Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 1 Chapter 6 Attention-Deficit/Hyperactivity Disorder Introduction to Special Education: Making a Difference Seventh Edition

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 2 Chapter Objectives Recognize the characteristics of students with ADHD Understand the relationship of ADHD to other, coexisting disabilities Understand medical treatment of ADHD Identify specific accommodations and classroom interventions used with students with ADHD Discuss the importance of collaborating and developing partnerships with families and with other professionals

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 3 Historical Context 1840s: Dr. Heinrich Hoffmann published a children’s book about the pitfalls of improper behavior featuring the character Fidgety Philip. 1902: George Still was first to document the characteristics of ADHD. 1919: Kurt Goldstein identified behaviors in soldiers with TBI that were similar to those found in children with ADHD. 1937: Alfred Strauss and Heinz Werner noted that children with ADHD never developed strong skills in reading, writing and speaking; this condition was called Strauss Syndrome. 1997: In this reauthorization of IDEA, the federal government recognized ADHD.

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 4 History of the Field (continued) Newell Kephart used repeated motor activities to minimize these behaviors. Laura Lehtinen devised highly-structured teaching routines for children with brain injuries. William Cruikshank was one of the first to develop educational programs for children with behaviors similar to ADHD. Barbara Keogh noted a possible biological basis in children with hyperactivity.

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 5 Thinking About Dilemmas to Solve Think about: How the characteristics of ADHD impact adults with these behavioral characteristics.

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 6 Attention-Deficit/Hyperactivity Disorder Defined ADHD is classified under “other health impairments” under IDEA ’04. The American Psychiatric Association (APA) defines ADHD as a persistent pattern of frequent and severe inattention and/or hyperactivity- impulsivity. These behaviors occur in more than one setting. These behaviors significantly impair social, academic, or occupational functioning.

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 7 Attention-Deficit/Hyperactivity Disorder Defined Students with ADHD may not qualify for special education services if the behaviors associated with it do not interfere with academic performance. Section 504 of the Rehabilitation Act provides students with the right to receive accommodations within the general education environment for testing and to complete assignments. To qualify for special education services, students must “experience heightened alertness to environmental stimuli, which results in limited alertness to their educational environment,” which in turn adversely affects educational performance (U.S. Department of Education, 2006).

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 8 Comorbidity of ADHD Comorbidity of ADHD with Learning Disabilities: Approximately one-third of all students with ADHD also have a learning disability. Students with ADHD tend to score lower on standardized achievement tests than students without disabilities. Comorbidity of ADHD with Emotional or Behavioral Disorders: One study shows approximately 58% of students with ADHD were also classified as EBD. Boys have higher referral rates due to their exhibiting more aggressive behaviors.

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 9 Characteristics Inattention Inability to focus on details of tasks Difficulty following directions Difficulty in changing tasks Organizational problems Carelessness, distractibility, and forgetfulness Hyperactivity These behaviors are subjective, ranging from “energetic” to “squirmy.”

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 10 Characteristics (continued) Impulsivity Inability to pinpoint relevant information in questions or problems Blurting out answers without careful consideration Interrupting other conversations, leading to a decrease in social acceptance Academic Performance Difficulty studying Disorganization Forgetfulness

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 11 Characteristics (continued) Social Behavior Hyperactivity and poor social behaviors that cause these students to have few friends (rejection that may result in social withdrawal and isolation) Positive Characteristics Intuitiveness Emotional awareness Creativity Exuberance

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 12 Prevalence General consensus is that between 3% and 7% of all schoolchildren have ADHD. Boys are identified at significantly higher rates. Girls are under-identified. Lack of awareness of how girls’ behavior differs from that of boys Rates of ADHD identification in U.S. are no greater than those in many other countries. Japan (7%) Germany (18%) Australia (2%) Culture is an important factor when interpreting student behavior.

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 13 Causes and Prevention Causes Unknown Possibly brain injury, genetic contributions Risk factors (prenatal drug and alcohol use) Biological predisposition Growing consensus for neurological basis Research focus is on executive functioning of the brain Clear evidence of physiological differences between people with and without ADHD

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 14 Causes and Prevention Prevention More must be learned about the causes of ADHD before preventive measures can be devised

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 15 Overcoming Challenges Many students require more than just behavioral and instructional interventions. Medication can provide students with additional help to focus on academic instruction. “Just as some students need glasses to see better, some students need medication to help them pay better attention and control their behavior.” (AAP, 2005)

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 16 Assessment and Identification Diagnostic interviews Medical examinations Behavior-rating scales Standardized tests Observations

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 17 Early Identification It is difficult to differentiate between preschoolers with ADHD and typically-active preschoolers. However, governmental regulations require the behavioral characteristics of ADHD to be demonstrated before the age of seven to qualify for special education.

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 18 Pre-Referral and Identification Pre-Referral Teachers should focus on preventing behavior problems. The physical and instructional environment and structure of classrooms should be assessed. Classroom routines are critical. Consistent rules, procedures, and consequences are needed. Identification Multi-dimensional evaluations Diagnostic interviews Medical examinations Behavior rating scales Standardized tests Observations

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 19 Evaluation: Testing Accommodations The most common testing accommodation is extended time. Although research shows that extended time does not improve performance, students have reported feeling more positive about the testing situation. Testing in an alternate setting Fewer distractions Less comparing to peers, relief of testing anxiety

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 20 Early Intervention Medical intervention Parent behavior training Classroom intervention Positive reinforcement Daily rewards Response cost

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 21 Teaching Students with ADHD Access to general education curriculum It is important to identify each student’s specific challenges and develop strategies to address these areas of need in order for students to benefit. Instructional Accommodations Desk placement in quiet, distraction-free area Preferential seating near teacher Visual cues to prompt appropriate behavior Immediate feedback is critical!

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 22 Teaching Students with ADHD Validated Practices Functional Behavior Analysis (FBA): useful in determining why students engage in specific behaviors Highly-structured learning environment Direct instruction Peer tutoring Self-regulation strategies Self-monitoring Self-instructions Self-reinforcement Goal setting Graphic organizers

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 23 Technology Students with ADHD do not rely on technology; however, instructional technology, like computers and special processing software that help organize thoughts and assist in problem-solving, is often helpful to these students.

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 24 Transition Through Adulthood Most people with ADHD do not “grow out of it,” and they may require support to continue academically. Important components of an effective college program for students with ADHD include: Individualized Academic Support Plan (similar to IEP). Frequent communication with academic specialists. A center that provides help in study skills. Self advocacy. Assistance to students with managing stress. Career development activities.

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 25 Collaboration With Related Service Providers (Nurse) Frequently involved with dispensing medication Serves as liaison between parent, school, and medical office

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 26 Collaborative Practices Information Sharing The teacher is often the one who spends the most time with the student during the school day. It is critical to collaborate and share information with the school nurse and other members of the IEP team regarding the student’s behavior and performance in class.

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 27 Partnerships with Families and Communities Information can empower parents. Teachers can assist parents in finding resources, support groups, and accurate information. Teachers can assist families with the implementation of successful strategies. Home schedules, organization, rewards

Introduction to Special Education: Making a Difference, 7th ed., ISBN Deborah Deutsch Smith © 2010 Pearson Education, Inc. All rights reserved. 28 Why is it important for teachers to be aware of the characteristics of ADHD? What are some examples of how the learning environment can be modified to help these students succeed? Challenge Questions