Help! How Do I Manage These Strong-Willed Hyperactive Kids? Presented by: Mayra Rodriguez, Ed.S. School Psychologist

ATTENTION DEFICIT DISORDERS Teachers, child care workers, and school personnel are key to diagnosis and successful outcomes

INTRODUCTION ACTIVITY Identify a current student you suspect might have A.D.H.D.

Many Names for A.D.H.D. Early 1900’s....Minimal Brain Damage Early 1900’s....Minimal Brain Dysfunction Mid 1900’s....Hyperkinetic Reaction of Childhood Early 1980’s....Attention Deficit Disorder w/wo Hyperactivity Late 1980’s.....Attention-Deficit Hyperactivity Disorder Present Attention-Deficit / Hyperactivity Disorder (Type I, Type II, or Combined)

A.D.H.D. STATISTICS Occurs in 3-5% of school-age children – All socioeconomic, cultural, and racial backgrounds – All intelligence levels More prevalent in males – 4:1 male to female ratio in general population – 9:1 male to female ratio in clinical population

A.D.H.D. STATISTICS Symptoms identified in up to 80% of adolescents with A.D.H.D. – Problems continue after childhood in 66% of cases Hereditary link suggested

Is ADHD Over-Diagnosed?

FACT – 3.5 million children meet criteria for ADHD; only 50% are diagnosed and treated FACT – 57% of children with ADHD receive accurate diagnosis FACT – Only 20% of black children with ADHD are diagnosed FACT – Overall parental knowledge about ADHD among African-American parents may play an important role in delaying diagnosis

The Societal Burden of Not Treating ADHD 30% of children in special education 30% repeat a grade 25% of adolescents expelled from school 35% of students drop out of school 26% arrested 55% untreated grow up to be substance abusers Engage in other high risk behaviors, more partners

Children With A.D.H.D. Exhibit Age-Inappropriate Behavior Patterns Inattention Impulsivity Hyperactivity

A.D.H.D. Interferes with School Success Inattention Symptoms: Child experiences difficulty in…. Starting, staying with, and completing tasks that require sustained attention Making careless mistakes Making transitions Following directions / listening Performing consistently Organizing tasks Losing things / forgetfulness

Impulsivity Symptoms Low frustration tolerance Difficulty waiting turn Interrupts others & ignores boundaries Blurting out answers before question is completed Difficulty anticipating outcomes Often irritable/ impatient; but otherwise quite charming

Impulsivity Symptoms Cannot keep hands to themselves Often appear reckless, clumsy, or accident-prone Often provoke conflict just for the love of excitement!!!! Can easily produce chaos in class or turn home into a battleground

Hyperactivity Symptoms Fidgeting Rarely seated, or squirms in seat Moving excessively Difficulty playing or working quietly Always “on the go” Excessive talking Varies with age & developmental level Often makes noise during quiet activities Up often during meals

Symptoms often disappear when the child is with another person who is closely scrutinizing him, when confronted with an interesting task, or a novel situation

DSM-V DIAGNOSTIC TERMS Attention-Deficit / Hyperactivity Disorder Inattentive Type Hyperactive-Impulsive Type Combined Type

Persistence, Pattern, and Frequency of Symptoms A persistent pattern… more frequent & severe than developmentally appropriate First appeared before age 7 Persist for 6 months or more Present in at least 2 settings Interference with social or academic functioning

Symptoms Change Over the Years Adolescence Restlessness Talks out of turn Problems at school Problems with peers Poor judgment Difficulty getting independence from parents Elementary School Fidgety Excessive talking Erratic performance Bossy Constant demand for attention Easily loses control

DIAGNOSTIC PROCESS TIER 1: Presence of Symptoms Interview parents and teachers Obtain developmental history Review school and medical records Complete behavioral rating scales Observe during an auditory vigilance task. Interview student / self-report

DIAGNOSTIC PROCESS TIER 2: Degree of Impact on Functioning Classroom observation Psychoeducational tests

Intervention Strategies Should Target... Classroom behavior Academic performance Social interactions

Strategies That Enhance Productivity and Behavior

Classroom Management Strategies Schedule academic skills subjects in AM Provide regular and frequent breaks Agree on “secret signal” for student Develop “time-to-begin” cues

Classroom Management Strategies Teach self-monitoring techniques Devise & practice attention-getting strategies Divide assignments and present in smaller segments Use behavioral reinforcement system

Organization Strategies Orderly, predictable, structured, consistent environment Minimal distractions, quiet work area, background noise (white noise) Prominent display of rules, schedules, and assignments Advanced warning before transition of activity

Curriculum Accommodations Reduced homework / classwork Increased time for completing assignments and tests Mixture of high- and low-interest activities (task novelty) Curriculum integration Seek meaning/ purpose

Curriculum Accommodations Use of computers for written assignments Teach/ prompt organization and study skills Interactive instruction vs. lecture Visual references for oral instructions Avoid timed tests

Social Skills Strategies/ Impulse Control Social skills training Conflict resolution training Anger management therapy Compliance training

Family Issues Parent training to learn how to parent an ADHD child Parent training to reinforce social skills training Family therapy to heal damaged relationship issues

What About Psychostimulant Medication?

70-75% of children with A.D.H.D. improve Degree of response may vary Effective dosage may vary

Medication is sometimes useful in helping ADHD children…. become less irritable & restless improve attention & motor coordination become less impulsive, therefor, better liked by others improve in pro-social & appropriate school behavior

What About Psychostimulant Medication? Effective with adolescents and adults, although the extent of improvement is smaller than with younger children Medication is only one part of a total management program

GROUP ACTIVITY Develop Classroom Management Strategies: Divide into groups of 3 or 4 Read “Situational Vignettes” Devise classroom interventions / strategies to help the student in question. List as many as possible. Elect a spokesperson to report back to group

Successful Management of A.D.H.D. Takes a Team Effort

AND…a great deal of prayer! Let your ADHD student know you love them & care about them regardless of how they behave!