Students with Attention Deficit- Hyperactivity Disorder Chapter 6 Students with Attention Deficit- Hyperactivity Disorder Copyright © Allyn & Bacon 2008

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, 2013)

Caucasian children more likely to receive medication for ADHD Prevalence 2-3 times as many boys identified as girls No difference in frequency among races Caucasian children more likely to receive medication for ADHD

Production deficits, not acquisition deficits Key elements of ADHD Neurological Developmental Chronic Not situational Production deficits, not acquisition deficits

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

Causation “Copyright© Allyn & Bacon 2006”

The striatum receives input from the frontal cortex and is responsible for the regulation of behavior. It consists of the caudate (top), putamen (lower right), and globus pallidus (lower left). Development of the striatum is often delayed in children with ADHD. Courtesy L. Hanford and G. Hall.

Behavioral Disinhibition Inattention, Hyperactivity & Impulsivity Working Memory Creative Problem Solving Emotion Regulation Internalized Speech ADHD: Inattention, Hyperactivity & Impulsivity Barkley’s neurodevelopmental model for ADHD. Early problems with behavioral inhibition can adversely affect the development of the four executive functions. Executive functioning deficits underlie symptoms of ADHD.

Cognitive Characteristics Problems with Executive Functioning Issues with ability to control impulses 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 Tourette’s syndrome 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 DISC IV (Diagnostic Interview Schedule for Children) Parent rating scales and checklists Teacher rating scales and checklists Samples of student’s work Anecdotal information

Gifted or ADHD? ADHD Gifted Students Behavior Poor sustained attention 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 ADHD Gifted Students Behavior

Eligibility for IDEA Services Does the ADHD “adversely affect” the student’s educational performance? Not all students with ADHD are eligible Students who are not eligible for IDEA may qualify for accommodations under Section 504 Students may be eligible because they also have a learning or emotional disability

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

Psychostimulants Ritalin Concerta Focalin Adderall Strattera

Stimulant medication is efficacious at reducing ADHD symptoms Stimulant medication is efficacious at reducing ADHD symptoms. Based on Biederman, Lopez et al. (2002).

Summer Treatment Program for youth with ADHD Summer Treatment Program for youth with ADHD. Chronis and colleagues (2004) used direct contingency management during treatment phases 1 and 2, but withdrew contingencies in between treatment phases. Children’s noncompliance increased during treatment withdrawal, indicating that treatment was efficacious.

Best Educational Practices Parent and professional education Environmental supports for students Behavior interventions Rewards Token economy systems Structure Quick Pace Variety

Should we combine medication and behavior therapy Should we combine medication and behavior therapy? Results of one large study indicated that combining medication with Multimodal Psychosocial Treatment (MPT) or Attention Control Treatment (ACT) did not lead to better improvement than using medication alone. Based on Abikoff et al (2004).

The MTA Study. Combining medication with behavior therapy, or using medication alone, is superior to behavior therapy alone to treat ADHD. Based on Swanson and colleagues (2001).

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