1. Students with Attention Deficit- Hyperactivity Disorder
Chapter 6
Students with Attention Deficit- Hyperactivity Disorder
Copyright © Allyn & Bacon 2008

2. Definition of ADHD
A pervasive pattern of inattention, impulsivity, and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development. (American Psychological Association, 2013)

7. Caucasian children more likely to receive medication for ADHD
Prevalence
2-3 times as many boys identified as girls
No difference in frequency among races
Caucasian children more likely to receive medication for ADHD

10. Production deficits, not acquisition deficits
Key elements of ADHD
Neurological
Developmental
Chronic
Not situational
Production deficits, not acquisition deficits

11. Maternal prenatal smoking and alcohol consumption
Causes of ADHD
Physiological causes
Heredity
Brain differences
Environmental Causes
Maternal prenatal smoking and alcohol consumption

12. Causation
“Copyright© Allyn & Bacon 2006”

13. The striatum receives input from the frontal cortex and is responsible for the regulation of behavior. It consists of the caudate (top), putamen (lower right), and globus pallidus (lower left). Development of the striatum is often delayed in children with ADHD.
Courtesy L. Hanford and G. Hall.

15. Behavioral Disinhibition Inattention, Hyperactivity & Impulsivity
Working
Memory
Creative
Problem Solving
Emotion
Regulation
Internalized
Speech
ADHD:
Inattention, Hyperactivity & Impulsivity
Barkley’s neurodevelopmental model for ADHD. Early problems with behavioral inhibition can adversely affect the development of the four executive functions. Executive functioning deficits underlie symptoms of ADHD.

16. Cognitive Characteristics
Problems with Executive Functioning
Issues with ability to control impulses
Working memory is not efficient
Self-directed speech not utilized effectively
Difficulty controlling emotions or motivation
Reconstitution – the ability to break down what is observed and to combine parts to carry out new actions

17. Academic Characteristics
Some students are very successful academically
Other students consistently achieve below their potential
Academic self-concept is important

18. Social/Emotional Characteristics
Self-esteem is a problem for some, but not all, students with ADHD
Students often have problems coping with social functioning
Developing and maintaining friendships
Rejection by peers

20. Behavior Characteristics
Failure to attend to details
Make careless mistakes in work
Failure to complete schoolwork
Failure to listen when spoken to directly
Difficulty organizing tasks and materials
Avoidance of tasks that require sustained mental effort

21. Comorbidity with Other Disorders
ADHD may occur simultaneously with other disorders such as:
Learning disabilities
Tourette’s syndrome
Emotional disabilities
Autism
Traumatic brain injury
Psychiatric disorders
Sleep disorders
Substance abuse problems

22. Initial Referral for Eligibility
Medical Diagnosis
Pediatrician, family physician, psychiatrist
Diagnosis may occur before child enters school
Educational referrals may come from
Child’s classroom teacher
Special education teacher

23. Assessments May Include:
Medical assessment
Continuous performance tests
DISC IV (Diagnostic Interview Schedule for Children)
Parent rating scales and checklists
Teacher rating scales and checklists
Samples of student’s work
Anecdotal information

25. Gifted or ADHD? ADHD Gifted Students Behavior Poor sustained attention
Inability to regulate behavior
Question rules and create their own
Problems with Rules
Primary characteristic of ADHD
Good judgment lags behind intellectual development
Impulsivity
Difficulty in most situations
Only in specific situations, e.g., when bored
Poor sustained attention
ADHD
Gifted Students
Behavior

26. Eligibility for IDEA Services
Does the ADHD “adversely affect” the student’s educational performance? Not all students with ADHD are eligible Students who are not eligible for IDEA may qualify for accommodations under Section 504 Students may be eligible because they also have a learning or emotional disability

27. Early Childhood Education
Diagnosis at an early age is difficult.
If children’s symptoms of ADHD are severe, early intervention is crucial.
Children may need a highly structured environment, immediate and consistent feedback, and age- appropriate rewards.

28. Elementary and Secondary School Services
Many students receive their education in general education classrooms.
Professionals must collaborate with parents to find effective techniques for students with ADHD.

29. Transition and Adulthood
66% of students with ADHD continue to have the disorder into adulthood
Many adults with ADHD are disorganized, impulsive, and have poor work skills
Students need to have a clear understanding of their disorder and learn to advocate for themselves

30. Medication is the Most Clearly Effective Intervention
The use of medication is controversial. The decision to prescribe medication only indirectly involves school personnel. Medication is helpful for many (70-80%) students for whom it is prescribed. Medication alone is not sufficient to improve academic performance

31. Psychostimulants
Ritalin Concerta Focalin Adderall Strattera

33. Stimulant medication is efficacious at reducing ADHD symptoms
Stimulant medication is efficacious at reducing ADHD symptoms. Based on Biederman, Lopez et al. (2002).

34. Summer Treatment Program for youth with ADHD
Summer Treatment Program for youth with ADHD. Chronis and colleagues (2004) used direct contingency management during treatment phases 1 and 2, but withdrew contingencies in between treatment phases. Children’s noncompliance increased during treatment withdrawal, indicating that treatment was efficacious.

35. Best Educational Practices
Parent and professional education
Environmental supports for students
Behavior interventions
Rewards
Token economy systems
Structure
Quick Pace
Variety

36. Should we combine medication and behavior therapy
Should we combine medication and behavior therapy? Results of one large study indicated that combining medication with Multimodal Psychosocial Treatment (MPT) or Attention Control Treatment (ACT) did not lead to better improvement than using medication alone. Based on Abikoff et al (2004).

37. The MTA Study. Combining medication with behavior therapy, or using medication alone, is superior to behavior therapy alone to treat ADHD. Based on Swanson and colleagues (2001).

40. Supporting Parents of Children with ADHD
Have realistic expectations of parents
Encourage parents to be good role models
Help parents have realistic expectations