Title: Attention Deficit Hyperactivity Disorder: What Educators Need To Know
1Attention Deficit Hyperactivity DisorderWhat
Educators Need To Know
- By Annie Schave
- Michigan State University
- CEP 841
2Have You Ever. . .
- Thought a child was lazy because they seemed to
never start - an assignment?
- Gotten mad at the child who kept getting out of
their seat?
- Become so frustrated with the child in the back
of the room - banging his pencil on his desk over and over
and over again?
- Reminded a child to bring home their book at
least five times - and then they still forget it?
- Been in the middle of a lesson when a child
blurts out some random - information irrelevant to the lesson?
- Had a child listen to you talk and then not know
what you just said?
3If You Answered Yes. . .
- You are not alone!
- Today, in every classroom across the country
there are several students who are diagnosed with
ADHD. - It is vital for teachers to understand ADHD so
you dont feel frustrated, upset, or defeated.
4What You Will Get From This Presentation
- What are the statistics and myths of ADHD?
- What is ADHD?
- How is it diagnosed and what is the teachers
role? - What causes ADHD?
- What are Executive Functions?
- What deficits do children with ADHD have?
- What can a teacher do to help children with these
deficits? - What medication should teachers know about?
- Where can help be found about ADHD?
5Statistics
- The Diagnostic and Statistical Manual of Mental
Disorders Fourth Edition (American Psychiatric
Association, 1994 DSM-IV) shows that ADHD
affects 3 to 5 of school aged children. - This adds up to 1.46 to 2.46 million children in
schools today (U.S. Department of Education,
2004). - ADHD is the most commonly diagnosed childhood
psychiatric disorder (Miernicki Hukriede, 2004) - 4 to 13 of the United States Population is
affected by ADHD (Meaux, 1999) - Boys are 4 to 9 times more likely to be diagnosed
than girls (U.S. Department of Education, 2004). - ¼ to 1/3 of ADHD students also have learning
disabilities (U.S. Department of Education, 2004) - Symptoms in a child may change as that child
grows older but that does not mean that the child
will grow out of their ADHD diagnosis (U.S.
Department of Education, 2004). - ADHD children are at higher risk for
unintentional injuries, delinquency, and
anti-social behavior (Meaux, 1999).
6ADHD Myths Busted
- As published on ADDitude Magazines website,
these are the most common ADHD myths - 7 People with ADHD are stupid and lazy.
- 6 ADHD children on medication will abuse drugs
as teenagers. - 5 ADHD is the result of bad parenting.
- 4 ADHD affects only boys.
- 3 Children with ADHD often outgrow the
condition. - 2 Children given ADHD accommodations are given
an unfair advantage. - 1 ADHD is not a real medical disorder.
From www.additudemag.com
7What is ADHD?
- The American Psychiatric Association in the
DSM-IV (1994) defines three main types of
Attention Deficit Hyperactivity Disorder.
Individuals can have predominately inattentive
ADHD, predominately hyperactive-impulsive ADHD,
or combined type depending on the presenting
symptoms (p. 83-85).
Inattention Hyperactivity-Impulsivity
Fails to give close attention to details Difficulty sustaining attention in tasks Does not seem to listen when spoken to directly Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace Often has difficulty organizing tasks and activities Often loses things necessary for tasks or activities Is often easily distracted Often forgetful in daily activities Hyperactivity -often fidgets with hands or feet or squirms in seat -often leaves seat in classroom or in other situations in which remaining seated is expected -often runs about or climbs excessively -often has difficulty playing or engaging in leisure activities -often is on the go or as if driven by a motor -talks excessively Impulsivity -often blurts out answers before questions are completed -has difficulty awaiting turn -interrupts or intrudes on others
8Diagnostic Criteria
- A Six or more of the previously noted symptoms
persisting for 6 months or longer qualifies for a
diagnosis of ADHD in either the inattentive
category or hyperactivity-impulsive category. If
both inattentive and hyperactive-impulsive
symptoms are present then a combined type
diagnosis is given. Please see chart on previous
screen. - B One of the symptoms needs to have been
present before the age of 7. - C Some impairment from the symptoms is present
in two or more settings, such as school or home. - D There must be clear and significant evidence
of a social, academic, or occupational
impairment. - E The symptoms are not better accounted for by
another mental disorder.
Note Taken from American Psychiatric
Association DSM-IV (1994, p. 83-85)
9Reasons ADHD Students Misbehave
- Frustration because they have a different
perception of the situation. - Lack of structure.
- They act the role of being bad.
- They dont know how to ask to get what they need
so they act out. - The classroom is full of distractions.
- The child feels misunderstood.
- Hunger.
- They feel overwhelmed with tasks assigned.
- They feel criticized.
- They are stuck in the victim cycle.
Note From Appelbaum Training Institutes How to
Handle the Hard-to-Handle Student Resource
Handbook, (2005).
10What Educators Need to Remember
- According to Schuck Crinella (2005), the most
worrisome deficits of children with ADHD are not
the product of low IQ, but rather of instability
of control processes that govern everyday
applications to the environment (p. 275). - The ADHD student is not dumb, lazy, or out of
control. They are smart kids who need our help
to gain the proper strategies to be successful!
11What Can An Educator Do If Some Symptoms Appear
To Be Present?
- Maintain behavior logs citing observations of
behaviors and situations. Remember to include
inventions used and their efficiency. - Inform parents of behavioral concerns and discuss
behaviors at home. - Request child study or equivalent meeting with
parents, special education teachers, school
psychologist, etc. to discuss classroom
behaviors. This can lead to diagnosis from a
doctor and then an IEP for the student. - If needed, rating scales may be given to teachers
and parents. - Remember Diagnosis and identification of ADHD
needs to come by a medical evaluation from a
family doctor, psychologist, or psychiatrist
outside of the school system! Your job is to
observe the child and find interventions that
work to make that child successful!
Note From Vaughn, Bos, Schumm (2006).
12What Rating Scales Are Used Most?
- The most common rating scale used is Conners
Teachers Rating Scale which will ask you to rate
the behaviors and form statements about the
behavior (Vaughn, Bos, Schumm, 2006). - Similar forms may include the ADHD Rating Scale
or the Behavior Rating Form based on DSM IV
symptoms (Vaughn, Bos, Schumm, 2006). - It is important to know how often the behavior
occurs when completing these forms!
13What Causes ADHD?
- According to Barkleys website (http//www.russell
barkley.org/adhd-facts.htm), there is significant
evidence that ADHD occurrences are due to
biological factors. - Other factors, as stated on the previous website,
may include difficulties during pregnancy,
prenatal exposure to alcohol or tobacco, low
birth weight, high lead levels, and prenatal
injury to the prefrontal lobe of the brain. - A recent study published in Pediatrics by
scientists at Texas Tech. University shows that
there is no link between ADHD and television.
This is however still heavily controversial
(www.additudemag.com).
14Causes continued. . .
- New research suggests that ADHD is present with
dysfunctions in the prefrontal lobes of the
brain. Prefrontal lobes control executive
functions which children with ADHD are lacking
(Dawson Guare, 2004). These dysfunctions being
studied include size differences in prefrontal
regions, basal ganglia, and cerebellum. This can
lead to abnormal activation patterns in the brain
(Barkley, 2003). - Other research still not concluded at this time
states that ADHD children have abnormal dopamine
and norepinephrine levels in the brain (Barkley,
2003). - Another neurological cause is related to lower
glucose levels affecting neurotransmitter
activity in parts of the brain (ADDA,
http//www.add.org/articles/index.html ).
15What Are Executive Functions?
- An executive function is a neuropsychological
concept referring to the cognitive processes
required to plan and direct activities, including
task initiation and follow through, working
memory, sustained attention, performance
monitoring, inhibition of impulses, and
goal-directed persistence. (Dawson Guare,
2004, p. vii)
16Why Are Executive Functions Important?
- These skills allow us to organize our behavior
over time and override immediate demands in favor
of longer-term goals (Dawson Guare, 2004, p.
1). - They also allow for the management of emotions
and effective thought monitoring. - Children with problems in a particular executive
function area have a deficit in that skill area.
17Deficit Response Inhibition
- This is the capacity to think before you act
(Dawson Guare, p. 47). - Children with this deficit tend to be impulsive.
They will say things without thinking about what
it is that they are saying.
18Deficit Working Memory
- This is the ability to hold information mind
while performing complex tasks (Dawson Guare,
p. 49). - Students with this deficit tend to forget easily.
They may forget their homework or books at
school on a regular basis.
19Deficit Self-Regulation Of Affect
- This is the ability to manage emotions in order
to achieve goals, accomplish tasks, or control
and direct behavior (Dawson Guare, p. 50). - These students tend to become upset quickly with
situations, unable to control their emotions.
These students tend to have outbursts that
disrupt daily functioning.
20Deficit Sustained Attention
- This is the capacity to maintain attention to a
situation or task in spite of distractibility,
fatigue, or boredom (Dawson Guare, p. 52). - Students with this deficit tend to have a hard
time getting started on a task. These students
will get up often when a task is given. They
talk to other students when they shouldnt.
Their attention is on everything in the room
other than their work.
21Deficit Task Initiation
- This is the ability to begin a task without
undue procrastination, in a timely fashion
(Dawson Guare, p. 54). - These students tend to put off doing work that
they need to complete. They lack the processes
to start the task.
22Deficit Planning
- This is the ability to create a roadmap to reach
a goal or to complete a task. It also involves
being able to make decisions about whats
important to focus on and whats not important
(Dawson Guare, p. 55). - These students tend to wait till the last minute
to complete tasks and then not know what to do
when they go to complete them.
23Deficit Organization
- This is the ability to arrange or place things
according to a system (Dawson Guare, p. 58). - These students tend to have messy desks or
cubbies. They lose papers often and frequently
shove papers instead of placing them in
appropriate spots.
24Deficit Time Management
- This is the capacity to estimate, allocate, and
execute within time constraints (Dawson Guare,
p. 60). - These children get work done at the last minute
and frequently ask for assignment extensions.
Also, they often use excuses for not having work.
25Deficits Goal-Directed Persistence
- This is the capacity to have a goal, follow
through to the completion of the goal, and not be
put off by or distracted by competing interests
(Dawson Guare, p. 62). - These students are able to create goals for
themselves but are not able to achieve them.
They are not able to understand the necessary
steps to reach a goal and often become distracted
with outside stimuli negatively impacting their
task completion.
26Deficit Flexibility
- This is the ability to revise plans in the face
of obstacles, setbacks, new information, or
mistakes (Dawson Guare, p. 63). - These students have difficulty in transitions and
new situations. These students struggle longer
than others at the beginning of each year. They
also are thrown off by changes in daily
schedules. These students have limited problem
solving strategies.
27Deficit Metacognition
- This is the ability to stand back and take a
birds-eye view of oneself in a situation. It is
an ability to observe how you problem solve. It
also includes self-monitoring and self-evaluative
skills (Dawson Guare, p. 65). - These students make careless mistakes frequently.
They also will complete one step then stop
instead of finishing the series of steps. For
example, these students may add instead of
subtract over and over again while failing to
review their work and realizing their mistake.
Also, these students will do one step of long
division and then stop, not reflecting on the
whole process needed to complete the task.
28What Are The Intervention Areas?
- Educational Accommodations
- Executive Functioning Deficits
- Classroom Interventions
- Promoting Appropriate Behavior
- Medication Options
- Stimulant Medication
- Medication and Side Effects
29Response Inhibition
- Reduce situations where the child can get into
trouble - Proximity Control Increase supervision of the
child - Control impulses by modeling appropriate behavior
- To teach the skill
- Explain the skill and behaviors
- Model behaviors
- Discussion situations to use the skill
- Reinforce the skill
- Ignore inappropriate behavior
Note From Dawson Guare, (2004).
30Working Memory
- Enforce use of assignment books consistently
- Utilize checklists and to-do lists
- Use cue devices such as verbal reminders, alarm
clocks, and Post-Its - To teach the skill
- Explain the skill
- Give options to the child for cues and checklists
to use - Create a monitoring system for the child to
monitor their own skill usage
Note From Dawson Guare, (2004).
31Self-Regulation Of Affect
- Prepare child for problem situations
- Give child scripts for problem situations and
practice regularly - Structure environment to avoid situations that
can lead to problems - Break tasks down into small steps
- Give breaks to child during tasks as needed
- Teach child I-statements
- Use social stories that teach emotional control
- To teach this skill
- Explain the skill
- Provide coping strategies
- Practice with the child
- Reinforce child when strategies are used
- Discuss real life situations of using the strategy
Note From Dawson Guare, (2004).
32Sustained Attention
- Write start and stop times on assignments
- Use incentive systems
- Break down tasks into steps
- Make tasks interesting for students
- Give child something fun to do when task is
completed - Provide attention and praise when student is
remaining on task - To teach the skill
- Discuss attention time with the student
- Teach them to break down tasks on their own
- Help them make work plans for completing tasks
- Reinforce them when they use the plan
Note From Dawson Guare, (2004).
33Task Initiation
- Use verbal cues to get child started
- Create a visual cue to prompt child to get
started, such as a note on their desk - Walk through the first part of the task to help
child get started - Have child tell you when they will begin the task
and cue them when the time arrives - To teach the skill
- Teach the child to create a written plan for
starting the task including time and type of task - Teach child to break down the task if needed
- Teach child to use cue such as alarm clock to
start task - Reinforce child when no additional cues are
needed - Fade supervision
Note From Dawson Guare, (2004).
34Planning
- Plan a schedule for the child
- Use rubrics
- Break long assignments into smaller pieces with
deadlines for each piece - Create planning sheets with due dates
- Use assignment planners
- To teach the skill
- Walk through the planning process with the child
- Have child model the planning process
- Tell student to create roadmaps for tasks
- Ask questions such as What do you have to do
first?
Note From Dawson Guare, (2004).
35Organization
- Maintain an organized classroom
- Create schemes for organizing backpacks and
folders - Color-code folders, notebooks, and papers for
classes - To teach the skill
- Teach child to separate papers and categorize
them - Have them create their own organization plan
- Get the plan in writing
- Have them implement the plan
Note From Dawson Guare, (2004).
36Time Management
- Give child a schedule to follow
- Prompt student with each step of a task
- Impose time limits for assignments
- Provide frequent reminders for remaining time to
complete task - Use cueing devices such as alarm clocks
- To teach the skill
- Help child understand what the task involves
- Have child think of distractions that may be
present when completing task - Create an estimated time for completion compare
estimated time to actual time - Find strategies to decrease distractions
Note From Dawson Guare, (2004).
37Goal-Directed Persistence
- Give students goals and have them keep track of
their progress - Goals need to have motivational interest to the
student - Include students in establishing goals
- Create reasonable goals
- To teach the skill
- Follow a coaching process
- Hold a goal setting session where a goal is set,
obstacles are discussed and a plan is written - Hold daily coaching sessions where goal is
re-discussed and progress is assessed by asking
questions
Note From Dawson Guare, (2004).
38Flexibility
- Give advance warning for new schedules or
activities - Allow student to practice new schedules or
activities - Provide rubrics to follow
- Read social stories to teach coping strategies in
problem situations - Offer positive reinforcement and step by step
assistance with difficult problems - To teach the skill
- Teach students what inflexibility is and how to
recognize it - Teach and model coping strategies with plans and
cues - Create strategies to fall back on
- Teach relaxation strategies
Note From Dawson Guare, (2004).
39Metacognition
- Ask child to explain how they solved the problem
or if they can think of another way to solve the
problem. - Create buddy systems for students to check work.
- Give assignments where students can evaluate
their work ethic and give a grade. - Use rubrics.
- To teach the skill
- Define the skill and what is needed to use the
skill appropriately - Practice the skill
- Create error-monitoring checklists
- Teach children to ask themselves self-monitoring
questions while tasks are being completed
Note From Dawson Guare, (2004).
40Classroom Setup To Accommodate ADHD
- Seat ADHD student away from distractions,
preferably front and center (www.addinschools.com)
. - Seat student near a good role model
(www.addinschools.com). - Increase distance between desks to decrease
distractions (www.addinschools.com). - Create a cool-down area (National Education
Association, 2005). - Play quiet music (Appelbaum Training Institutes
How to Handle the Hard-to-Handle Student Resource
Handbook, (2005). - Create a stage for announcements in the classroom
(Appelbaum Training Institutes How to Handle the
Hard-to-Handle Student Resource Handbook, (2005).
41Other Solutions To Helping The ADHD Child
- Make lessons very clear
- Use lots of visuals
- Pair students together to complete assignments
- Provide hand signals
- Play beat the clock
- Use behavioral contracts
- Use sticker charts
- Provide study carrels or private offices
- Allow students to move around
- Allow more time for tests
- Put luggage tags on book bag to remind students
of what to bring home - Put sponges or mouse pads on desks for students
who like to tap - Have special highlighters for students to use
- Use picture mats or file folders cut into thirds
to chunk assignments - Provide headphones for students to use
- Use manipulatives such as Koosh balls or hand
exercisers for students
Note From Appelbaum Training Institutes How to
Handle the Hard-to-Handle Student Resource
Handbook, (2005).
42How To Promote Appropriate Behavior In The
Classroom
- Use positive reinforcement regularly.
- Implement Class-wide problem solving strategies
such as FAST or SLAM. - Practice Positive Behavioral Support by
conducting functional behavior assessments to
create individualized interventions. - Hold class meetings that teach and reinforce
proper social skills, acceptance of others and
conflict resolution.
From Vaughn, Bos, Schumm, (2006).
43Medicinal Treatments
- Miernicki Hukriede (2004) found that most
elementary school teachers and middle school
teachers feel that stimulant medications along
with interventions work best to help children
with ADHD. - Stimulant medication is used to alter perceptions
and feelings making the student more successful
by targeting the areas of the brain that effect
executive functioning (Miernicki Hukriede,
2004 Schuck Crinella, 2005). - 70 to 80 of children on psychostimulant
medications respond positively to them because
they help communication between nerve networks in
the brain (www.help4adhd.org).
44Commonly Used Medications
- Stimulants
- Ritalin, Concerta, Metadate, Focalin, Adderall,
Dexadrine - Given in short-acting (4-6 hours) or long-acting
(6-12 hours) doses - Side Effects difficulty sleeping, lack of
appetite, fatigue, headache, stomach-ache,
possible occurances of motor tics - Nonstimulants
- Strattera, antidepressants such as Zoloft or
Celexa - Affect dopamine and norepinephrine levels in the
brain - Side Effects difficulty sleeping, lack of
appetite, fatigue, headache, stomach-ache
From http//www.help4adhd.org/treatment/medical/
WWK3
45Conclusion
- Given the amount of children with ADHD today, we
are bound to encounter an ADHD student in our
classroom. Hopefully, the information in this
presentation will increase your knowledge of ADHD
and also help you effectively teach these
students. Thank you!
46Where to Find Help?
- www.addinschools.com
- http//www.nimh.nih.gov/publicat/adhd.cfm
- www.additudemag.com
- www.add.org/
- www.adhdinfo.com
- www.russellbarkley.org
47References
- Additude Magazine. (2004). http//www.additudema
g.com Viewed July 13, 2006 - ADHD in School. (2006) www.addinschool.com
Viewed July 13, 2006 - American Psychiatric Association (1994).
Diagnostic and statistical manual of mental
disorders (4th ed.). Washington, DC Author. - Applebaum Training Institute. (2005). How to
Handle the Hard-to-Handle Student Resource
Handbook. - Attention Deficit Disorder Associaton (ADDA).
(2006). http//www.add.org/articles/index.html
Viewed July 13, 2006 - Barkley, R. Attention-Deficit/Hyperactivity
Disorder. Child Psychopathology, Second Edition.
The Guilford Press. New York. 2003. - Dawson, P, Guare, R. (2004). Executive Skills
in Children and Adolescents A Practical Guide
to Assessment and Intervention. The Guilford
Press. New York. - Meaux, J, (2000). Stop, Look, and Listen The
Challenge for Children with ADHD. Issues in
Comprehensive Pediatric Nursing. 23, 1-13.
Viewed using ERIC Database on July 11, 2006.
48References continued. . .
- Miernicki, S. Hukriede, J. (2004).
Intervention Types and the Perceptions of
Academic Success of Students with Attention
Deficit Hyperactivity Disorder. Viewed Using
ERIC Database on July 11, 2006. - National Education Association. The D Word.
NEAToday. September 2005, p.29. - National Resource Center on ADHD. (2006).
http//www.help4adhd.org/ Viewed July 11, 2006 - Russell A. Barkley, Ph.D. The Official Site.
(2005). www.russellbarkley.org/adhd-facts.htm
Viewed July 13, 2006 - Schuck, S, and Crinella, F. (2005) Why Children
With ADHD Do Not Have Low IQs. Journal of
Learning Disabilities. May/June 2005. 262-280.
Viewed using ERIC Database on July 11, 2006. - U.S. Department of Education. (2004). Teaching
Children with Attention Deficit Hyperactivity
Disorder Instructional Strategies and
Practices. 2004. Viewed using ERIC Database on
July 11, 2006. - Vaughn, S, Bos, C, Schumm, J (2006). Teaching
Exceptional, Diverse, and At-Risk Students in the
General Education Classroom. Allyn and Bacon.
Boston, MA.