Attention Deficit Hyperactivity Disorder A Window into Disability as Variability -- Harvard University A Window into Disability as Variability -- Harvard University

ADHD in the Classroom / My daily “emotional rollercoaster” with Sean / We both had the same goal: academic success for Sean, but we couldn’t reach it… / My daily “emotional rollercoaster” with Sean / We both had the same goal: academic success for Sean, but we couldn’t reach it…

ADHD in the Classroom / Sean was a very tactile child / Velcro under the desk helped him focus, but why?

My Research Questions / Why did the Velcro trick work? / What is ADHD? / What are the major theories surrounding ADHD? / What is the neuroscience behind ADHD? / How will this information help me avoid the “emotional rollercoaster” in my classroom? / Why did the Velcro trick work? / What is ADHD? / What are the major theories surrounding ADHD? / What is the neuroscience behind ADHD? / How will this information help me avoid the “emotional rollercoaster” in my classroom?

What is ADHD? / 3-7% of children in the US are diagnosed / DSM-IV diagnostic tool / Inattention / Impulsivity / Hyperactivity / Variability!!! / For our purposes, we will think about children like Sean… / 3-7% of children in the US are diagnosed / DSM-IV diagnostic tool / Inattention / Impulsivity / Hyperactivity / Variability!!! / For our purposes, we will think about children like Sean…

What do we traditionally think of when we think of a good student? “Good”“Bad” Sits stillDistracted

Key Points in the Presentation / ADHD Theory / Barkley’s Behavior Inhibition Theory (1997) / Neuroscience and ADHD: structure/function differences that have been studied in children with ADHD / Sikstrom and Soderlund’s Moderate Brain Arousal Theory / Why the Velcro trick worked! / ADHD Theory / Barkley’s Behavior Inhibition Theory (1997) / Neuroscience and ADHD: structure/function differences that have been studied in children with ADHD / Sikstrom and Soderlund’s Moderate Brain Arousal Theory / Why the Velcro trick worked!

Key Points in the Presentation / What does this mean for the classroom? / Examples of interventions that do not work for most kids / Examples of interventions that might work when considering MBA theory / Discussion on changing our ideas of what a good student is to account for variability / What does this mean for the classroom? / Examples of interventions that do not work for most kids / Examples of interventions that might work when considering MBA theory / Discussion on changing our ideas of what a good student is to account for variability

Barkley’s Behavior Inhibition Theory (1997) / Behavior inhibition deficits cause executive function deficits. / Children with ADHD will have deficits in the following executive functions: working memory, self- regulation, and motor control. / What do all of these terms mean? / Behavior inhibition deficits cause executive function deficits. / Children with ADHD will have deficits in the following executive functions: working memory, self- regulation, and motor control. / What do all of these terms mean?

Barkley’s Theory / Behavior inhibition is the ability to stop an initial or ongoing response and the ability to redirect yourself to a goal- oriented behavior / Sean during independent reading as an example / Behavior inhibition is the ability to stop an initial or ongoing response and the ability to redirect yourself to a goal- oriented behavior / Sean during independent reading as an example

Barkley’s Theory / Executive Functions / Self-regulation / Sequencing behaviors / Planning and organization / Working memory / Internal speech / Defined differently even by leaders in the field / Executive Functions / Self-regulation / Sequencing behaviors / Planning and organization / Working memory / Internal speech / Defined differently even by leaders in the field

Executive Functions / Self-regulation / The ability to regulate your affect, motivation, or arousal in service of a goal directed action (Barkley 1997). / An inability to self-regulate will also cause a deficit in the ability to self-direct motor functioning / Sean was unable to self-regulate motivation during independent reading / Self-regulation / The ability to regulate your affect, motivation, or arousal in service of a goal directed action (Barkley 1997). / An inability to self-regulate will also cause a deficit in the ability to self-direct motor functioning / Sean was unable to self-regulate motivation during independent reading

Executive Functions / Working Memory / The ability to store and manipulate information in your mind / Sean often couldn’t hold the academic goal in his WM / Working Memory / The ability to store and manipulate information in your mind / Sean often couldn’t hold the academic goal in his WM

Executive Functions / Working Memory Task / Count the number of times the team in white passes the basketball / Basketball Video Basketball Video / Working Memory Task / Count the number of times the team in white passes the basketball / Basketball Video Basketball Video

Gaps in Barkley’s Theory / Barkley’s theory puts the onus of change on the child / Barkley leaves out neuroscience / His theory tells us a lot about behaviors, but it does not tell us why they occur. / Barkley’s theory puts the onus of change on the child / Barkley leaves out neuroscience / His theory tells us a lot about behaviors, but it does not tell us why they occur.

Brain 101 / Neurons - receive and transmit info / Neurotransmitters / Chemicals that help neurons “talk” / Example: Dopamine / Cerebral Cortex / 4 lobes / Occipital, Parietal, Temporal, Frontal / Prefrontal Cortex / Houses EF’s / Neurons - receive and transmit info / Neurotransmitters / Chemicals that help neurons “talk” / Example: Dopamine / Cerebral Cortex / 4 lobes / Occipital, Parietal, Temporal, Frontal / Prefrontal Cortex / Houses EF’s

Structural Differences / Tannock (1998) reviewed structural imaging studies. / Children with ADHD show differences in: / prefrontal cortex / basal ganglia / corpus callosum

Functional Differences / Tannock (1998) reported that ERP studies show children with ADHD perform poorly in sustained and selective attention tasks compared to controls

Individual Variability and Careful Interpretation / Important to remember that all individuals have structural and functional differences / We must interpret findings with care / Important to remember that all individuals have structural and functional differences / We must interpret findings with care

Why? / We still want to know why children with ADHD exhibit the behaviors they do / Moderate Brain Arousal will help us understand behaviors so we don’t confuse them with the child’s intentions. / We still want to know why children with ADHD exhibit the behaviors they do / Moderate Brain Arousal will help us understand behaviors so we don’t confuse them with the child’s intentions.

Sikstrom and Soderlund (2007) Moderate Brain Arousal Theory / Children with ADHD have a dysfunctional dopamine system / What is dopamine? / Children with ADHD have a dysfunctional dopamine system / What is dopamine? Dopamine Video

Dopamine Levels ADHD v. “Normal” A. Tonic (ever present) dopamine is lower in children with ADHD B. Their phasic response (response to stimuli) is higher Sikstrom & Soderlund(2007)

Sikstrom and Soderlund (2007) Moderate Brain Arousal Theory / Low dopamine levels cause a higher dopamine release in response to external stimuli / This large boost in dopamine levels causes hypersensitivity to the environment / Secondary effects / The body becomes conditioned to seek out external stimuli because it’s highly rewarding / Low dopamine levels cause a higher dopamine release in response to external stimuli / This large boost in dopamine levels causes hypersensitivity to the environment / Secondary effects / The body becomes conditioned to seek out external stimuli because it’s highly rewarding

MBA Theory: Stochastic Resonance / “Noise” imported through the perceptual system can compensate for low levels of dopamine / Too much or too little noise can be detrimental! / “Noise” imported through the perceptual system can compensate for low levels of dopamine / Too much or too little noise can be detrimental!

External Stimuli / The Velcro and the gorilla are instances of children with ADHD seeking out external, novel stimuli to bring themselves to a normal arousal level

Listen to the Noise / Sikstrom, Soderlund, and Smart (2007) / Kids with ADHD performed better on a memory recall task with white noise / White noise was detrimental for controls doing the same task Soderlund, Sikstrom, & Smart (2007)

More Noise! / MBA can explain a 1996 study of auditory stimulation and arithmetic performance / Kids with ADHD did better listening to their favorite music! / Speech had no effect / MBA can explain a 1996 study of auditory stimulation and arithmetic performance / Kids with ADHD did better listening to their favorite music! / Speech had no effect

What strategies do not work? / Keeping MBA theory in mind… / Minimizing distractions? / Behavior contracts? / Keeping MBA theory in mind… / Minimizing distractions? / Behavior contracts?

What does work? / Appealing stimuli / Color differentiation / Salient visuals / Novel ways of starting lessons…any ideas? / Appealing stimuli / Color differentiation / Salient visuals / Novel ways of starting lessons…any ideas?

Counterintuitive Strategies / Strategic seating chart for lessons and independent work / Sitting Sean at the front of the rug never worked! / Music (as “white noise”) / “Blurting out answers” - stop to think about the context of the “blurting out” / Strategic seating chart for lessons and independent work / Sitting Sean at the front of the rug never worked! / Music (as “white noise”) / “Blurting out answers” - stop to think about the context of the “blurting out”

Classroom Reality / Make goals available in the environment / Break down independent work into clear steps / Teach strategies for self-help / Sketching out steps / Asking questions / Make goals available in the environment / Break down independent work into clear steps / Teach strategies for self-help / Sketching out steps / Asking questions

Variability / As teachers we are keen observers. / Notice what modality your student might be most attracted to. Sean liked tactile things / Notice their energy level and help them find strategies that work to keep them at a moderate arousal level / Make lessons the most “salient” thing in the environment! Notice what works. / As teachers we are keen observers. / Notice what modality your student might be most attracted to. Sean liked tactile things / Notice their energy level and help them find strategies that work to keep them at a moderate arousal level / Make lessons the most “salient” thing in the environment! Notice what works.

What is a good student? / How does MBA theory change our concept of “good” students? / Is ADHD a deficit or an example of variablity? / What role does the environment play? / How does MBA theory change our concept of “good” students? / Is ADHD a deficit or an example of variablity? / What role does the environment play?