempo control• Self-monitoring and correcting
Distraction delay training
COMPREHENSIVE ADHD EVALUATION
Curious Compassionate Nonjudgmental Evaluation
• Skillfully eliciting the chief complaint• HËDŸDT?• Forming a diagnostic impression• Defending your diagnosis / impression
What are our data sources?
• Record review• Interview• Collateral interview• Checklists• Mental status examination • Test scores
COMPREHENSIVE ADHD TREATMENT
Comprehensive ADHD Treatment
• Medication• Behavioral Support• Working Memory
Training• Movement• Vestibular and
Cerebellar Interventions• Neurofeedback• Breathwork /
meditation
• Creative visualization
• Mindfulness • Bodywork• Supplements / diet• Hypnosis• Coaching • Counseling
Comprehensive ADHD Treatment
• Medication– Stimulant– Non-stimulant– “Off-label” treatment
Image: wikimedia commons
Cortico-striatal loop
Increase salience
Two weeks from now, how will you know whether it’s working?
Appendix F / G
Daily report card
Appendix D
Comprehensive ADHD Treatment
• Behavioral Support
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
183
AANTECEDENTS
BBEHAVIOR
CCONSEQUENCE
S
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
184
AANTECEDEN
T
BBEHAVIOR
CCONSEQUENC
ES
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
185
AANTECEDENTS
BBEHAVIOR
CCONSEQUENC
ES
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
186
AANTECEDENTS
Set them up for success
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
187
AANTECEDENTS
Identify exceptions
Where do you see it the most?
Where do you see it the least?
Rules
•Waking up•Bedtime•Chores•Homework•TV / internet
AANTECEDENTS
Launching Pad
Expectations
•Specific•Behavioral•In advance
AANTECEDENTS
Communication
•Get eye contact•Speak clearly•Provide behavioral info•Check for understanding
AANTECEDENT
S
Ask for What You Want
• Talk like a behaviorist• Tell your partner what you want• Post classroom expectations visibly
(for the non-ADD partner) Ask for what you want
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
196
AANTECEDENTS
Provide prosthetic cues at the “point-of-performance” (Barkley)
• Staff mentor• “Fall-back” peer
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
197
AANTECEDENTS
Provide prosthetic cues at the “point-of-performance” (Barkley)
Appendix H
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
200
AANTECEDEN
T
BBEHAVIOR
CCONSEQUENC
ES
Behavioral Support
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
201
BBEHAVIOR
“A healthy high-functioning 26 year old”
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
202
BBEHAVIOR
More
• Behavioral control• Choices and options• Self-regulation• Arousal• Motivation• Mood• Attention
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
204
AANTECEDEN
T
BBEHAVIOR
CCONSEQUENCES
Don’t reward them with stuff
Rotate rewards frequently
Determine what basic provisions are unconditional…
• Love• Respect• Safety• 3 meals• Essential clothing• Temperature-controlled environment• 30 minutes of video games
…and which are contingent• Special foods• Expensive or trendy clothing• Extra video game time
Appendix I
Clip and share horrible articles about teens falling out of the back of pickup trucks
• Review cause and effect• Discuss consequences• Emphasize behavioral agency
Working Memory Training
• CogMed• Lumosity
Movement Techniques
• Exercise• Rhythm and timing and cognition• Integrated movement • Yoga• Martial arts
Turn 30 minutes into 45
Balance screen time and “green time”
Balance screen time and “green time”
Movement Techniques
• Exercise• Rhythm and timing and cognition• Yoga• Martial arts
Bal-A-Vis-X
Vestibular and Cerebellar Exercises
• Dyslexia Dyspraxia Attention Treatment• Interactive metronome
amygdala
Prefrontalcortex
Managing our Cave(wo)man
• Meditation• Creative visualization• Mindfulness • Neurofeedback
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
238
04/11/2023 239
© 2011 David D. Nowell, Ph.D. All rights reserved.
04/11/2023 240
© 2011 David D. Nowell, Ph.D. All rights reserved.
04/11/2023 241
© 2011 David D. Nowell, Ph.D. All rights reserved.
Managing our Cave(wo)man
• Meditation• Creative visualization• Mindfulness • Neurofeedback
Mindfulness
Mindfulness
Managing our Cave(wo)man
• Meditation• Creative visualization• Mindfulness • Neurofeedback
Bodywork
• Massage• Chiropractic • Acupuncture• Transcranial magnetic stimulation
Supplements and Diet
• Omegas• Food additives• Food allergies• Pesticides• Dietary recommendations
Supplements and Diet
• Omegas– Zinc
• Food additives• Food allergies• Pesticides• Dietary recommendations
Nutrition essentials
• Emphasize protein at every snack and meal• Eat fewer processed foods• Choose local• Pay close attention to patterns between food
and focus/mood
Hypnosis
ADD Coaching
Comprehensive ADHD Treatment
– May be expensive
Consider online peer support
www.reddit.com/r/ADHD/
Counseling Goals with the ADHD Client
Basic Brain Supports (without these the rest may not matter)• Sleep• Nutrition• Exercise
Family Supports (any ADHD treatment should include support for the spouse or parents)• Rules• Expectations• Communication
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
262
AANTECEDENTS
BBEHAVIOR
CCONSEQUENC
ES
Rules,Expecations, and Communication
The Self-esteem
Abacus
Counseling Goals with the ADHD Client
Therapeutic Interventions (traditional counseling tasks)• Self-esteem• Self-efficacy
Lend-Me-Your-Brain Interventions (executive function support)• Reading skills• Study skills• Time/goal management
– Calendar– To-do list
The “Big Five”
• Daily focus time• Nutrition• Movement• Sleep• Connection
10-Minute Morning Review
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
267
…the most important 10 minutes of the day….
The “Big Five”
• Daily focus time• Nutrition• Movement• Sleep• Connection
Barter Social/Practical Support
• Food prep for optimal nutrition• Domestic organization• Pre-tax paperwork
The “Big Five”
• Daily focus time • Nutrition• Movement• Sleep• Connection
“Exercise for focus” is different from "exercise for fitness”
The “Big Five”
• Daily focus time• Nutrition• Movement• Sleep• Connection
The “Big Five”
• Daily focus time• Nutrition• Movement• Sleep• Connection
Marry well and get a crackerjack assistant at work
The ADHD Couple
The ADHD Couple: The Problems
The ADD Partner May Have:• High need for stimulation• Poorer impulse control• Inattention to detail
The Non-ADD Partner May Have:
• Rigid style• Mild anxiety• Unrealistic expectations
The ADHD Couple: Counseling Goals
• Remembering what drew you to your partner• Getting to “fair”• Outsourcing / professional supports• Feeling your contributions are valued• Communication skills training
Positive characteristics of many people with attentional / executive challenges
Appendix J
The ADHD Couple: Counseling Goals
• Remembering what drew you to your partner• Getting to “fair”• Outsourcing / professional supports• Feeling your contributions are valued• Communication skills training
Allow your non-ADHD partner or roommate to tackle longer-term projects: You take on more of the easy/quick tasks.
Don’t do anything for your ADHD partner or teenager which could just as easily be managed by a machine or an app
Shower Coach
“Walk Me Up” app
MORE STRATEGIES THAT JUST MIGHT CHANGE YOUR LIFE
Tickler System
Why Don’t Nuns Worry about What to Wear?
Strategy to rule to habit
• Let’s spend 30 seconds right now determining where you’ll put your keys from now on upon entering your home.
Strategy to rule to habit
3. habit
2. rule
1. strategy
Upstairs downstairs box
60-Second Bathroom Cleaning Routine
Clear (see-through) storage
Model and practice self-talk
• “I’m checking email then returning phone calls”
• “When do I need to be ready?”• “How long will this take?”
Reck, S.G. et al (2013)
ASK TWO QUESTIONSSelf-talk proficiency
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
305
Am I having fun now?Is this important?
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
306
important?
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
308
fun?
What does dopamine feeeel like?
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
318
YesYes
NoYes
YesNo
NoNo
Am I having fun now?Is this important?
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
319
YesYes
NoYes
YesNo
NoNo
I’m having fun.I’m on task.
Am I having fun now?
Is this important?
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
321
YesYes
NoYes
YesNo
NoNo
I’m having fun.I’m not on task.
Am I having fun now?
Is this important?
Beware dopamine tricksters!
• Facebook• Gambling• Shopping• Video games• Free online Aramaic course
StayOnTask app
The best defense against the manipulation of our attention is to determine for ourselves – in advance - how we want to invest it.
- E. Goldberg
Key features of a great planner system
Key features of a great planner system
• 2 pages per day• Master to-do list• With the client at all times
Yoga / read
Staff meeting
Planningsession
Phone calls
billing
Vh: jeff w/ puritan oil
Vc: kate re: brimfield
TC umass dermatology. Spoke w/ cindy 508 8564000
Key features of a great planner system
• 2 pages per day• Master to-do list• With the client at all times
What’s a To-Do list for anyway?
Key features of a great planner system
• 2 pages per day• Master to-do list• With the client at all times
Key features of a great planner system
• The “technology”• The “practice”
Key features of a great planner system
• The “technology”
• The “practice”
Weekly Overview
10-Minute Morning Review
Where will I most likely feel distracted today?
What will you do today that you'll still remember one year from now??
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
352
YesYes
NoYes
YesNo
NoNo
I’m not having fun.I’m on task.
Am I having fun now?
Is this important?
Increase salience
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
355
Use extrinsic reward creatively
Emphasize the sensory details of your desired outcome
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
357
easy hard
If It’s Harder than a “3” Find Some Way to Make It Easier
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
359
Assign separate due dates for smaller parts of big projects
Barter Social/Practical Support
• Food prep for optimal nutrition• Domestic organization• Pre-tax paperwork
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
362
YesYes
NoYes
YesNo
NoNo
I’m not having fun.I’m not on task.
Am I having fun now?
Is this important?
MORE STRATEGIES THAT JUST MIGHT CHANGE YOUR LIFE
Celebrate Boxing Day
• Valentine’s Day• Memorial Day• Arbor Day• Diwali
Celebrate Boxing Day
• Valentine’s Day• Earth Day• Diwali
Using your phone’s navigator as a time-management tool
STRATEGIC BEHAVIORAL INQUIRY
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
384
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
385
Objectives of SBI
• Specific behavioral strategy• What was the feeling-goal?• Motivational level on a scale from 1-10
Benefits of SBI
• Affirms the value of clients’ unique internal experience
• Emphasizes the culture of self-regulation• Encourages metacognition
Assumptions of SBI
• Everybody’s doing the best they can• Behavior is not incomprehensible or random• Behavior follows patterns which reveal
themselves to the curious observer free of prejudice or blame or theory
How to do SBI
“How exactly did you do that?”
04/11/2023 © 2011 David D. Nowell, Ph.D. All rights reserved.
394
Personal Application
…and How Exactly Did You Do That?
…and How Exactly Did You Do That?
Personal Application
• What bad habit persists? And How Exactly Do You Do That?
ADHD and Insight
Fall in Love with the Truth
• Self-monitor and collect data:– How long does your morning routine take,
exactly?– How much time – exactly – do you need to
complete expense forms?– How, exactly, do you follow through on
commitments to others and not to yourself?
Learn from your To-Do list
• Which things are not getting completed?• How – exactly – are these not getting
completed? How do you do that?
Clinical Application
• Who in your clinic or classroom is demonstrating remarkable “resilience” – persistence despite significant obstacles? And how, exactly, does he/she do that?
Clinical Application
• Who in your clinic or classroom is demonstrating remarkable “resilience” – persistence despite significant obstacles? And how, exactly, does he/she do that?
• What recurring behavioral problem is showing up in your clinic or classroom?
Clinical Application
• Who in your clinic or classroom is demonstrating remarkable “resilience” – persistence despite significant obstacles? And how, exactly, does he/she do that?
• What recurring behavioral problem is showing up in your clinic or classroom?
• Note: we aren’t asking “why did you do that,” but rather “how exactly did you do that.”
Living in The Gap
• Compassion• Self-compassion
www.slideshare.net/dnowell
Let’s stay in touch!
Join my e-newsletter list:
Fill out a card today and drop it in the box.
Sign up on my web site or Facebook page
Visit on the web: www.DrNowell.com
@davidnowell David Nowell Seminars
David D Nowell PhD
Notes
• Add barkley 2012 to references• Add mccloskey to references• Upload to slideshare• Pack 2 paddles or marker• Pack talk points• Add moonwalking bear video to stick• Insert slide with pushpin in dictionary• Check “appendx” references in slides