1. Chapter 11 ADHD

2. Attention-Deficit/Hyperactivity Disorder The essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity (DSM-IV) Problems paying attention and controlling their “impulses” and behavior. –“Andy never stops moving” –“Mike is withdrawn and disorganized” –“He has difficulties planning ahead and often does not complete his assignments” Controversial diagnosis –Some believe there is no such disability, the behaviors are merely a product of environmental experiences such as poor parenting or poor teaching –ADHD is recognized by the courts, US Dpt of Education, etc.

3. Inattentive symptoms Failure to give close attention to details, prone to careless mistakes Difficulty completing tasks Appears that mind is elsewhere Shifts from one activity to another Difficulty organizing activities Avoid activities that require sustained effort Disorganized work habits Distracted by irrelevant stimuli Forgetful of daily activities

4. Hyperactive/Impulsive symptoms Tendency to fidget and squirm when seated Not remain seated when needed Excessive running or climbing when inappropriate Difficulty playing quietly Often “on the go” Talks excessively Difficulty delaying responses – answers before question is completed Difficulty waiting one’s turn Frequently interrupting others

5. Academic and Social Characteristics Typically do not achieve their academic potential Greater risk of grade retention and school drop out –Student may be good at math, but makes careless mistakes –Student may be bad at math do to a learning disability in addition to ADHD Difficult peer relationships –Great tendency to display bullying behaviors –Aggression or withdrawn (more impulsive or inattentive type, respectively) Half of students have another disability

6. Identification Symptoms must be present for at least 6 months Some of the symptoms must be displayed before the age of 7 (controversial) Behavior caused by a temporary situation (e.g., divorce) not diagnosed Symptoms need to be exhibited at multiple settings. Impact social, academic and occupational areas. Inconsistent with developmental level. Usually seen by doctor first Interviews, scales, checklists, direct observation (Talking out, Out of seat, Attention problems, Disruption, etc.

7. ADHD Children with ADHD can be served under the “other health impairments” category –Not considered a separate disability under IDEA 04, may fall under “other health impairments” –May also qualify under LD or ED because of co-morbidity –Or are allowed accommodations under section 504 of rehabilitation Act (allow for instructional accommodations for students who do not qualify for special ed, but still need help) They usually attend general ed classes, requiring support.

8. Prevalence Estimates of prevalence of ADHD range from 3% to 5% of all school-age children (APA, 2000) About two students in a 30-35 student class will have ADHD Disorder will not be outgrown. 70% of children continue with the disorder into adolescence, and 50% into adulthood. Lots of children go undiagnosed.

9. Causes Why is finding the cause important? Myths about ADHD –Poor diet –Food additives –Too much sugar –Too much TV –Fluorescent lights Although poor teaching and/or parenting may contribute to the increase of problem behavior, it does not cause them

10. Causes Although most research has focused on brain and genetic causes there are some evidence for possible nongenetic causes such as: –Premature birth –Maternal smoking –Alcohol use –Exposure to lead Brain anatomy and function (lag in development) –Although no perfect correlation between these differences and ADHD Genetic Causes –Result of multiple interacting genes –Child of an adult with ADHD has 25% of having it.

11. Drug Therapy Two treatment approaches that are widely used with children with ADHD are drug therapy and behavioral intervention Psychostimulants such as Ritalin, Dexedrine, Cylert, or Adderall, or nonstimulants such as Strattera Increases the concentration of neurotransmitters, improving memory, cognition and attention. Improvement in behavior and ability to learn. Although controversial –Academic problems need to be dealt with. –May be dependent on the medication

12. Behavioral Treatment Direct Instruction (presentation, guided practice, demonstration of mastery) –Clear and explicit –Repeat and highlight concepts many times –High levels of accuracy before moving to another activiy Precision Teaching –Method of evaluating instruction –Direct, continuous, and precise measurements of student performance – fluency Functional-based treatments –FBA –Behavior intervention programs should be embedded in teaching activities –Similar strategies used with students with EBD and ASD such as reinforcement, token systems, contracting, etc.

13. Other Strategies Peer tutoring –Immediate, frequent feedback following students pace –Peers can also be behavior modifiers, providing differential reinforcement Computer-Assisted Instruction (CAI) –Use of computers to introduce new materials with graphics, words, and sounds Attention maintained technology –Response cost, token systems, self monitoring (support ABA strategies)

14. Ervin et al. Background –Use of FBA for intervention selection –Antecedent manipulations for decreasing problem behavior (task duration) Purpose –Test school-based assessment model to select interventions for ADHD –Teacher involvement and acceptability Participants Setting Dependent Measures

15. Ervin et al. Hypothesis development Informant and structured FBA –Joey –Paper and pencil task evoked off task –Carl – Lack of attention evoked off task behavior Hypothesis testing –Reversal design – typical conditions alternated with potential interventions –Joey – use of computer + escape extinction, or brainstorm with peer –Carl – Self-evaluation of peer attention seeking behavior + reinforcement or extinction