1. DIFFERENTIATION: ATTENTION DEFICIT/HYPERACTIVITY DISORDER

2. What is AD/HD: Inattentive Type A disorder of age-inappropriate symptoms in:  Failure to give close attention to details/careless mistakes  Difficulty sustaining attention in tasks or play  Does not seem to listen when spoken to  Does not follow through on instructions (failure to complete  Difficulty organizing tasks and activities  Avoids, dislikes, or is reluctant to engage in tasks that require sustaining mental effort  Often loses things  Is often easily distracted by extraneous stimuli  Is forgetful in daily activities

3. What is AD/HD: Hyperactive-Impulsive Type Hyperactivity:  Often fidgets or squirms in seat  Often leaves seat in classroom  Often runs or climbs excessively  Often has difficulty playing or engaging in leisure activities quietly  Is often “on the go” or acts as if driven by a motor  Often talks excessively Impulsivity  Blurts out answers  Difficulty waiting turns  Often interrupts or intrudes on others

4. What is AD/HD: Prevalence  7-8% of children  4-5% of adults  3:1 males to female  More common in population dense areas  No evidence of ethnic differences

5. Co-occurring Disorders  Oppositional Defiant Disorder – 55%  Conduct Disorder – 45%  Major Depression – 25-35%  Anxiety Disorders – 20-35%  Also 97% of Bipolar Disorders have AD/HD as well

6. Other Risks  Language Disorders (Expressive 10-54%, Pragmatic Deficits in 60%)  7-10% IQ deficit  Poor school performance in 90%+

7. What Causes AD/HD?  Disorder arises from multiple causes  All of which fall with in the realm of biology (neurology and genetics)  Pathway for the disorder falls within a brain structure called the fronto-striatal-cerebellar circuits.  Social theories of causes for AD/HD lack research/empirical basis.

8. Deficit in Executive Functioning The Brain’s GPS  Maps  Traffic Updates  Directions  Detours/Rerouting  Directories  Bluetooth/Hands Free  Clock  Calculator

9. Executive Functioning  Those self-directed actions of the individual that are being used to self-regulate.  This may include one’s ability to plan, set goals, organize, problem-solving, implement a plan, maintain attention, regulate emotion and inhibit undesirable responses.

10. Executive Functioning and the Brain Executive Functioning Memory, Language, Hearing Integration of Sensory Information Visual Perception Voluntary Movement, Balance

11. Empirically Proven Treatments  Parent Education about ADHD  Parent Education in Behavior Management  Family Therapy for Teens: Problem-solving and communication training  Psychopharmacology – Stimulants (Ritalin, Adderall, Focalin, Concerta, etc)  Noardrenergic Medication (Wellbutrin)  Antihypertensives (.e.g., Catapres, Tenex)  Tricyclic Anti-depressants

12. Unproved/Disproved Therapies  Elimination Diets  Megavitamins  Sensory Integration  Chiropractic Interventions  Play Therapy  Biofeedback  Self-control therapies

13. Classroom Considerations/Strategies  Do not retain in grade  Use September to establish behavioral control  Decrease total workload/chunk assignments  Seat close to teaching area  Target productivity first, accuracy later  Don’t send home unfinished classwork  Give weekly homework assignments  Allow some fidgeting/restlessness  Give movement breaks  Use participatory teaching methods  Use interactive technology

14. Classroom Considerations/Strategies cont’d  Post homework at the start of class  Intersperse low appeal activities with high appeal activities  Schedule most difficult subjects in a.m. when possible  Use direct instruction, programmed learning, or highly structured teaching materials  Create work goals in the beginning of class  Increase praise, approval, and appreciation (be a minute to minute manager)  Use team based rewards  Allow access to rewards daily or more often  Use token or point system with rewards and consequences

15. Externalize the Rules  Plan for all transitions  Post rules on posters for each period  Have child read and restate rules at the start of each activity.  Use timers, watches, taped time signals

16. Punishment  Use mild, private, direct, personal, and immediate reprimands  Establish chill out location in the classroom for child to regain control.  Use a “Do-A-Task” procedure. The child has a desk in the back of the classroom with a binder of worksheet. The teacher states the rule that was broken and and a number, and that is the number of worksheet that the student is required to complete.  Hallway timeouts do not work.