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Addressing Barriers to Learning: Helping Students Cope with Disruptive Behaviors ADHD, ODD, CD

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Title: Addressing Barriers to Learning: Helping Students Cope with Disruptive Behaviors ADHD, ODD, CD


1
Addressing Barriers to Learning Helping Students
Cope with Disruptive Behaviors (ADHD, ODD, CD)
  • Mental Health in the Schools Module II

2
QUESTION WHAT DO THESE DISORDERS LOOK LIKE IN
THE CLASSROOM?
3
ADHD 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

4
Subtypes of ADHD (DSM-IV)
  • ADHD, Combined Type
  • ADHD, Primarily Hyperactive-Impulsive Type
  • ADHD, Primarily Inattentive Type

5
New 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)

6
Definition 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.

7
What 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

8
Oppositional Defiant Disorder (ODD)
  • Argues
  • Loses temper, angry
  • Defies rules
  • Easily annoyed, deliberately annoys
  • Resentful
  • Spiteful, vindictive
  • Non-compliant
  • Blames others

9
ODD 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

10
Conduct 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)

11
Relationship 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

12
MEDICATION
  • STIMULANTS
  • Methylphenidate Ritalin, Concerta, Medadate CD,
    Daytrana
  • Amphetamine Dexedrine, Adderall, Vyvanse
  • STRATERRA (ATOMOXETINE)
  • ANTI-HYPERTENSIVES
  • Guanfacine, Guanfacine XR, Clonidine

13
Why 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.

14
Why 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.)

15
Stimulants
  • 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)

16
Behavioral 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

17
Benefits 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

18
Benefits 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)

19
Side 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)

20
Strattera (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

21
MANAGEMENT OF ADHD BEHAVIORS
  • Planning and Organization
  • Attention to task
  • Work completion
  • Impulsivity
  • Social Skills

22
WHAT 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

23
Basic 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

24
More 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

25
Classroom 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

26
Classroom 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

27
18 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

28
18 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)

30
Punishment 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

31
The 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

32
Peer 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

33
STRATEGY INFORMATION SHARE
  • WHAT WORKS?
  • WHAT DOESNT?

34
CASE STUDY
35
AVAILABLE SCHOOL-BASED SUPPORT SERVICES
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