1. Attention Deficit Hyperactivity Disorder: What Educators Need To Know

2. Hyperactivity-Impulsivity
What is ADHD?
The American Psychiatric Association in the DSM-IV (1994) defines three main types of Attention Deficit Hyperactivity Disorder. Individuals can have predominately inattentive ADHD, predominately hyperactive-impulsive ADHD, or combined type depending on the presenting symptoms
Inattention
Hyperactivity-Impulsivity
Fails to give close attention to details
Difficulty sustaining attention in tasks
Does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
Often has difficulty organizing tasks and activities
Often loses things necessary for tasks or activities
Is often easily distracted
Often forgetful in daily activities
Hyperactivity
-often fidgets with hands or feet or squirms in seat
-often leaves seat in classroom or in other situations in which remaining seated is expected
-often runs about or climbs excessively
-often has difficulty playing or engaging in leisure activities
-often is “on the go” or as if “driven by a motor”
-talks excessively
Impulsivity
-often blurts out answers before questions are completed
-has difficulty awaiting turn
-interrupts or intrudes on others

3. Diagnostic Criteria
A: Six or more of the previously noted symptoms persisting for 6 months or longer qualifies for a diagnosis of ADHD in either the inattentive category or hyperactivity-impulsive category. If both inattentive and hyperactive-impulsive symptoms are present then a combined type diagnosis is given.
B: One of the symptoms needs to have been present before the age of 7.
C: Some impairment from the symptoms is present in two or more settings, such as school or home.
D: There must be clear and significant evidence of a social, academic, or occupational impairment.
E: The symptoms are not better accounted for by another mental disorder.

4. What Educators Need to Remember:
According to Schuck & Crinella (2005), “the most worrisome deficits of children with ADHD are not the product of low IQ, but rather of instability of control processes that govern everyday applications to the environment” (p. 275).
The ADHD student is not dumb, lazy, or out of control. They are smart kids who need our help to gain the proper strategies to be successful!

5. What Can An Educator Do If Some Symptoms Appear To Be Present?
Maintain behavior logs citing observations of behaviors and situations. Remember to include inventions used and their efficiency.
Inform parents of behavioral concerns and discuss behaviors at home.
Request child study or equivalent meeting with parents, special education teachers, school psychologist, etc. to discuss classroom behaviors. This can lead to diagnosis from a doctor and then an IEP for the student.
If needed, rating scales may be given to teachers and parents.
Remember: Diagnosis and identification of ADHD needs to come by a medical evaluation from a family doctor, psychologist, or psychiatrist outside of the school system! Your job is to observe the child and find interventions that work to make that child successful!

6. What Rating Scales Are Used Most?
The most common rating scale used is Conners Teachers Rating Scale which will ask you to rate the behaviors and form statements about the behavior (Vaughn, Bos, & Schumm, 2006).
Similar forms may include the ADHD Rating Scale or the Behavior Rating Form based on DSM IV symptoms (Vaughn, Bos, & Schumm, 2006).
It is important to know how often the behavior occurs when completing these forms!

7. What Causes ADHD?
According to Barkley’s there is significant evidence that ADHD occurrences are due to biological factors.
Other factors, as stated on the previous website, may include: difficulties during pregnancy, prenatal exposure to alcohol or tobacco, low birth weight, high lead levels, and prenatal injury to the prefrontal lobe of the brain.
A recent study published in Pediatrics by scientists at Texas Tech. University shows that there is no link between ADHD and television. This is however still heavily controversial

8. Causes continued. . .
New research suggests that ADHD is present with dysfunctions in the prefrontal lobes of the brain. Prefrontal lobes control executive functions which children with ADHD are lacking (Dawson & Guare, 2004). These dysfunctions being studied include size differences in prefrontal regions, basal ganglia, and cerebellum. This can lead to abnormal activation patterns in the brain (Barkley, 2003).
Other research still not concluded at this time states that ADHD children have abnormal dopamine and norepinephrine levels in the brain (Barkley, 2003).
Another neurological cause is related to lower glucose levels affecting neurotransmitter activity in parts of the brain (ADDA, ).

9. What Are Executive Functions?
An executive function is “a neuropsychological concept referring to the cognitive processes required to plan and direct activities, including task initiation and follow through, working memory, sustained attention, performance monitoring, inhibition of impulses, and goal-directed persistence.” (Dawson & Guare, 2004, p. vii)

10. Why Are Executive Functions Important?
These skills allow us to “organize our behavior over time and override immediate demands in favor of longer-term goals” (Dawson & Guare, 2004, p. 1).
They also allow for the management of emotions and effective thought monitoring.
Children with problems in a particular executive function area have a deficit in that skill area.

11. Deficit: Response Inhibition
This is “the capacity to think before you act” (Dawson & Guare, p. 47).
Children with this deficit tend to be impulsive. They will say things without thinking about what it is that they are saying.

12. Deficit: Working Memory
This is “the ability to hold information mind while performing complex tasks” (Dawson & Guare, p. 49).
Students with this deficit tend to forget easily. They may forget their homework or books at school on a regular basis.

13. Deficit: Self-Regulation Of Affect
This is “the ability to manage emotions in order to achieve goals, accomplish tasks, or control and direct behavior” (Dawson & Guare, p. 50).
These students tend to become upset quickly with situations, unable to control their emotions. These students tend to have outbursts that disrupt daily functioning.

14. Deficit: Sustained Attention
This is “the capacity to maintain attention to a situation or task in spite of distractibility, fatigue, or boredom” (Dawson & Guare, p. 52).
Students with this deficit tend to have a hard time getting started on a task. These students will get up often when a task is given. They talk to other students when they shouldn’t. Their attention is on everything in the room other than their work.

15. Deficit: Task Initiation
This is “the ability to begin a task without undue procrastination, in a timely fashion” (Dawson & Guare, p. 54).
These students tend to put off doing work that they need to complete. They lack the processes to start the task.

16. Deficit: Planning
This is “the ability to create a roadmap to reach a goal or to complete a task. It also involves being able to make decisions about what’s important to focus on and what’s not important” (Dawson & Guare, p. 55).
These students tend to wait till the last minute to complete tasks and then not know what to do when they go to complete them.

17. Deficit: Organization
This is “the ability to arrange or place things according to a system” (Dawson & Guare, p. 58).
These students tend to have messy desks or cubbies. They lose papers often and frequently shove papers instead of placing them in appropriate spots.

18. Deficit: Time Management
This is “the capacity to estimate, allocate, and execute within time constraints” (Dawson & Guare, p. 60).
These children get work done at the last minute and frequently ask for assignment extensions. Also, they often use excuses for not having work.

19. Deficits: Goal-Directed Persistence
This is “the capacity to have a goal, follow through to the completion of the goal, and not be put off by or distracted by competing interests” (Dawson & Guare, p. 62).
These students are able to create goals for themselves but are not able to achieve them. They are not able to understand the necessary steps to reach a goal and often become distracted with outside stimuli negatively impacting their task completion.

20. Deficit: Flexibility
This is “the ability to revise plans in the face of obstacles, setbacks, new information, or mistakes” (Dawson & Guare, p. 63).
These students have difficulty in transitions and new situations. These students struggle longer than others at the beginning of each year. They also are thrown off by changes in daily schedules. These students have limited problem solving strategies.

21. Deficit: Metacognition
This is “the ability to stand back and take a bird’s-eye view of oneself in a situation. It is an ability to observe how you problem solve. It also includes self-monitoring and self-evaluative skills” (Dawson & Guare, p. 65).
These students make careless mistakes frequently. They also will complete one step then stop instead of finishing the series of steps. For example, these students may add instead of subtract over and over again while failing to review their work and realizing their mistake. Also, these students will do one step of long division and then stop, not reflecting on the whole process needed to complete the task.

22. What Are The Intervention Areas?
Educational Accommodations
Executive Functioning Deficits
Classroom Interventions
Promoting Appropriate Behavior
Medication Options
Stimulant Medication
Medication and Side Effects

23. Response Inhibition
Reduce situations where the child can get into trouble
Proximity Control: Increase supervision of the child
Control impulses by modeling appropriate behavior
To teach the skill:
Explain the skill and behaviors
Model behaviors
Discussion situations to use the skill
Reinforce the skill
Ignore inappropriate behavior

24. Working Memory Enforce use of assignment books consistently
Utilize checklists and to-do lists
Use cue devices such as verbal reminders, alarm clocks, and Post-Its
To teach the skill:
Explain the skill
Give options to the child for cues and checklists to use
Create a monitoring system for the child to monitor their own skill usage

25. Self-Regulation Of Affect
Prepare child for problem situations
Give child scripts for problem situations and practice regularly
Structure environment to avoid situations that can lead to problems
Break tasks down into small steps
Give breaks to child during tasks as needed
Teach child I-statements
Use social stories that teach emotional control
To teach this skill:
Explain the skill
Provide coping strategies
Practice with the child
Reinforce child when strategies are used
Discuss real life situations of using the strategy

26. Sustained Attention Write start and stop times on assignments
Use incentive systems
Break down tasks into steps
Make tasks interesting for students
Give child something fun to do when task is completed
Provide attention and praise when student is remaining on task
To teach the skill:
Discuss attention time with the student
Teach them to break down tasks on their own
Help them make work plans for completing tasks
Reinforce them when they use the plan

27. Task Initiation Use verbal cues to get child started
Create a visual cue to prompt child to get started, such as a note on their desk
Walk through the first part of the task to help child get started
Have child tell you when they will begin the task and cue them when the time arrives
To teach the skill:
Teach the child to create a written plan for starting the task including time and type of task
Teach child to break down the task if needed
Teach child to use cue such as alarm clock to start task
Reinforce child when no additional cues are needed
Fade supervision

28. Planning Plan a schedule for the child Use rubrics
Break long assignments into smaller pieces with deadlines for each piece
Create planning sheets with due dates
Use assignment planners
To teach the skill:
Walk through the planning process with the child
Have child model the planning process
Tell student to create roadmaps for tasks
Ask questions such as “What do you have to do first?”

29. Organization Maintain an organized classroom
Create schemes for organizing backpacks and folders
Color-code folders, notebooks, and papers for classes
To teach the skill:
Teach child to separate papers and categorize them
Have them create their own organization plan
Get the plan in writing
Have them implement the plan

30. Time Management Give child a schedule to follow
Prompt student with each step of a task
Impose time limits for assignments
Provide frequent reminders for remaining time to complete task
Use cueing devices such as alarm clocks
To teach the skill:
Help child understand what the task involves
Have child think of distractions that may be present when completing task
Create an estimated time for completion; compare estimated time to actual time
Find strategies to decrease distractions

31. Goal-Directed Persistence
Give students goals and have them keep track of their progress
Goals need to have motivational interest to the student
Include students in establishing goals
Create reasonable goals
To teach the skill:
Follow a coaching process:
Hold a goal setting session where a goal is set, obstacles are discussed and a plan is written
Hold daily coaching sessions where goal is re-discussed and progress is assessed by asking questions

32. Flexibility Give advance warning for new schedules or activities
Allow student to practice new schedules or activities
Provide rubrics to follow
Read social stories to teach coping strategies in problem situations
Offer positive reinforcement and step by step assistance with difficult problems
To teach the skill:
Teach students what inflexibility is and how to recognize it
Teach and model coping strategies with plans and cues
Create strategies to fall back on
Teach relaxation strategies

33. Metacognition
Ask child to explain how they solved the problem or if they can think of another way to solve the problem.
Create buddy systems for students to check work.
Give assignments where students can evaluate their work ethic and give a grade.
Use rubrics.
To teach the skill:
Define the skill and what is needed to use the skill appropriately
Practice the skill
Create error-monitoring checklists
Teach children to ask themselves self-monitoring questions while tasks are being completed

34. Classroom Setup To Accommodate ADHD
Seat ADHD student away from distractions, preferably front and center (
Seat student near a good role model (
Increase distance between desks to decrease distractions (
Create a cool-down area (National Education Association, 2005).
Play quiet music (Appelbaum Training Institute’s How to Handle the Hard-to-Handle Student Resource Handbook, (2005).
Create a stage for announcements in the classroom (Appelbaum Training Institute’s How to Handle the Hard-to-Handle Student Resource Handbook, (2005).

35. How To Promote Appropriate Behavior In The Classroom
Use positive reinforcement regularly.
Implement Class-wide problem solving strategies such as FAST or SLAM.
Practice Positive Behavioral Support by conducting functional behavior assessments to create individualized interventions.
Hold class meetings that teach and reinforce proper social skills, acceptance of others and conflict resolution.

36. Medicinal Treatments
Miernicki & Hukriede (2004) found that most elementary school teachers and middle school teachers feel that stimulant medications along with interventions work best to help children with ADHD.
Stimulant medication is used to alter perceptions and feelings making the student more successful by targeting the areas of the brain that effect executive functioning (Miernicki & Hukriede, 2004; Schuck & Crinella, 2005).
70 to 80% of children on psychostimulant medications respond positively to them because they help communication between nerve networks in the brain (

37. Commonly Used Medications
Stimulants
Ritalin, Concerta, Metadate, Focalin, Adderall, Dexadrine
Given in short-acting (4-6 hours) or long-acting (6-12 hours) doses
Side Effects: difficulty sleeping, lack of appetite, fatigue, headache, stomach-ache, possible occurances of motor tics
Nonstimulants
Strattera, antidepressants such as Zoloft or Celexa
Affect dopamine and norepinephrine levels in the brain
Side Effects: difficulty sleeping, lack of appetite, fatigue, headache, stomach-ache