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Title: Characteristics of Attention Deficit Hyperactivity Disorder (AD/HD)


1
Characteristics of Attention Deficit
Hyperactivity Disorder (AD/HD)
  • Presented by Connie McDonald BrookinsDeveloped
    by Renee B. Leach,
  • Consultants
  • Upper Cumberland Special Education Cooperative

2
Definition of ADHD
  • ADHD (attention deficit hyperactivity disorder)
    is a condition characterized by severe problems
    of inattention, hyperactivity, and/or
    impulsivity. (Hallahan and Kauffman, 2003,
    p.513) 

3
Prevalence of ADHD
  • ADHD is the most common behavioral disorder in
    children in America. (Kollins, Barkley, and
    DuPaul, 2001) 
  • It exists in between 3 and 5 percent of
    school-aged children. 
  • Boys are more often diagnosed with ADHD than are
    girls, ranging somewhere between a 2.5 1 and 5
    1 ratio.
  • This may be because the behaviors associated with
    ADHD are more characteristic and natural in boys
    than they are in girls. 

4
  • Girls that do have ADHD most likely have the
    inattentive type.  (Boschett, 2002). 
  • Less than half of the children who have ADHD use
    special education programs in school.

5
Three Types of ADHD as defined under Diagnostic
and Statistical Manual of Mental Disorders (DSM).
  • -ADHD Predominately Inattentive Type
  • -ADHD Predominately Hyperactive Impulsive Type
  • -ADHD Combined Type (Inattentive and Hyperactive
    Impulsive)

6
Signs of Hyperactivity -Impulsivity
  • Feeling restless, often fidgeting with hands or
    feet, or squirming while seated
  • Running, climbing, or leaving  a seat in
    situations where sitting or quiet behavior is
    expected
  • Blurting out answers before hearing the whole
    question
  • Having difficulty waiting in lines or taking tours

7
Signs of Inattention
  • Often becomes easily distracted by irrelevant
    sights and sounds
  • Often failing to pay attention to details and
    making careless mistakes
  • Rarely following instructions carefully and
    completely losing or forgetting things  like
    toys, or pencils, books, and tools needed for a
    task
  • Often skipping from one uncompleted activity to
    another

8
The Symptoms
  • Typically, AD/HD symptoms arise in early
    childhood, unless associated with some type of
    brain injury later in life.
  • Some symptoms persist into adulthood and may pose
    life-long challenges.
  • Although the official diagnostic criteria state
    that the onset of symptoms must occur before age
    seven, leading researchers in the field of AD/HD
    argue that criterion should be broadened to
    include onset anytime during childhood.

9
Criteria for the three primary subtypes are
summarized as follows
10
AD/HD predominately inattentive type
  • Fails to give close attention to details or makes
    careless mistakes.
  • Has difficulty sustaining attention.
  • Does not appear to listen.
  • Struggles to follow through on instructions.
  • Has difficulty with organization.
  • Avoids or dislikes tasks requiring sustained
    mental effort.
  • Loses things.
  • Is easily distracted.
  • Is forgetful in daily activities.

11
AD/HD predominately hyperactive-impulsive type
  • Fidgets with hands or feet or squirms in chair.
  • Has difficulty remaining seated.
  • Runs about or climbs excessively.
  • Difficulty engaging in activities quietly.
  • Acts as if driven by a motor.
  • Talks excessively.
  • Blurts out answers before questions have been
    completed.
  • Difficulty waiting or taking turns.
  • Interrupts or intrudes upon others.

12
AD/HD combined type
  • Individual meets both sets of inattention and
    hyperactive/impulsive criteria.

13
  • Because everyone shows signs of these behaviors
    at one time or another, the guidelines for
    determining whether a person has AD/HD are very
    specific.
  • To be diagnosed with AD/HD, individuals must
    exhibit six of the nine characteristics in either
    or both DSM-IV categories listed above.

14
  • In children and teenagers, the symptoms must be
    more frequent or severe than in other children
    the same age.
  • In adults, the symptoms must affect the ability
    to function in daily life and persist from
    childhood. In addition, the behaviors must create
    significant difficulty in at least two areas of
    life, such as home, school, social settings and
    work.
  • Symptoms must be present for at least six months.

15
The Evaluation
  • Determining if a child has AD/HD is a
    multifaceted process.
  • Many biological and psychological problems can
    contribute to symptoms similar to those exhibited
    by children with AD/HD.
  • For example, anxiety, depression and certain
    types of learning disabilities may cause similar
    symptoms.

16
  • There is no single test to diagnose AD/HD.
  • Consequently, a comprehensive evaluation is
    necessary to establish a diagnosis, rule out
    other causes and determine the presence or
    absence of co-existing conditions.
  • Such an evaluation should include a clinical
    assessment of the individuals academic, social
    and emotional functioning and developmental
    level.

17
  • A careful history should be taken from the
    parents, teachers and when appropriate, the
    child.
  • Checklists for rating AD/HD symptoms and ruling
    out other disabilities are often used by
    clinicians.

18
  • There are several types of professionals who can
    diagnose AD/HD, including school psychologists,
    private psychologists, social workers, nurse
    practitioners, neurologists, psychiatrists and
    other medical doctors.
  • Regardless of who does the evaluation, the use of
    the Diagnostic and Statistical Manual IV (DSM-IV)
    criteria is necessary.

19
  • A medical exam by a physician is important and
    should include a thorough physical examination,
    including hearing and vision tests, to rule out
    other medical problems that may be causing
    symptoms similar to AD/HD.
  • Only medical doctors can prescribe medication if
    it is needed.

20
  • According to a June 1997 AMA study, AD/HD is one
    of the best researched disorders in medicine, and
    the overall data on its validity are far more
    compelling than that for most mental disorders
    and even for many medical conditions.
  • Goldman, L.S., Genel, M., Bezman, R, et.al.
    (1998) Diagnosis and treatment of
    attention-deficit/hyperactivity disorder in
    children and adolescents. Journal of the American
    Medical Association.

21
  • The exact causes of AD/HD remain illusive.
  • Currently, most research suggests a
    neurobiological basis.
  • Since AD/HD runs in families, inheritance appears
    to be an important factor.
  • U. S. Department of Health and Human Services.
    (1999). Mental Health A Report of the Surgeon
    General (Children and Mental Health).

22
  • Even though a diagnostic test for AD/HD does not
    exist, the 1998 National Institute of Health
    Consensus Statement concludes, there is evidence
    supporting the validity of the disorder.
  • National Institute of Health. (1998). Diagnosis
    and treatment of attention deficit hyperactivity
    disorder. Washington, D.C. NIH Consensus
    Statement.

23
Multimodal Treatment
  • There may be serious consequences for persons
    with AD/HD who do not receive treatment or
    receive inadequate treatment.
  • These consequences may include low self-esteem,
    social and academic failure, career
    underachievement and a possible increase in the
    risk of later antisocial and criminal behavior.

24
  • Treatment plans should be tailored to meet the
    specific needs of each individual and family.
  • So treating AD/HD in children often requires
    medical, educational, behavioral, and
    psychological intervention.

25
This comprehensive approach to treatment is
called multimodal and often includes
  • Parent training
  • Behavioral intervention strategies
  • An appropriate educational program
  • Education regarding AD/HD
  • Individual and family counseling
  • Medication, when required

26
  • Research from the landmark NIMH Multimodal
    Treatment Study of AD/HD is very encouraging.
  • Children who received medication, alone or in
    combination with behavioral treatment showed
    significant improvement in their behavior and
    academic work plus better relationships with
    their classmates and family.

27
  • Psychostimulants are the most widely used class
    of medication for the management of AD/HD related
    symptoms.
  • Approximately 70 to 80 percent of children with
    AD/HD respond positively to psychostimulant
    medications.

28
  • Significant academic improvement is shown by
    students who take these medications increased
    attention and concentration, compliance and
    effort on tasks, amount and accuracy of
    schoolwork produced and decreased activity
    levels, impulsivity, negative behaviors in social
    interactions and physical and verbal hostility

29
  • Other medications that may decrease impulsivity,
    hyperactivity and aggression include some
    antidepressants and antihypertensives.
  • However, each family must weigh the pros and cons
    of taking medication.

30
  • Behavioral interventions are also a major
    component of treatment for children who have
    AD/HD.
  • Important strategies include being consistent and
    using positive reinforcement, and teaching
    problem-solving, communication, and self-advocacy
    skills.
  • Children, especially teenagers, should be
    actively involved as respected members of the
    school planning and treatment teams.

31
  • School success may require a variety of classroom
    accommodations and behavioral interventions.
  • Most children with AD/HD can be taught in the
    regular classroom with minor adjustments to the
    environment.
  • Some children may require special education
    services if an educational need is indicated.
  • These services may be provided within the regular
    education classroom or may require a special
    placement outside of the regular classroom that
    meets the childs unique learning needs.

32
  • Behavioral treatments for AD/HD should be started
    as soon as the child receives a diagnosis.
  • There are behavioral interventions that work well
    for preschoolers, elementary-age students, and
    teenagers with AD/HD, and there is consensus that
    starting early is better than starting later.
  • Parents, schools, and practitioners should not
    put off beginning effective behavioral treatments
    for children with AD/HD

33
What is behavior modification?
  • With behavior modification, parents, teachers and
    children learn specific techniques and skills
    from a therapist, or an educator experienced in
    the approach, that will help improve childrens
    behavior.
  • Parents and teachers then use the skills in their
    daily interactions with their children with
    AD/HD, resulting in improvement in the childrens
    functioning in the key areas noted above.
  • In addition, the children with AD/HD use the
    skills they learn in their interactions with
    other children.

34
  • Behavior modification is often put in terms of
    ABCs Antecedents (things that set off or happen
    before behaviors), Behaviors (things the child
    does that parents and teachers want to change),
    and Consequences (things that happen after
    behaviors).

35
  • In behavioral programs, adults learn to change
    antecedents (for example, how they give commands
    to children) and consequences (for example, how
    they react when a child obeys or disobeys a
    command) in order to change the childs behavior
    (that is, the childs response to the command).
  • By consistently changing the ways that they
    respond to childrens behaviors, adults teach the
    children new ways of behaving.

36
  • Parent, teacher and child interventions should be
    carried out at the same time to get the best
    results.
  • The following four points should be incorporated
    into all three components of behavior
    modification  
  • Start with goals that the child can achieve in
    small steps.
  • Be consistent across different times of the
    day, different settings, and different people.
  • Implement behavioral interventions over the long
    haul not just for a few months.
  • Teaching and learning new skills take time, and
    childrens improvement will be gradual.

37
  • Parents who want to try a behavioral approach
    with their children should learn what
    distinguishes behavior modification from other
    approaches so they can recognize effective
    behavioral treatment and be confident that what
    the therapist is offering will improve their
    childs functioning.

38
How does a behavior modification program begin?
  • The first step is identifying a mental health
    professional who can provide behavioral therapy.
  • Finding the right professional may be difficult
    for some families, especially for those that are
    economically disadvantaged or socially or
    geographically isolated.

39
  • The mental health professional begins with a
    complete evaluation of the child's problems in
    daily life, including home, school (both
    behavioral and academic), and social settings.
  • Most of this information comes from parents and
    teachers. The therapist also meets with the child
    to get a sense of what the child is like.

40
  • The evaluation should result in a list of target
    areas for treatment. Target areas often called
    target behaviors are behaviors in which change
    is desired, and if changed, will help improve the
    childs functioning/impairment and long-term
    outcome.

41
  • Target behaviors can be either negative behaviors
    that need to stop or new skills that need to be
    developed.
  • That means that the areas targeted for treatment
    will typically not be the symptoms of AD/HD
    overactivity, inattention and impulsivity but
    rather the specific problems that those symptoms
    may cause in daily life.

42
  • Common classroom target behaviors include
    completes assigned work with 80 percent
    accuracy and follows classroom rules.
  • At home, plays well with siblings (that is, no
    fights) and obeys parent requests or commands
    are common target behaviors.

43
  • After target behaviors are identified, similar
    behavioral interventions are implemented at home
    and at school.
  • Parents and teachers learn and establish programs
    in which the environmental antecedents (the As)
    and consequences (the Cs) are modified to change
    the childs target behaviors (the Bs).
  • Treatment response is constantly monitored,
    through observation and measurement, and the
    interventions are modified when they fail to be
    helpful or are no longer needed.

44
Parent Training
  • Behavioral parent training programs have been
    used for many years and have been found to be
    very effective.
  • Although many of the ideas and techniques taught
    in behavioral parent training are common sense
    parenting techniques, most parents need careful
    teaching and support to learn parenting skills
    and use them consistently.

45
  • It is very difficult for parents to buy a book,
    learn behavior modification, and implement an
    effective program on their own.
  • Help from a professional is often necessary.

46
  • However, with early identification and treatment,
    children and adults can be successful.
  • Studies show that children who receive adequate
    treatment for AD/HD have fewer problems with
    school, peers and substance abuse, and show
    improved overall functioning, compared to those
    who do not receive treatment.

47
  • The topics covered in a typical series of parent
    training sessions include the following
  • Establishing house rules and structure
  • Learning to praise appropriate behaviors
    (praising good behavior at least five times as
    often as bad behavior is criticized) and ignoring
    mild inappropriate behaviors (choosing your
    battles)
  • Using appropriate commands
  • Using whenthen contingencies (withdrawing
    rewards or privileges in response to
    inappropriate behavior)
  • Planning ahead and working with children in
    public places
  • Time out from positive reinforcement (using time
    outs as a consequence for inappropriate behavior)
  • Daily charts and point/token systems with rewards
    and consequences
  • School-home note system for rewarding behavior at
    school and tracking homework

48
The Prognosis
  • Children with AD/HD are at-risk for potentially
    serious problems academic underachievement,
    school failure, difficulty getting along with
    peers, and problems dealing with authority.
  • Furthermore, up to 67 percent of children will
    continue to experience symptoms of AD/HD in
    adulthood.

49
Contact Todays Presenter at
  • Renee B. Leach
  • Technology/Curriculum Consultant
  • Upper Cumberland Special Education Cooperative
  • 116 North 4th Street
  • Williamsburg, KY
  • Phone 606-539-0510
  • Email rleach_at_whitley.k12.ky.us

50
Additional resources
  • www.chadd.org
  • http//www.help4adhd.org/index.cfm
  • http//www.chadd.org/fs/fs2.htm
  • http//www.familyeducation.com/article/1,1120,23-1
    6631,00.html
  • www.add.org

51
For your attention!!!!
52
Characteristics of Attention Deficit
Hyperactivity Disorder (AD/HD)
  • Renee B. Leach, Consultant
  • Upper Cumberland Special Education Cooperative
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