1. Learners with Attention Deficit Hyperactivity Disorder
Chapter 7
Learners with Attention Deficit Hyperactivity Disorder

2. History Discovered mid-nineteenth century
Dr. George F. Still, credited as being one of the first authorities to being ADHD to attention
Behavioral inhibition is still one of the components of ADHD that is still discussed today

3. History Still’s cases similar to today’s population
Children had mild brain pathology
Some had normal intelligence
More prevalent in males than females
Some basis as hereditary condition
Some had comorbid disorders such as depression
Many of his cases would still be labeled with ADHD or ADHD with conduct disorder

4. History Goldstein’s Brain-Injured Soldiers of WWI
Noticed symptoms such as
Disorganized behavior
Hyperactivity
Perseveration
Forced responsiveness to stimuli
Lack of ability to focus on figure, instead attention was paid to ground
Laid the work for Strauss and Werner in 1930s-40s
Strauss Syndrome
Figure background task

5. History William Cruickshank
Children with CP more likely to respond to background than figure in figure/background task
All children had normal intelligence
Brought to light that distractibility and hyperactivity could occur in “normal” children
First to establish educational program for children with ADHD

6. Progression of Terms 1950’s-1960’s-Minimal brain injury
1960’s-1970’s-Hyperactive child syndrome
1980’s-ADHD

7. Definition
American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM)
Fourth edition (DSM-IV)
ADHD, Predominantly Inattentive Type
ADHD, Predominantly Hyperactivity Type
ADHD, Combined Type
Criteria on p. 229

8. Prevalence
Most frequent reason children are referred for behavior problems
3-7% of school-age population
Hard to have accurate percentage since ADHD is served under “other health impaired” (OHI)
3:1 males to females
Males have hyperactivity or impulsive type
Females have inattentive type

9. Identification of ADHD
4 main components
Medical examination
Clinical interview
Teacher and parent rating scales
Conners Rating Scales-Revised
ADHD Rating Scale-IV
Behavioral observations
Continuous performance test (CPT) stimuli presented one at a time on a screen rapidly, with child pressing button when a particular stimulus is shown

10. Causes Strong evidence of neurological abnormalities
Prefrontal lobes & Frontal Lobes
Executive functions
Basal ganglia (caudate & globus pallidus) & Cerebellum
Coordination & control of motor behavior
Corpus callosum
Communication between hemispheres
The size of these areas is smaller
Suggested reduced metabolic activity in the frontal lobes and basal ganglia

11. Hereditary Factors Family studies indicate
32% chance if sibling has ADHD
57% chance if parent has ADHD
2-8 more times likely if parent has ADHD than a parent that does not
In identical twins, increased chance versus fraternal twins
No single gene cause of ADHD
Possible link to gene that regulates dopamine

12. Medical Factors Not as strong a link as heredity Exposure to lead
Alcohol abuse during pregnancy
Tobacco use during pregnancy
Low birthweight
Complications at birth

13. Barkley’s Model of ADHD
Behavioral inhibition is the critical element
leads to problems with executive functioning
time awareness and management
Disrupts person’s ability to persist in goal-directed behavior
Problem’s with wait for turn
Refraining from interrupting conversations
Inability to resist distractions
Inability to delay immediate gratification
In the classroom, problems with transitions/switching tasks

14. Executive Functions Ability to regulate one’s behavior
Children with ADHD have problems with
Working memory
Forgetfulness, lack of hindsight, time management
Delayed inner speech
Following rules or instructions
Controlling emotions and arousal levels
Overreact to negative/positive experiences
Quick to show anger/frustration
Analyzing problems and communicating solutions to others
Responds impulsivity to the first solution that comes to mind

15. Other Areas of Deficits
Adaptive skills
Usually discussed when talking about intellectual disabilities
New research shows children with ADHD have difficulties with these skills
Socializing with peers
More often rejected by peers
Fewer close friends
Disliked by students who enjoy high social status
Research indicates this could be a defining characteristic of ADHD
Difficult to overcome and is long lasting
Can lead to social isolation

16. Comorbid Conditions Learning disabilities
Overlap of percent
Suggest strongest link ADHD, predominately inattentive type
Emotional or behavioral disorders
25-50% exhibit some form of EBD
25-35% anxiety is present
Substance abuse
Adolescents are more likely to experiment
Twice as likely to abuse alcohol or drugs

17. Educational Considerations
Classroom Structure
Reduce irrelevant stimuli/distractions
Teacher Direction
Clear breakdown of instructional day
Functional Behavior Assessment
Identifies ABC-antecedent, behavior, consequence
Contingency-based self management
Students keep track of own behavior, then receive consequences

18. Introducing Lessons Provide an advance organizer
Review previous lessons
Set learning expectations
State needed materials
Explain additional resources
Simplify instructions, choices and scheduling

19. Conducting Lessons Be predictable
Support the student’s participation in class
Check student performance
Perform ongoing student evaluation
Follow-up directions
Written
oral
Divide work into smaller units
Eliminate or reduce frequency of timed tests

20. Concluding Lessons Provide advance warnings Check assignments
Can use overhead timer
Visual timer
Check assignments
Preview the next lesson
Remember break the work into smaller chunks helps the children focus and limit distractions

21. Medical Considerations
Controversial topic
Psychostimulants
Stimulate or activate neurological functioning
Ritalin
Takes about one hour to take effect
Optimal effect in 2 hours
Wears off in 4 hours
Adderall
Stratera-non stimulant

22. What Research Says
Ritalin has positive effects in helping students have more normalized behavioral inhibition and executive functioning
Leads to increased results on parent-teacher rating scales and academic achievement
Increased classroom behaviors
Better at taking notes
On-task behavior
Quiz scores
Homework completion
Written-langauge work

23. What the Research Says Not effective for everyone
Around 30% do not have favorable response
Side effects
Insomnia, reduced appetite, abdominal pain, headaches, and irritability
Some reports can cause tics or increase tics that children already have
Can have rebound effect
Some studies suggest taking Ritalin can decrease adolescent use of drugs

24. Monitoring Progress Curriculum-based measurement (CBM)
Attention & Behavior
Momentary time sampling
Allows the teacher to conduct brief observations and collect data on a specific set of behaviors
Observer determines length of observation & divides it into intervals
At beginning of interval, observer notes whether the student is exhibiting the target behavior & then waits until the beginning of the next interval to document behavior

25. Testing Accommodations
Small-group or individual administration in a quiet location
Extended time
Frequent breaks
Presentation format
Response format

26. Early Intervention Diagnosis is difficult at an early age
Most commonly will see a great deal of motor activity and a lack of impulse control
Stronger use of contingencies such as praise, points, and tangible rewards
Intensive, structured methods of applying behavioral management can be successful in improving behavior and pre-academic skills
Symptoms such as strong aggression can not remediate completely the symptoms of ADHD, will need long-term programming

27. Transition into Adulthood
2/3 of children with ADHD will continue to have significant symptoms in adulthood
4-5%, similar to the rate in children
Person’s history is important in determining adult ADHD
Some adults also exhibit antisocial, anxiety, and depression disorders, including employment
Comorbid conditions lead to poorer outcomes compared to those who do not have them

28. Transition into Adulthood
Employment difficulties
Getting along with others
Being bored
Being disciplined by supervisors
Solution is for the person to choose a job/career that maximizes individual’s strengths
Coaching-identifying someone whom the person with ADHD can rely on for support