Attention Deficit Hyperactivity Disorder

							Attention Deficit Hyperactivity
           Disorder
              EDU381
        Immaculata University
          Matthew Speicher
               6/2/10
      Recent Changes in Definition
• For many years, the Diagnostic and Statistical Manual of
  Mental Disorders (DSM) used the term attention deficit
  disorder (ADD) to refer to all people with the condition, but
  it allowed for subtypes of ADD with and without
  hyperactivity.
• Recent changes to the DSM have begun using the general
  term attention deficit hyperactivity disorder (ADHD) to
  refer to all people with the condition. However, ADHD is
  now divided into the following subtypes:
   – ADHD (Predominantly Inattentive Type)
   – ADHD (Predominantly Hyperactive-Impulsive Type)
   – ADHD (Combined Type)
       Characteristics / Symptoms of
                 Subtypes
• ADHD (Predominantly 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 and finish tasks.
   – Has difficulty with organization.
   – Avoids or dislikes tasks requiring sustained mental effort.
   – Often loses things necessary for tasks and activities
   – Is easily distracted.
   – Is forgetful in daily activities.
• ADHD (Predominantly Hyperactive-Impulsive Type)
   – Fidgets with hands or feet or squirms in chair.
   – Has difficulty remaining seated.
   – Runs around or climbs excessively during inappropriate
     situations.
   – Has difficulty engaging in activities quietly.
   – Acts as if driven by a motor.
   – Talks excessively.
   – Blurts out answers before questions have been completed.
   – Has difficulty waiting or taking turns.
   – Interrupts or intrudes upon others.
• ADHD (Combined Type)
   – Meets both inattentive and hyperactive/impulsive criteria.
                       Diagnosis
• Diagnosing ADHD can be tricky (especially when
  taking the three subtypes of the disorder into
  account), so most authorities stress the use of
  several sources of information before arriving at a
  firm diagnosis. These sources include:
   –   A medical examination
   –   A clinical interview
   –   Teacher and parent rating scales
   –   Behavioral observations
            Diagnosis of Subtypes
• ADHD (Predominantly Inattentive Type)
   – Six or more of the Inattentive Type symptoms have been
     observed for at least six months to a degree that is
     maladaptive and inconsistent with developmental level of
     the subject.
• ADHD (Predominantly Hyperactive-Impulsive Type)
   – Six or more of the Hyperactivity-Impulsive Type symptoms
     have been observed for at least six months to a degree
     that is maladaptive and inconsistent with developmental
     level of the subject.
• ADHD (Combined Type)
   – Both the criteria for Inattentive Type and Hyperactivity-
     Impulsive Type have been met by the subject.
               Potential Causes
• There are five areas of the brain that might be affected
  in people with ADHD: the prefrontal lobes, the frontal
  lobes, the basal ganglia, the cerebellum, and the
  corpus callosum.
• An imbalance of the two following neurotransmitters:
  dopamine and norepinephrine.
• Studies have suggested that heredity may be a
  significant cause of ADHD.
• Exposure to toxins (such as lead), abuse of substances
  (such as tobacco and alcohol), and other medical
  factors (such as complications at birth and low birth
  weight) have been linked to ADHD.
     Interesting Myths and Facts
• Myth: All people with ADHD are hyperactive.
  – Why is this not true?
• Myth: The primary symptom of ADHD is
  inattention.
  – Fact: Although inattention is a symptom of ADHD, the
    primary behavioral problems associated with ADHD
    are:
     •   Behavioral inhibition
     •   Issues with executive function
     •   Issues with time awareness and management
     •   Issues with goal-directed behavior
      Interesting Myths and Facts
• Myth: ADHD is primarily the result of minimal brain injury.
   – Fact: In most cases of ADHD, there is no evidence of actual
     damage to the brain.
• Myth: Social problems of students with ADHD are due to
  their not knowing how to interact socially.
   – Fact: Most people with ADHD know how to interact, but their
     problems with behavioral inhibition make it difficult to utilize
     socially appropriate behaviors.
• Myth: ADHD is primarily a U.S. phenomenon, due to our
  society’s emphasis on achievement and conformity.
   – Fact: Evidence strongly suggests that prevalence rates of ADHD
     are at least as high in the following countries (among others) as
     they are in the United States: Canada, Australia, New Zealand,
     Germany, Japan, China, Brazil, and the Netherlands.
      Interesting Myths and Facts
• Fact: ADHD is widely recognized as one of the most
  frequent reasons children are referred for behavioral
  problems to guidance clinics. 30% - 50% of cases referred to
  guidance clinics are for ADHD.
• Fact: Most authorities estimate that between 3% and 7% of
  all school-age children have ADHD.
• Fact: ADHD is much more prevalent in boys than girls.
  Authorities estimate that ADHD affects boys at a rate of 3:1
  in comparison to girls. Some gender bias in referral may
  exist, and it has been noted that boys are more likely to
  exhibit the more highly noticeable behaviors associated
  with ADHD, but current research suggests that these
  factors are not enough to account for the wide disparity in
  prevalence rates between boys and girls.
      Instructional Strategies / SDI
• Accommodations: These are changes in the way in which
  the child is treated in order to best accommodate the
  child's physical, cognitive or emotional challenges.
   – Extended time for tests (the standard is one and a half times as
     long as allowed, but for academic tests in most general
     education classrooms, unlimited time is not uncommon).
   – Frequent test breaks.
   – The ability to move around the classroom.
   – Bathroom breaks when needed.
   – Special seating (in front of class and/or separated from peers).
   – A water bottle at the student's desk (some medications create
     dry-mouth).
      Instructional Strategies / SDI
• Modifications: These change the academic or curricular
  demands made of a child to better fit the child's ability.
   – Modified homework.
   – Limited amount (fewer) words on spelling tests.
   – Scribing: the teacher or an aide writes the responses as dictated
     by a child.
   – Separate / modified tests in content areas.
   – Alternate forms of assessment: dictating, oral retelling,
     portfolios, etc.
• Sample SDI:
  http://www.ohio.k12.ky.us/OCEC/information/Specially%2
  0Design%20Instruction.pdf
                   Sample Goals
• The student will complete assignments in a timely
  manner with 80% accuracy.
   – The student will utilize teachers and study skills class to
     complete assignments and get a better understanding of
     the material.
   – The student will bring appropriate supplies to class so that
     all work can be completed.
   – The student will raise their hand or approach the teacher
     to ask for help when they do not have a clear
     understanding.
   – When the student is having trouble staying on task, they
     can take a time out in the hall or use the appropriate
     suggestions in their behavior plan.
                Sample Goals
• The student will be able to answer inference
  questions, make predictions, outline, and
  summarize with 80% accuracy.
  – The student will be able to use an outline, web, or
    graphic organizer to get a better understanding of
    a reading passage.
  – The student will be able to make predictions and
    assumptions by organizing their information to get
    a better understanding.
                Parental Strategies
• Schedule: Keep the same routine every day, from wake-up time to
  bedtime. Include time for homework, outdoor play, and indoor
  activities. Keep the schedule on the refrigerator or on a bulletin
  board in the kitchen. Write changes on the schedule as far in
  advance as possible.
• Organize everyday items: Have a place for everything, and keep
  everything in its place. This includes clothing, backpacks, and toys.
• Use homework and notebook organizers: Use organizers for school
  material and supplies. Stress to your child the importance of writing
  down assignments and bringing home the necessary books.
• Be clear and consistent: Children with ADHD need consistent rules
  they can understand and follow.
• Give praise or rewards when rules are followed: Children with
  ADHD often receive and expect criticism. Look for good behavior,
  and praise it.
                   Video Segments
•   ADHD Facts Video: http://www.youtube.com/watch?v=iJIU1ybbYWI
•   ADHD Diagnosis Video: http://www.youtube.com/watch#!v=YBFH81zbCiY
•   ADHD and the Brain: http://www.youtube.com/watch#!v=ZJHT5XROrBA
•   Frontline: “The Medicated Child”
     – Full Video:
       http://www.pbs.org/wgbh/pages/frontline/medicatedchild/parents/
     – Part 1: http://www.youtube.com/watch#!v=yCfRqNISQZg
     – Part 2: http://www.youtube.com/watch?v=o0GE6VtFrNs
     – Part 3: http://www.youtube.com/watch?v=sZyK86_KD-g
     – Part 4: http://www.youtube.com/watch?v=LoHv-_Rwu6c
     – Part 5: http://www.youtube.com/watch?v=CVcurkmosUQ
     – Part 6: http://www.youtube.com/watch?v=3J7QkyS_nCg
               Useful Links
• http://www.nimh.nih.gov/health/publications
  /attention-deficit-hyperactivity-
  disorder/index.shtml
• http://www.chadd.org/
• http://www.cdc.gov/ncbddd/adhd/index.html
• http://www.ohio.k12.ky.us/OCEC/information
  /Specially%20Design%20Instruction.pdf
• See “Video Segments” section for more useful
  links.