Attention-Deficit Hyperactivity Disorder Catherine Jones-Hazledine 2/2/06

Symptoms (Must have 6 of these, present for 6 months, before age 7) Inattentive Type Fails to attend to details, makes careless mistakes Difficulty sustaining attention in play or work Does not listen when spoken to Does not follow through Difficulty organizing tasks Avoids tasks requiring sustained mental effort Loses things needed Distracted by extraneous stimuli Often forgetful Hyperactive-Impulsive Type Often fidgets hands/feet or squirms Often leaves seat when sitting is expected Runs about or climbs excessively Difficulty playing or engaging in leisure activities quietly Often “on the go” Talks excessively Blurts out answers before questions completed Difficulty awaiting turn Interrupts or intrudes on others

Things to Rule Out Depression/Anxiety Drug/Alcohol Use Academic Problems Physical Illness Home problems

Assessment Parent  Parent interview to obtain history  Standardized rating scales School  Academic testing, if applicable  School History  Standardized rating scales Clinic observations

Treatments Drug Therapy Behavioral Interventions Combined Approach

Medication Pros/Cons (thanks to Dr. Jodi Polaha) Can decrease disruption Increased on-task behavior Increased productivity Not effective for all kids Compliance issues Side-effects Only works when taken Does not impact some problem areas Some children should not take  Under 6  Anxious  Thought disorder  Tics or Tourettes

What Causes ADHD? (Russell Barkley, 2000) Bottom line: We don’t know yet… Possibilities  Deficiencies in neurochemicals  Lower electrical activity in the brain  Less blood flow to areas of the brain  Structural changes in the brain What it is NOT:  Bad parenting  Too much sugar  Too much t.v.

What It Isn’t What it Is (Barkley, 2000) What it isn’t Not a problem simply filtering information May not be an issue of simply being “more distractible” What it is Being easily bored with activities Being drawn to most rewarding parts Problem delaying gratification Problem controlling impulses

New Conceptualization Russell Barkley, Ph.D “ADHD is a delay in the development of behavioral inhibition” Impacts executive functioning, rather than processing Results in problems with persistence and motivation

Co-occurring Problems ODD Learning Disabilities Poor social relationships Family conflict Depression School resistance

Rules for Schools (Barkley, 2000) Keep instructions brief and clear  Visuals, charts, lists good Make commands effective Rewards and consequences delivered promptly Frequent feedback Rewards should be used first, more often Rewards must be more powerful Rewards should be changed frequently

Strategies for Learning (Barkley,2000) Be sure tasks are matched to academic ability Intersperse active with passive tasks Keep assignments brief  Assignments for child 30% younger Keep time-limits short  Timers can help Feedback immediately More academic am, more active pm  Concentration and inhibition decrease over day Classroom placement CAN make a difference  Decreases attention from other students  More opportunities to cue

Strategies for behavior Positives Strategic use of attention  Cues to remember can be helpful (e.g. coins in pocket) Tangible rewards Token programs  Can be used with entire class Consequences Ignoring  Must sometimes teach other students to do this, too Time-outs

Partnering with Parents Home-school note program  Provides frequent feedback on behaviors  Opportunities for teacher to reinforce throughout the day  Information can be easily conveyed to parents  Rewards/consequences can be delivered at home

References Barkley, R.A. (2000). Taking charge of ADHD. New York: Guilford Press. Polaha, J. (2004). An ADHD Primer: Diagnosis and Treatment for Educators. Presented at annual conference titled Addressing Issues Related to Mild Brain Injury and ADHD

Resources CHADD Corman, C., & Trevion, E. (1995). Eulcee the jumpy jumpy elephant. Plantation, FL: Specialty Press. Johnson, D. (1992). I can’t sit still: Educating and affirming inattentive and hyperactive chidren. Santa Cruz, CA: ETR Associates