ADHD Bridget Connolly

ADHD- Diagnosis-Criteria-Symptoms Attention Deficit Hyperactivity Disorder is a neurobehavioral disorder characterized by pervasive inattention and/or hyperactivity-impulsivity and resulting in significant functional impairment. Predominately Inattentive Hyperactive-Impulsive Combined Type  This is a picture of a comparing the brain of an ADHD child and a non-ADHD child (PET scan)

Diagnostic Criteria of ADHD 6 symptoms of inattention and/or 6 symptoms of hyperactive-impulsive behavior (high frequency) At least 6-month duration of symptoms Onset of symptoms before age 7 Symptoms occur across two or more settings Symptoms have a significant negative impact on social, academic, or occupational functioning Another psychiatric disorder (e.g. autism, mood disorder, anxiety disorder, psychotic disorder) is not the primary cause of symptoms DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition)

Common Symptoms for ADHD- Predominately Inattentive Avoids tasks that require sustained attention Daydreams (tends to stare into space) Delays initiation or completion of tasks Has difficulty listening to or following instructions Does not pay close attention to details Displays inconsistent academic performance Forgets or loses materials Demonstrates a slow speed of cognitive processing (

Common Symptoms for ADHD- Hyperactive-Impulsive Acts before thinking Begins work before directions are given Has difficulty delaying gratification Makes careless mistakes in schoolwork Does not wait turn in games or activities Engages in risk-taking/dangerous behavior Grabs things from others Interrupts or intrudes on others Blurts out comments in class Runs or climbs excessively Has difficulty remaining seated Fidgets with nearby objects Taps pencil, feet, or fingers Shifts position in seat frequently Talks excessively Experiences rapid changes in mood Overreacts to negative situations (

Prevalence Estimates ADHD-Predominately Inattentive Type - 1.3% of school-aged children are diagnosed - ratio for boys to girls = 1:1 ADHD- Hyperactive-Impulsive Type - most children identified are of preschool age ADHD- Combined Type - ~4% of school-aged children are diagnosed - ratio for boys to girls = 3:1 ( )

Associated Problems ~80% have achievement problems ~20–40% are diagnosed with learning disabilities (more common with ADHD- Inattentive) ~40% exhibit oppositional behavior in childhood (more common with ADHD- Combined) ~65% exhibit oppositional behavior as adolescents (more common with ADHD- Combined) ~25% engage in antisocial behavior (truancy, physical aggression, stealing- most often ADHD- Combined) ~50% have impaired social relationships ~25% experience co-morbid emotional disorders (

ADHD in Schools As an adolescent, a student may display any of the following characteristics: - Displays poor organizational skills - Underachieves academically - Exhibits impulsive or risk-taking behavior - Engages in temper outbursts - Sometimes experiences legal difficulties

School-Based Assessment of ADHD Symptoms PURPOSE To gather information for a potential medical diagnosis To determine the extent to which attentional problems are interfering with a child’s academic, affective, and social needs To perform a functional analysis of target behaviors for intervention

Assessment Methods Parent and teacher interviews Information should be obtained from multiple adults Standardized behavior rating scales Provides a normative perspective to assist in determining symptom severity Direct observation Systematic on-task observation and assessment of environmental and instructional variables

ADHD Treatment -Ineffective Interventions Herbal supplements/vitamins Biofeedback-although there is growing research regarding its effectiveness with ADHD, depression and anxiety Elimination diet (unless there is a sensitivity to food) Caffeine (may work in short run, but in long run decreases blood flow to brain) (

ADHD Treatment -Effective Interventions Comprehensive Treatment Approach Education/Parent Support Groups Medication Behavior Management at Home & School Counseling--Individual & Family Social Skills Training School and Home Support Strategies Physical Activity (

ADHD Medications Effective for 70-90% ( Stimulants RitalinDexedrineAdderallConcertaCylert

Stimulant Side Effects Decreased appetite Weight loss Growth inhibition Insomnia/sleep disturbance Irritability/weepiness Abdominal pain Headaches Dizziness/drowsiness Tics ( )

ADHD: Treatment in Schools Behavior Management Clear, simple rules & consequences Consistency Eliminate emotion, talking/arguing Giving directions--get attention, be firm, have repeat back to you, give time limits Visual reminders Break down assignments and homework Keep on task with timer, stop-watch

Behavior Management, cont. Encouraging Good Behavior Immediate Feedback, Frequent Rewards/Incentives & Praise Frequent Change in Reward (Mystery Motivator) Immediate Consequences for Selected Behavior (time-out, loss of privilege or points)- make them predictable Positive Rewards Before Consequences Priorities--Choose Battles Don’t Personalize Problems Provide clear expectations for appropriate behavior  Post classroom rules  Use behavior contracts as needed Provide specific and frequent verbal feedback  Name the specific behavior that was performed well or should be performed Use if/then statements  If you continue to …, then… Provide brief, matter-of-fact redirections

Suggested Classroom Modifications Provide preferential seating Give only one or two-step directions at a time Break assignments down in to smaller segments Use a timer to monitor/ improve timely work completion Vary instructional style and incorporate opportunities for active participation Minimize visual distractions Ensure a correct match between the difficulty level of the curriculum and the student’s abilities Establish non-verbal communication

Parents & Teachers Working Together Communication Weekly or daily progress reports Assignment notebooks signed by both Phone calls/ Checklists Homework support Regular time Quiet place Break down assignments/Set timer Breaks--physical activity Materials available Monitor closely & reward good homework behavior Check assignment books regularly (

ADHD and 504 ADHD and IDEA  Consider a 504 plan for the student who has a medical diagnosis of ADHD and: Needs regular, ongoing general ed modifications or Needs regular positive behavioral support or Takes medication at school  Can a student with ADHD have an IEP? OHI Category Significant impact on classroom performance Consider if:  Student demonstrates competency on criterion tests, but has failing grades  Student does not have a diagnosable processing disorder at the root of failure  Ongoing general ed modifications are not providing enough support for successful access to the curriculum

Behavior Intervention Plans Describe the target behavior and its severity Describe the function of the target behavior Clearly describe the desired positive behavior Identify how the environment can be changed to decrease negative behavior Identify reinforcers to maintain positive behavior Describe the method for monitoring the behavior plan and who will be responsible

Resources ADDA (Attention Deficit Disorder Association) ADHD News – Drug Side Effects Behavioural Neurotherapy Clinic Center for Disease Control (Attention Deficit-Hyperactivity Disorder) CHADD (Children and Adults with Attention Deficit Disorder) LIDA (Learning Disabilities Association) National Resource Center on ADHD