Title: Addressing Barriers to Learning: Helping Students Cope with Disruptive Behaviors ADHD, ODD, CD
1Addressing Barriers to Learning Helping Students
Cope with Disruptive Behaviors (ADHD, ODD, CD)
- Mental Health in the Schools Module II
2QUESTION WHAT DO THESE DISORDERS LOOK LIKE IN
THE CLASSROOM?
3ADHD Core Symptoms
- Fidgets
- Squirms in seat
- Easily distracted
- Difficulty waiting turn
- Blurts out answers
- Difficulty following directions
- Difficulty sustaining attention
- Shifts quickly and often between activities
- Forgetful
- Avoidance of tasks that require sustained
attention - Poor organization
- Interrupts/intrudes
- Restlessness
- Talks excessively
4Subtypes of ADHD (DSM-IV)
- ADHD, Combined Type
- ADHD, Primarily Hyperactive-Impulsive Type
- ADHD, Primarily Inattentive Type
5New Thinking (Barkley, 2008)
- DSM-V will probably not have ADHD, Primarily
Inattentive Type another disorder altogether
(not impulsive, sluggish cognitive tempo,
hesitant, shy, socially anxious)
6Definition ADHD
- ADHD is a developmental disorder, or a disorder
of age-inappropriate behavior, that is
characterized by difficulties with persistence
toward a goal, working memory, impulsiveness, and
inhibition. Onset is during childhood.
7What causes ADHD?
- Multiple causes
- Not parenting skills
- Not social factors
- All reliably supported causes fall in the realm
of biology (neurology, genetics) - 25-35 attributed to acquired brain injuries
- 65-75 due to genetics/ heredity
8Oppositional Defiant Disorder (ODD)
- Argues
- Loses temper, angry
- Defies rules
- Easily annoyed, deliberately annoys
- Resentful
- Spiteful, vindictive
- Non-compliant
- Blames others
9ODD VS. ADHD-HYPERACTIVE
- ODD
- AGGRESSIVE
- PURPOSELY ANNOYS
- DENIES BEHAVIOR
- MORE DIFFICULT TO MANAGE
- ABILITY TO CONTROL ACTIVITY LEVEL
- ADHD-HYPERACTIVE
- IMPULSIVE
- NOT PURPOSEFUL
- SHOWS REMORSE
- INABILITY TO CONTROL ACTIVITY LEVEL
10Conduct Disorder (CD)
- Aggression to people and animals (bullies,
fights, weapons) - Destruction of property (fire setting, vandalism)
- Deceitfulness or theft (lies, forgery)
- Serious violations of rules (stays out at night,
runs away, truant)
11Relationship between ADHD/ ODD/ CD
- ADHD can cause ODD negative cycle of coercive
behavior - 50 of ODD alone goes away in 2 years if ODD is
comorbid, it is more resistant and a precursor to
CD - CD is a precursor to Antisocial Personality
Disorder
12MEDICATION
- STIMULANTS
- Methylphenidate Ritalin, Concerta, Medadate CD,
Daytrana - Amphetamine Dexedrine, Adderall, Vyvanse
- STRATERRA (ATOMOXETINE)
- ANTI-HYPERTENSIVES
- Guanfacine, Guanfacine XR, Clonidine
13Why use medication?
- Results of hundreds of studies indicate that
stimulant medication and Atomoxetine (Strattera)
are the most effective treatments available for
ADHD. - Safety is well established.
- Medication treatment improves 70-90 of clinical
cases and normalizes 50-60 of such cases.
14Why use medication? Cont.
- Medications are convenient to administer, with
the least effort. - Can be used for years, even into adulthood.
- Active in community settings where no caregivers
may be present to provide active treatment
(unsupervised activities, driving alone or with
friends, free time in schools, bus rides, etc.)
15Stimulants
- Most well studied drugs in psychiatry.
- Used for more than 40 years, 350 studies, and
thousands of cases. - Whats new?
- Extended release delivery systems
- The 5 Ps- Pills, pumps (Concerta), pellets,
patches, pro-drug (Vyvanse)
16Behavioral Benefits of Stimulants
- Increased concentration and persistence
- Decreased impulsivity and hyperactivity
- Increased work productivity
- Decreased likelihood of grade retention
- Decreased days absent from school
- Increased reading achievement by age 18
- Better emotional control
- Decreased aggression and defiance
- Decreased antisocial activities
17Benefits of Stimulants (cont.)
- Improved compliance and rule following
- Better working memory and internalizing language
- Improved handwriting and motor control
- Improved self-esteem
- Improved attention and reaction time during
driving performance
18Benefits of Stimulants (cont.)
- Note on use of stimulants in preschoolers
- Stimulant medication is considered safe to use
with preschoolers however, preschoolers exhibit
a decreased degree of change relative to older
children. - Additionally, preschoolers exhibit an increased
risk of side effects (e.g., insomnia, poor
appetite, and weight loss)
19Side Effects of Stimulants
- Largely benign lt5 discontinue use due to
adverse events. - Mild Weight Loss (mean 1-4 lbs.)
- Growth effects are short term and limited to
first 3 years of therapy - Most common
- Insomnia (50 )
- Loss of appetite (50 )
- Headaches (20-40)
- Stomach Aches (20-40)
20Strattera (Atomoxetine)
- Effective for kids, teens, and adultsno abuse
potential. - Reduces ADHD, ODD, and aggression
- Also, treats anxiety
- Less insomnia
- Takes 3-4 weeks to get the full result
21MANAGEMENT OF ADHD BEHAVIORS
- Planning and Organization
- Attention to task
- Work completion
- Impulsivity
- Social Skills
22WHAT IS YOUR ROLE AS A TEACHER?
- CLEAR RULES AND EXPECTATIONS
- FAIR AND LOGICAL CONSEQUENCES
- STUDENT PARTICIPATION IN ESTABLISHING
CONSEQUENCES/ REWARDS
- ROLE MODEL
- LOOK FOR STUDENT STRENGTHS
- FLEXIBILILTY
23Basic Considerations for Classroom Management
- Decrease total workload (How much work does the
student need to do to show he knows and/or is
proficient in the task?) - Give smaller amounts of work at a time
- Target productivity first, accuracy later
24More Basic Considerations
- Use the traditional desk arrangement
- Seat the student close to teaching area
- Keep homework to 10 minutes per grade level
- Do not retain
- Establish a school ADHD liaison
25Classroom Management Tips
- Allow some restlessness at work area
- Build in frequent exercise breaks
- Organize by using color-coded binders
- Use white erase boards for question and answer
times instead of hands in the air
26Classroom Management Tips, contd
- Always be thinking How do I involve this child
within my lesson plan - Schedule more difficult subjects in AM
- Intersperse low with high appeal activities
- Be more animated and theatrical
- Require continuous note taking
2718 Great Ideas
- Know that parents are Shepherds, not Engineers
- Reduce Delays, Externalize Time
- Externalize Important Information
- Externalize Motivation (Think Win/Win)
- Externalize Problem-Solving
- Use immediate Feedback
2818 Great Ideas, contd
- Increase frequency of consequences
- Increase accountability to others
- Use more salient and artificial rewards
- Change rewards periodically
- Touch more, talk less
- Act, Dont Yak
- Use rewards before punishment
29 18 Great Ideas cont.
- Keep your sense of humor
- Anticipate problem settings (make a plan)
- Keep a sense of priorities
- Maintain a Disability Perspective
- Practice Forgiveness (student, self, parents,
others)
30Punishment cont.
- Loss of tokens /Response Cost
- Moral essays/Reflection papers
- Establish a Chill Out location
- Formal time out in class or private room
- In-school suspension or go to IBS class
31The Punishment Hierarchy
- ADHD children are punished 2 to 8 times
- more than other children SO
- Swift justice is the key to discipline
- Do a Task variation of time out
- -have desk in back of class with
worksheets - -child told what they did wrong and given a
number - -child goes to desk and completes number of
worksheets assigned
32Peer Tutoring
- Children are more sensitive to other children so
peer tutoring can be effective. - Teach new concepts and skills to class
- Break class into dyads
- Have one student tutor and quiz the other
- Alternate student/tutor roles
- Re-organize into new dyads weekly
33STRATEGY INFORMATION SHARE
34CASE STUDY
35AVAILABLE SCHOOL-BASED SUPPORT SERVICES