At the end of this presentation you should be able to:

• Describe the characteristics of attention deficit/hyperactivity disorder.

• Understand the different terminology and probable causes of ADHD.

• Understand the characteristics of ADHD and it’s educational implications.

• Describe the educational strategies that are commonly used with this population.

Chapter 5 Objectives

ADD/ADHD

Chapter Objectives

Definition• Neurological condition

– Failure of brain circuitry that monitors inhibition and self-control

– Impairs ability to defer immediate rewards for later gain• Inattention• Hyperactivity/impulsivity• Excessive motor activity which may be seen as non-compliance• Developmentally inconsistent with age of child• Runs in families

Case Study

• Attention video• http://www.pbs.org/wgbh/misunderstoodminds/

attention.html• Nate’s story• http://www.pbs.org/wgbh/misunderstoodminds/

meetnathanS.html

Subtypes• ADHD (with hyperactivity)

– easier to diagnose – move continuously– trouble sitting still– poor impulse control– temper outbursts

• ADHD without hyperactivity (impulsive and inattentive form)– withdrawn or "spaced-out" – poor academic achievers– occur concurrently with Learning Disabilities– excessive anxiety or shyness

DSM-IV

• Three sub-types– Predominantly inattentive– Predominantly hyperactive-impulsive– Combined types

DSM-IV

• Must exhibit several characteristics– Severity– Early onset– Duration– Impact– Settings

• At least 6 symptoms of one or both of the following:– Inattention– Hyperactivity

Symptoms• Inattention

– Lacks of attention to detail, careless– Has difficulty sustaining attention– Does not appear to be listening when spoken to directly– Is not able to follow through on instructions– Difficulty organizing– Avoids tasks requiring mental effort– Often loses things– Easily distracted– Forgetful

Symptoms• Hyperactivity

– Fidgets/squirms– Difficulty remaining seated– Runs or climbs excessively– Difficulty playing quietly– “On the go”– Talks excessively– Blurts out answers– Difficulty awaiting turn– Interrupts or intrudes on others

Causes• Inability of brain to filter competing sensory inputs• Inability to inhibit impulsive motor responses to sensory inputs• Possible genetic and/or biological

– Certain portion of brain (basal ganglia) is smaller in some children– Area which regulates impulses

• Non-genetic factors– Prematurity– Maternal chemical use– Exposure to lead– Prenatal neurological damage– Influence of environment

Incidence

• Symptoms apparent before 7 years of age• Symptoms present in two or more settings• Significant impairment in social, academic, or

occupational functioning• Symptoms not occurring exclusively during a

course of a mental health condition

Incidence

• 1.5-2.5 million in U.S.• Boys - 4-9 times more likely to be diagnosed• Found in all cultures• 1/3 identified with LD• 40-60% co-exist with other conditions

Historical Account• ADHD has been known by many names over the last century:

– Hyperactive Impulse Disorder– Hyperactive Child Syndrome– Developmental Hyperactivity– Hyper-kinetic Syndrome– Minimal Brain Dysfunction– Minimal Brain Damage Syndrome– Moral Control Deficit– Organic Drivenness (1930)

Historical Account• 2500 years ago, the great physician-scientist, Hippocrates

described a condition that seems to be compatible with what we now know as ADHD.

• He described patients who had.... "quickened responses to sensory experience, but also less tenaciousness because the soul moves on quickly to the next impression".

• Hippocrates attributed this condition to an "overbalance of fire over water". His remedy for this "overbalance" was "barley rather than wheat bread, fish rather than meat, water drinks, and many natural and diverse physical activities".

From Hippocrates: Aphorisms. In The Genuine Works of Hippocrates (Translated from greek by Fancis Adams).

Diagnosis

• mental health professionals– parents and teachers observations of

child– rate behavior using specific

questionnaires

Evaluation• Behavioral

– Questionnaires and rating scales• Educational

– Impact on educational progress– Classroom observation– Measurement of productivity

• Medical– Medical exam– Questionnaires– DSM-IV criteria– Assessment of co-existing conditions

Legal/Educational Requirements

• Free and Appropriate Public Education (FAPE)– IDEA– Section 504 of Rehabilitation Act of 1973

• Categorical placement– “other health impaired”– Limits strength, vitality, or alertness (response to

environmental stimuli)– Significant impact on educational performance

Treatment Options• Behavioral approach

– Modify physical and social environment to alter behavior– Behavioral training

• Pharmacological approach– Most common and controversial– Prescribing is responsibility of qualified health care provider

• Psychostimulants• Antidepressants• Anti-anxiety medications• Antipsychotics• Mood stabilizers

Treatment Options

• Multimodal approach– Combination of approaches

• Educational approach• http://www.pbs.org/wgbh/misunderstoodminds/

attentionstrats.html#suggestions– Mental energy– Processing– Production

Discussion• Parent perspective• http://www.pbs.org/wgbh/misunderstoodminds/

attentionbasics.html• Does AD/HD exist?• http://www.pbs.org/wgbh/misunderstoodminds/

attentiondiffs.html• Medication debate• http://www.pbs.org/wgbh/misunderstoodminds/

attentionstrats.html

Educational Implications

• Consistent failure to understand or follow school rules• Frequent classroom interruptions• Poor academic performance• Lower daily grades• Failed courses• Expulsions• Increased dropout rates• Low rate of college-bound students

Inattention

• Missing important details• Daydreaming• Difficulty organizing materials/assignments

Hyperactivity

• Verbal or physical disruptions• Constant movement• Blurting/interrupting

Impulsivity

• Careless errors• Giving answers before thinking• Attending only to entertaining or novel activities

Approach to AD/HD in the classroom• Collaborate between home and school• Develop a behavior plan• Feedback on response to medications• Positive behavioral intervention plan• Student input• Work on most difficult concepts early in the day• One assignment at a time• Vary pace and types of activities• Structure student environment

Approach to ADHD at home

• Discreet rewards and consequences• Daily routine• Time-out from reinforcing behaviors• Use tangible reminders• Be consistent when responding to inappropriate

behaviors• Avoid surprise consequences

Activity

• http://www.pbs.org/wgbh/misunderstoodminds/attention.html