DIFFERENTIATION: ATTENTION DEFICIT/HYPERACTIVITY DISORDER

What is AD/HD: Inattentive Type A disorder of age-inappropriate symptoms in:  Failure to give close attention to details/careless mistakes  Difficulty sustaining attention in tasks or play  Does not seem to listen when spoken to  Does not follow through on instructions (failure to complete  Difficulty organizing tasks and activities  Avoids, dislikes, or is reluctant to engage in tasks that require sustaining mental effort  Often loses things  Is often easily distracted by extraneous stimuli  Is forgetful in daily activities

What is AD/HD: Hyperactive-Impulsive Type Hyperactivity:  Often fidgets or squirms in seat  Often leaves seat in classroom  Often runs or climbs excessively  Often has difficulty playing or engaging in leisure activities quietly  Is often “on the go” or acts as if driven by a motor  Often talks excessively Impulsivity  Blurts out answers  Difficulty waiting turns  Often interrupts or intrudes on others

What is AD/HD: Prevalence  7-8% of children  4-5% of adults  3:1 males to female  More common in population dense areas  No evidence of ethnic differences

Co-occurring Disorders  Oppositional Defiant Disorder – 55%  Conduct Disorder – 45%  Major Depression – 25-35%  Anxiety Disorders – 20-35%  Also 97% of Bipolar Disorders have AD/HD as well

Other Risks  Language Disorders (Expressive 10-54%, Pragmatic Deficits in 60%)  7-10% IQ deficit  Poor school performance in 90%+

What Causes AD/HD?  Disorder arises from multiple causes  All of which fall with in the realm of biology (neurology and genetics)  Pathway for the disorder falls within a brain structure called the fronto-striatal-cerebellar circuits.  Social theories of causes for AD/HD lack research/empirical basis.

Deficit in Executive Functioning The Brain’s GPS  Maps  Traffic Updates  Directions  Detours/Rerouting  Directories  Bluetooth/Hands Free  Clock  Calculator

Executive Functioning  Those self-directed actions of the individual that are being used to self-regulate.  This may include one’s ability to plan, set goals, organize, problem-solving, implement a plan, maintain attention, regulate emotion and inhibit undesirable responses.

Executive Functioning and the Brain Executive Functioning Memory, Language, Hearing Integration of Sensory Information Visual Perception Voluntary Movement, Balance

Empirically Proven Treatments  Parent Education about ADHD  Parent Education in Behavior Management  Family Therapy for Teens: Problem-solving and communication training  Psychopharmacology – Stimulants (Ritalin, Adderall, Focalin, Concerta, etc)  Noardrenergic Medication (Wellbutrin)  Antihypertensives (.e.g., Catapres, Tenex)  Tricyclic Anti-depressants

Unproved/Disproved Therapies  Elimination Diets  Megavitamins  Sensory Integration  Chiropractic Interventions  Play Therapy  Biofeedback  Self-control therapies

Classroom Considerations/Strategies  Do not retain in grade  Use September to establish behavioral control  Decrease total workload/chunk assignments  Seat close to teaching area  Target productivity first, accuracy later  Don’t send home unfinished classwork  Give weekly homework assignments  Allow some fidgeting/restlessness  Give movement breaks  Use participatory teaching methods  Use interactive technology

Classroom Considerations/Strategies cont’d  Post homework at the start of class  Intersperse low appeal activities with high appeal activities  Schedule most difficult subjects in a.m. when possible  Use direct instruction, programmed learning, or highly structured teaching materials  Create work goals in the beginning of class  Increase praise, approval, and appreciation (be a minute to minute manager)  Use team based rewards  Allow access to rewards daily or more often  Use token or point system with rewards and consequences

Externalize the Rules  Plan for all transitions  Post rules on posters for each period  Have child read and restate rules at the start of each activity.  Use timers, watches, taped time signals

Punishment  Use mild, private, direct, personal, and immediate reprimands  Establish chill out location in the classroom for child to regain control.  Use a “Do-A-Task” procedure. The child has a desk in the back of the classroom with a binder of worksheet. The teacher states the rule that was broken and and a number, and that is the number of worksheet that the student is required to complete.  Hallway timeouts do not work.