Learners with Attention Deficit Hyperactivity Disorder Chapter 7 Learners with Attention Deficit Hyperactivity Disorder

History Discovered mid-nineteenth century Dr. George F. Still, credited as being one of the first authorities to being ADHD to attention Behavioral inhibition is still one of the components of ADHD that is still discussed today

History Still’s cases similar to today’s population Children had mild brain pathology Some had normal intelligence More prevalent in males than females Some basis as hereditary condition Some had comorbid disorders such as depression Many of his cases would still be labeled with ADHD or ADHD with conduct disorder

History Goldstein’s Brain-Injured Soldiers of WWI Noticed symptoms such as Disorganized behavior Hyperactivity Perseveration Forced responsiveness to stimuli Lack of ability to focus on figure, instead attention was paid to ground Laid the work for Strauss and Werner in 1930s-40s Strauss Syndrome Figure background task

History William Cruickshank Children with CP more likely to respond to background than figure in figure/background task All children had normal intelligence Brought to light that distractibility and hyperactivity could occur in “normal” children First to establish educational program for children with ADHD

Progression of Terms 1950’s-1960’s-Minimal brain injury 1960’s-1970’s-Hyperactive child syndrome 1980’s-ADHD

Definition American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) Fourth edition (DSM-IV) ADHD, Predominantly Inattentive Type ADHD, Predominantly Hyperactivity Type ADHD, Combined Type Criteria on p. 229

Prevalence Most frequent reason children are referred for behavior problems 3-7% of school-age population Hard to have accurate percentage since ADHD is served under “other health impaired” (OHI) 3:1 males to females Males have hyperactivity or impulsive type Females have inattentive type

Identification of ADHD 4 main components Medical examination Clinical interview Teacher and parent rating scales Conners Rating Scales-Revised ADHD Rating Scale-IV Behavioral observations Continuous performance test (CPT) stimuli presented one at a time on a screen rapidly, with child pressing button when a particular stimulus is shown

Causes Strong evidence of neurological abnormalities Prefrontal lobes & Frontal Lobes Executive functions Basal ganglia (caudate & globus pallidus) & Cerebellum Coordination & control of motor behavior Corpus callosum Communication between hemispheres The size of these areas is smaller Suggested reduced metabolic activity in the frontal lobes and basal ganglia

Hereditary Factors Family studies indicate 32% chance if sibling has ADHD 57% chance if parent has ADHD 2-8 more times likely if parent has ADHD than a parent that does not In identical twins, increased chance versus fraternal twins No single gene cause of ADHD Possible link to gene that regulates dopamine

Medical Factors Not as strong a link as heredity Exposure to lead Alcohol abuse during pregnancy Tobacco use during pregnancy Low birthweight Complications at birth

Barkley’s Model of ADHD Behavioral inhibition is the critical element leads to problems with executive functioning time awareness and management Disrupts person’s ability to persist in goal-directed behavior Problem’s with wait for turn Refraining from interrupting conversations Inability to resist distractions Inability to delay immediate gratification In the classroom, problems with transitions/switching tasks

Executive Functions Ability to regulate one’s behavior Children with ADHD have problems with Working memory Forgetfulness, lack of hindsight, time management Delayed inner speech Following rules or instructions Controlling emotions and arousal levels Overreact to negative/positive experiences Quick to show anger/frustration Analyzing problems and communicating solutions to others Responds impulsivity to the first solution that comes to mind

Other Areas of Deficits Adaptive skills Usually discussed when talking about intellectual disabilities New research shows children with ADHD have difficulties with these skills Socializing with peers More often rejected by peers Fewer close friends Disliked by students who enjoy high social status Research indicates this could be a defining characteristic of ADHD Difficult to overcome and is long lasting Can lead to social isolation

Comorbid Conditions Learning disabilities Overlap of 10-25 percent Suggest strongest link ADHD, predominately inattentive type Emotional or behavioral disorders 25-50% exhibit some form of EBD 25-35% anxiety is present Substance abuse Adolescents are more likely to experiment Twice as likely to abuse alcohol or drugs

Educational Considerations Classroom Structure Reduce irrelevant stimuli/distractions Teacher Direction Clear breakdown of instructional day Functional Behavior Assessment Identifies ABC-antecedent, behavior, consequence Contingency-based self management Students keep track of own behavior, then receive consequences

Introducing Lessons Provide an advance organizer Review previous lessons Set learning expectations State needed materials Explain additional resources Simplify instructions, choices and scheduling

Conducting Lessons Be predictable Support the student’s participation in class Check student performance Perform ongoing student evaluation Follow-up directions Written oral Divide work into smaller units Eliminate or reduce frequency of timed tests

Concluding Lessons Provide advance warnings Check assignments Can use overhead timer Visual timer Check assignments Preview the next lesson Remember break the work into smaller chunks helps the children focus and limit distractions

Medical Considerations Controversial topic Psychostimulants Stimulate or activate neurological functioning Ritalin Takes about one hour to take effect Optimal effect in 2 hours Wears off in 4 hours Adderall Stratera-non stimulant

What Research Says Ritalin has positive effects in helping students have more normalized behavioral inhibition and executive functioning Leads to increased results on parent-teacher rating scales and academic achievement Increased classroom behaviors Better at taking notes On-task behavior Quiz scores Homework completion Written-langauge work

What the Research Says Not effective for everyone Around 30% do not have favorable response Side effects Insomnia, reduced appetite, abdominal pain, headaches, and irritability Some reports can cause tics or increase tics that children already have Can have rebound effect Some studies suggest taking Ritalin can decrease adolescent use of drugs

Monitoring Progress Curriculum-based measurement (CBM) Attention & Behavior Momentary time sampling Allows the teacher to conduct brief observations and collect data on a specific set of behaviors Observer determines length of observation & divides it into intervals At beginning of interval, observer notes whether the student is exhibiting the target behavior & then waits until the beginning of the next interval to document behavior

Testing Accommodations Small-group or individual administration in a quiet location Extended time Frequent breaks Presentation format Response format

Early Intervention Diagnosis is difficult at an early age Most commonly will see a great deal of motor activity and a lack of impulse control Stronger use of contingencies such as praise, points, and tangible rewards Intensive, structured methods of applying behavioral management can be successful in improving behavior and pre-academic skills Symptoms such as strong aggression can not remediate completely the symptoms of ADHD, will need long-term programming

Transition into Adulthood 2/3 of children with ADHD will continue to have significant symptoms in adulthood 4-5%, similar to the rate in children Person’s history is important in determining adult ADHD Some adults also exhibit antisocial, anxiety, and depression disorders, including employment Comorbid conditions lead to poorer outcomes compared to those who do not have them

Transition into Adulthood Employment difficulties Getting along with others Being bored Being disciplined by supervisors Solution is for the person to choose a job/career that maximizes individual’s strengths Coaching-identifying someone whom the person with ADHD can rely on for support