Attention Deficit Hyperactivity Disorder: What Educators Need To Know

1
Attention Deficit Hyperactivity DisorderWhat
Educators Need To Know

• By Annie Schave
• Michigan State University
• CEP 841

2
Have 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?

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If 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.

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What 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?

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Statistics

• 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).

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ADHD 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
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What 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
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Diagnostic 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)
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Reasons ADHD Students Misbehave

1. Frustration because they have a different
   perception of the situation.
2. Lack of structure.
3. They act the role of being bad.
4. They dont know how to ask to get what they need
   so they act out.
5. The classroom is full of distractions.
6. The child feels misunderstood.
7. Hunger.
8. They feel overwhelmed with tasks assigned.
9. They feel criticized.
10. They are stuck in the victim cycle.

Note From Appelbaum Training Institutes How to
Handle the Hard-to-Handle Student Resource
Handbook, (2005).
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What 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!

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What 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).
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What 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!

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What 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).

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Causes 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 ).

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What 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)

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Why 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.

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Deficit 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.

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Deficit 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.

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Deficit 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.

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Deficit 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.

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Deficit 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.

22
Deficit 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.

23
Deficit 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.

24
Deficit 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.
  

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Deficits 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.

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Deficit 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.

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Deficit 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.

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What Are The Intervention Areas?

• Educational Accommodations
• Executive Functioning Deficits
• Classroom Interventions
• Promoting Appropriate Behavior
• Medication Options
• Stimulant Medication
• Medication and Side Effects

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Response 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).
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Working 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).
31
Self-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).
32
Sustained 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).
33
Task 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).
34
Planning

• 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).
35
Organization

• 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).
36
Time 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).
37
Goal-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).
38
Flexibility

• 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).
39
Metacognition

• 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).
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Classroom 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).

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Other 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).
42
How 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).
43
Medicinal 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).

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Commonly 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
45
Conclusion

• 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!

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Where 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

47
References

• 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.

48
References 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.