Students with Attention Deficit- Hyperactivity Disorder Nov. 24, 2009

Attention Deficit Disorder (ADD) or Attention Deficit/Hyperactivity Disorder (ADHD) ADHD is not something we can “cure”. A child with ADD/ADHD does not “outgrow” it. Many successful adults with ADD/ADHD as well as troubled ones. MRI studies has demonstrated decreased blood flow in areas of brain that is associated with attention (Zametkin et al., 1993)

Development of the ADHD Field First description by Dr. George Still 1920s – Children who survived encephalitis lethargica often were distractible and impulsive 1930s – Dr. Charles Bradley used stimulant medication to control children’s behavior 1960s – term hyperactive was used Today – research on the brain’s role in ADHD

Definition of ADHD A pervasive pattern of inattention, impulsivity, and/or hyperactivity- impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development. (American Psychological Association, 2000)

3 Types of ADHD Predominately inattentive Predominately hyperactive/impulsive Combined

Inattention Those subtypes have different achievement Inattention (over six months, six of following behaviors) –Failing to pay close attention to details and making careless mistakes that are inconsistent with child’s developmental level –Failing to sustain attention to tasks and /or play activities

–Failing to listen even when spoken to directly –Failing to complete tasks –Having difficulty with organization –Resisting working on tasks that require sustained attention –Losing materials and objects –Becoming easily distracted –Being forgetful

Hyperactivity/Impulsivity Hyperactivity –Fidgeting or squirming –Having difficult time remaining seated during class, even when other students are able to do so –Running and climbing excessively when it is not appropriate –Having difficulty playing quietly

–Acting as though he/she is “driven by a motor” –Talking too much Impulsivity –Blurting out answers –Difficulty waiting for his/her turn –Interrupting activities ort butting into activities

These characteristics of inattention and/or hyperactivity-impulsivity should be present before age of 7 and in two or more settings (e.g., school and home) Also, these characteristics significantly impair social, academic, or occupational functioning.

Inattentive Type : Teachers define these students as daydreamers, distracted, and forgetful. Hyperactive-Impulsive Type: have difficulty sitting still, talk out of turn, most challenging to parents and teachers, more likely to develop conduct disorder or defiant disorder in adolescence.

Combined Type: 85% of students with ADHD are the combined type. Exhibit features of both, but more like students with hyperactivity and impulsiveness

Characteristics of Students with Attention Deficit Hyperactivity Disorder Manifest itself early in youngster's life. The precursors have been identified in infancy Some early indicators of ADHD include poor sleeping and eating habits, a difficult temperament, and high levels of activity By 3 years, approximately 50 % of those who will be identified as having ADHD demonstrate such behaviors as high levels of activity, behavior problems, and short attention span.

They may demonstrate many of the behaviors associated with ADHD as early as kindergarten and first grade. The core characteristics of ADHD include the following: Poor sustained attention and vigilance Impulsive or poor delay of gratification Diminished rule-governed behavior Increased variability of task performance

May be diagnosed at age four or later childhood or early adolescence. Parents describe these children as –restless –always on the go –acting as if driven by a motor –persistent in their wants –demanding of their parental attention –insatiable in their curiosity about their environment.

What distinguishes ADHD from other common problems Onset in early childhood Chronic over time Generally pervasive across situations Deviant from age-based standards Increased co-morbidity with other learning and psychiatric disorders

In the elementary years, teachers often view these children as having “immature” behaviors and making slow academic progress About % are likely to have reading difficulties They struggle with phonological processing tasks and executive functioning (regulation of one’s behavior and control over the tasks), which related to both reading and behavior

Current research suggests that the key characteristics of ADHD is difficulty with self- control or behavioral inhibition. Behavioral Inhibition: It refers to the ability to withhold a planned response, interrupt a response that has been started, protect an ongoing activity from interfering activities, and delay a response.

Teachers state that these children have difficulty waiting their turn, refraining from interrupting in conversations, delaying immediate gratification, working for long- term rewards, and resisting potential distractions when working.

Executive Functioning: refers to the ability to regulate one’s thinking and behavior through the use of working memory, inner speech, control of emotions, and arousal levels, and analysis of problems, and communication of problem solutions to others.

These students have problems in guiding their behavior in situations that demand the ability to follow rules or instructions. They have more limited persistent goal- directed behavior and can find it exceedingly difficult to stay focused on tasks that require effort or concentration that are not exciting.

Hyperactivity may be reduced by age but inattention likely to continue Individuals with ADHD do get better as they get older, however more than half of them continue to have difficulty in the areas of impulsivity, inattention, self- esteem, and restlessness as adults.

As in high school at work, adults with ADHD may have significant problems with their ability to work independently of supervision, meet deadlines and work schedules, be persistent and productive in getting assigned work done, and interact cordially with fellow workers.

It will co-occur with LD or conduct disorder. They frequently have other behavioral or academic problems. Prevalence: 3-5% Higher rates for males than females (3 to 1 or 6 to 1) Identification: Conners Teacher Rating Scale, ADHD Rating Scale, Child Behavior Checklist Cultural bias, overdiagnosis or underdiagnosis

Causes of ADHD Physiological causes –Heredity –Brain differences Environmental Causes –Lead poisoning –Maternal prenatal smoking and alcohol consumption

Cognitive Characteristics Problems with Executive Functioning –Working memory is not efficient –Self-directed speech not utilized effectively –Difficulty controlling emotions or motivation –Reconstitution – the ability to break down what is observed and to combine parts to carry out new actions

Academic Characteristics Some students are very successful academically Other students consistently achieve below their potential Academic self-concept is important

Social/Emotional Characteristics Self-esteem is a problem for some, but not all, students with ADHD Students often have problems coping with social functioning –Developing and maintaining friendships –Rejection by peers

Behavior Characteristics Failure to attend to details Make careless mistakes in work Failure to complete schoolwork Failure to listen when spoken to directly Difficulty organizing tasks and materials Avoidance of tasks that require sustained mental effort

Comorbidity with Other Disorders ADHD may occur simultaneously with other disorders such as: –Learning disabilities –Emotional disabilities –Autism –Traumatic brain injury –Psychiatric disorders –Sleep disorders –Substance abuse problems

Initial Referral for Eligibility Medical Diagnosis –Pediatrician, family physician, psychiatrist –Diagnosis may occur before child enters school Educational referrals may come from –Child’s classroom teacher –Special education teacher

Assessments May Include: Medical assessment Continuous performance tests Parent rating scales and checklists Teacher rating scales and checklists Samples of student’s work Anecdotal information

Gifted or ADHD? Inability to regulate behavior Question rules and create their own Problems with Rules Primary characteristic of ADHD Good judgment lags behind intellectual development Impulsivity Difficulty in most situations Only in specific situations, e.g., when bored Poor sustained attention ADHDGifted StudentsBehavior

Early Childhood Education Diagnosis at an early age is difficult. If children’s symptoms of ADHD are severe, early intervention is crucial. Children may need a highly structured environment, immediate and consistent feedback, and age-appropriate rewards.

Elementary and Secondary School Services Many students receive their education in general education classrooms. Professionals must collaborate with parents to find effective techniques for students with ADHD.

Transition and Adulthood 66% of students with ADHD continue to have the disorder into adulthood Many adults with ADHD are disorganized, impulsive, and have poor work skills Students need to have a clear understanding of their disorder and learn to advocate for themselves

Medication is the Most Clearly Effective Intervention The use of medication is controversial. The decision to prescribe medication only indirectly involves school personnel. Medication is helpful for many (70-80%) students for whom it is prescribed. Medication alone is not sufficient to improve academic performance

Instructional Guidelines Positive attitudes toward inclusion of students with ADHD Knowledge of behavior-management procedures (they are essential skills to meet those children's needs). Personal characteristics

Educational Interventions Use novelty in instruction and directions Maintain a schedule Prepare students for transitions and provide support in completing transitions Emphasize time limits Provide organizational assistance Provide rewards consistently and often

Be brief and clear Arrange the environment to facilitate attention Provide optimal stimulation Allow for movement and postures other than sitting

Guidelines for homework Keep homework assignments separate from unfinished classwork Use homework as practice for material that has already been taught Identify the minimum amount to demonstrate learning Provide timelines for tasks associated with long-term assignments

Best Educational Practices Parent and professional education Environmental supports for students Behavior interventions –Rewards –Low involvement strategies –Token economy systems

Supporting Parents of Children with ADHD Have realistic expectations of parents Encourage parents to be good role models Help parents have realistic expectations Make related resources available