Working with the adhd student Brittany n. bates ● Pasadena ISD LSSP

Which child has adhd? This child’s presentation could mirror that of other problems or disorders. Which ones? What other problem behaviors might this child develop and why?

What is adhd? Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development Symptoms presenting in two or more settings (e.g. at home, school, or work; with friends or relatives; in other activities) Negatively impacts directly on social, academic, or occupational functioning. Several symptoms must have been present before age 12 years. The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. (American Psychiatric Association, 2013)

Adhd in adolescence Hyperactivity may be less prevalent. Restlessness, inattention, poor planning, & impulsivity may persist. A significant number of children remain impaired in adulthood. What types of activities may cause concern for adolescents with ADHD? (American Psychiatric Association, 2013)

Presentations of adhd inattentive Hyperactive/impulsive combined At least 6 symptoms of inattention Less than 6 symptoms of hyperactivity/impulsivity Persist at least 6 months At least 6 symptoms of hyperactivity/impulsivity Less than 6 symptoms of inattention Persist at least 6 months 3 core features At least 6 symptoms each of inattentive and hyperactive/impulsive presentations Persist at least 6 months (American Psychiatric Association, 2013)

Can be mistaken for: Emotional problems Disciplinary problems Comorbidity: Learning Disabilities Anxiety Disorder Conduct Disorder Depression Substance Abuse (national institute of mental health, 2016)

What is it like to have adhd? No matter how much you want to force yourself to pay attention, boredom allows curiosity to find the key and open the dungeon door, allowing attention to escape and find some interesting place to visit. Edward m. Hallowell, M.D. What is it like to have adhd?

7 executive functions Cognitive & mental abilities needed to pursue goals Inhibition Self-awareness Working memory (verbal & nonverbal) Self-motivation Self-regulation Planning and problem-solving

Executive functioning Executive inhibition Executive attention Motor inhibition Verbal inhibition Impulsive cognition Impulsive motivation Emotional dysregulation Poor persistence Distractible Low task re-engagement after disruption Impaired working memory Decreased self-monitoring (Barkley, 2013)

Other considerations The disorder is not: Children with ADHD are less mature Parents, teachers, and caregivers must consider seriousness of the disorder. Caused by parenting A lack of desire Limited by age

Academic strategies

Productivity in the classroom Target productivity first and accuracy later. Give smaller chunks of work at a time. Use light touch or an inconspicuous signal to redirect to task (talk less). Use a timer for task completion (externalize time). Use interactive components in lessons. Provide immediate feedback. Preferential seating Consider alternate methods for providing answers. (Barkley, 2011)

Study tips for adolescents Have a planner. Schedule everything in. Study in increments. Figure out which study tools work best. Create your own contingency plan. Have realistic expectations. Build a routine (where and when to study). (Tartakovsky, 2016)

Classroom arrangement Minimize distractions. Arrange desks so all students can view the instructional area. Seat the student where he/she can be closely monitored. Be sure each area of the room has a designated purpose.

Personal schedules Incorporate break times ● use visuals as needed

Behavior and executive functioning strategies

Contingency systems rewards consequences GENERAL RULES Children with ADHD like immediate gratification. Consider smaller maintenance rewards with an opportunity to earn a larger reward. Change the rewards often. Try group incentives Do not delay consequences Use school-home reports for both positives and negatives. Incentives must be present for consequences to be effective. Provide mild, private reprimands. Consider response cost. Use rewards before punishment. Maintain a disability perspective. Focus on approval and recognition; increase positive attention. Increase accountability to others. Use when-then contingencies.

Chart moves

Point cards

Reinforcer menu

Student tracking form

Daily tracking form Older students

Handling hyperactivity Allow some restlessness. Provide frequent movement or brain breaks. Use a “chill zone”. Use fidget tools.

Fidget tools

Movement tools

Impulse control Catch him/her on task and provide praise. Model your thought process. Use checklists.

Defiance & disruptions 40% of children with ADHD also develop oppositional defiant disorder (ODD). Aggression Outbursts Ignore requests Argue Intentionally ignore or disrupt Share resources between home and school Accentuate the positives Avoid power struggles Carry out the consequences you warn about Be firm and consistent (Flippin, Not Dated)

Off-task & disruptive behavior interventions Am I working? Red dot system “first, then” language Provide one task/instruction at a time Gradually increase on-task expectation Response cost Behavior momentum Calm, neutral tone Be brief Provide choices and time to comply

Self-monitoring

Organization & planning Use color-coded organization systems Assign a peer buddy. Teach the student to use a planner. Use a to-do list. Use graphic organizers.

Social & emotional functioning

Teaching social & emotional regulation Tootles (Younger students) FAST & SLAM (older students) Teaching social & emotional regulation Social skills groups & training Problem-solving training Friendship coaching Communication training Use social narratives and role play. Teach coping strategies. Use social autopsies.

Other recommendations Need collaboration of teachers, parents, and other treating professionals Encourage parent education Encourage involvement and participation in activities Maintain a disability perspective

resources ADDitude: Strategies & Support for ADHD and LD ADD Warehouse http://www.additudemag.com/ ADD Warehouse http://www.addwarehouse.com ADHD Together http://www.adhdtogether.com/ A Shared Focus http://www.adhdandyou.com/?utm_source=asharedfocus&utm_medium=vanity&utm_campaign=sharedfocus2012 Tough Kid Toolbox (available for purchase)

references American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth edition. Washington, DC: American Psychiatric Association. Barkley, R. (2013). ADHD: Diagnosis & Demographics. (PowerPoint slides). Presented at Region 4, Houston, TX. Barkley, R. (2011). Parent Counseling and Home Management of ADHD. (PowerPoint slides). Presented at Region 4, Houston, TX. Barkley, R. (2013). School Management of ADHD. (PowerPoint slides). Presented at Region 4, Houston, TX. Flippin, R. (Not dated). Why is my child so angry? Retrieved from http://www.additudemag.com/adhd-web/article/4636.html. Tartakovsky, M. (2016). A Toolkit for School Success: 15 Study Tips for Students with ADHD. Psych Central. Retrieved from http://psychcentral.com/lib/a-toolkit-for-school-success-15-study-tips-for-students-with-adhd/. National Institute of Mental Health. (2016). Attention Deficit Hyperactivity Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml.

Brittany n. bates brbates@pasadenaisd.org