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Attention Deficit Hyperactivity Disorder (ADHD)

Why Can't They Just Sit Still and Listen?!

Myths and Realities

What is Attention Deficit Hyperactivity Disorder?

ADHD is a chronic disorder caused by a chemical imbalance in the brain that can begin in infancy and extend through adulthood. Some hyperactive-impulsive or inattentive symptoms must be present before age 7 years.

  • It has negative effects on a child’s life at home, school, and within the community. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
  • It affects 3-7% of the school-age population.
  • Some impairments from the ADHD symptoms must be present in two or more settings (school, home, work, etc).
  • Some symptoms can be interpreted as indicators of ADHD when they are symptomatic of the stress of living in poverty or potentially violent situations.

An adverse effect on educational performance can incorporate all aspects of the child’s functioning at school, including educational performance as measured by grades or achievement test scores. It can also be manifested through behavioral difficulties at school; and impaired or inappropriate social relations; impaired work skills, such as being disorganized, tardy, having trouble getting to work on time and difficulty with following the rules. Schools are required to address the effects of a child’s disability in all areas of functioning, including academic, social/emotional, cognitive, communication, vocational and independent living skills.

DSM-IV classifications of Attention Deficit Hyperactivity Disorder

  • Combined Type
  • Predominantly Inattentive Type
  • Predominantly Hyperactive-Impulsive Type
  • Not Otherwise Specified

Do these descriptions of students remind you of anyone?

Six or more of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Inattention

  • Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
  • Often 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 (not due to oppositional behavior or failure to understand instructions).
  • Often has difficulty organizing tasks and activities.
  • Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework).
  • Often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books, or tools).
  • Often is easily distracted by extraneous stimuli.
  • Often is forgetful in daily activities.

Six or more of the following symptoms of hyperactivity-impulsivity

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 in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness).
  • Often has difficulty playing or engaging in leisure activities quietly.
  • Often is “on the go” or often acts as if “driven by a motor.”
  • Often talks excessively.

Impulsivity

  • Often blurts out answers before questions have been completed.
  • Often has difficulty awaiting turn.
  • Often interrupts or intrudes on others (e.g. butts into conversations and games).

Diagnostic Criteria from DSM-IV published by the American Psychiatric Association, 1994. ISBN – 0-89042-063-7

Differing paradigms regarding ADHD diagnosis

click here to view table

From ADD/ADHD Alternatives In The Classroom ~ Thomas Armstrong ISBN 0-87120-359-6

Teaching Strategies For Students With Attention Differences

Structure the classroom so that expectations are clearly understood, rules are plainly stated, and routines are predictable. Review the classroom rules frequently. If a student is having difficulty with a specific rule, write down the rule for the student. Be clear and concise. Provide the student with specific examples of the rules.
Assist the students with any transition difficulties that could lead to organizational or behavioral differences during class. Allow the student a few additional minutes to adjust and organize materials before beginning class.
Place the student in a location with minimal number of distractions. Students with attention differences should be seated away from doors, windows, or high traffic areas. Seat students who are good role models near students with attention differences.
Intersperse low interest, passive tasks with high interest, active tasks; strive for tasks that invite child participation.
Give directions clearly, after gaining the attention of the student. Keep directions short and simple, and avoid giving a long series of commands at one time. Have the student repeat the directions to you, if necessary, to ensure understanding.
Encourage students to “talk themselves through tasks” as a means of reducing impulsive decision making and improving sequential organization of the steps involved in performing an assignment or handling a new situation. To counter self-esteem problems, encourage “self-talk” (i.e., “I worked well on that assignment”).
Develop a system to monitor the student. Make frequent eye contact with her. Create a private signal to use when the student must pay attention. You may also wish to create a signal that she can use to indicate that she needs your attention or help.
Help the student get organized. A “buddy” can help the student gather materials and prepare for class.
Keep independent work time as short as possible. It is easier for these students to work for two twenty-five minute sessions rather than one fifty-minute session.
Create smaller tasks from a large assignment. These students can be overwhelmed by large assignments. Smaller tasks make the assignment seem manageable and increase the possibility that the assignment will be completed.
Vary presentation style. Words written in varying colors on the board, underlined words, colored transparencies, colored type, or font changes can increase attention.
Handwriting can be very difficult for students with attention differences. Many of these students have weak written language skills (dysgraphia). Oral examinations can allow students to truly demonstrate their knowledge. Use of computers on written assignments and examinations can also help students with attention differences. Allowing another student to photocopy notes can also ensure that the student has received information from class.
When students are taking an examination, avoid timing the class. This can frustrate the student with attention differences and may lead the student to guess at answers or give up entirely. When giving group assessments, ask all students to remain in their seats and read quietly until everyone has finished.
Allow the student to release excess energy. It is difficult for many students with attention differences to sit for long period of times. This movement can include a trip to the restroom, serving as a messenger to another classroom, helping erase the board, or simply standing and stretching. Green and red flip cards can also be useful. When the red side is showing it means the student needs to remain seated. When the green side is showing the student may quietly move about the room.
Students with attention differences respond well to tasks they can complete by doing. Movement aids their ability to attend to classroom activities and retain information.
Coach the student in social skills. Students with attention differences often have difficulty relating to peers. They may cut in line, talk too much, blurt out answers, interrupt conversations, or intrude in games. They also sometimes have difficulty making friends. Give the student guided practice in ways to handle various situations. Over time, this can help the student become more observant of his behavior, more aware of alternative ways of behaving, and less impulsive when responding.
Put emphasis on quality rather than quantity when making assignments. Consider reducing assignments and emphasizing competency and mastery. Students with attention differences may also need extra time to complete assignments.
Keep a daily schedule on the board or other prominent place. Discuss the schedule and remind in advance any changes that will occur. Use signals such as turning the light off/on, ringing a bell or playing music as a gentle reminder the activity is coming to a close.
If possible, allow the student to have an extra set of classroom materials, or an extra instrument at home. This can help with transition and assure that the student will be in class with all required materials.
If the student is having difficulty completing assignments within the allotted time, set a timer. The timer can coincide with the amount of time you perceive the student is able to remain focused. Tell the student what you expect to be completed in the allotted time. Gradually, the time can be increased and the student can experience success in completing assignment.
Use random strategies when calling on students during large and small group activities. Place the students’ names in a basket and randomly select one. Be sure to call on the student with attention differences before she becomes agitated from waiting longer than she is able.
When working with students, especially elementary level students, use a lot of whole-body (gross motor) activities. Keep hands busy and allow for postures other than sitting. Provide strong visual input and “show” then “tell” students.
Place the majority of colorful items in the back of the classroom, or an area not facing the students during group instruction. This will help alleviate distractions.
Encourage students to learn to plan by requiring the use of a homework and/or day planner and helping students develop a “stop” strategy:
    • S top - slow down….take a deep breath
    • T hink – What is my problem?
    • O ptions – What are my choices?
    • P lan – What am I going to do?

An ADHD Toxic Teacher is:

 

  • A teacher who doesn’t "believe in" ADHD, and refuses to accommodate students
  • A teacher who shows little interest in his/her students
  • A teacher who is rigid and inflexible
  • A teacher who is boring or non-creative
  • A teacher who is disorganized
  • A teacher who can’t be bothered to help students individually
  • A teacher who motivates through shame and criticism rather than praise and encouragement

From “Is your Teacher ADD-Friendly or ADD-Toxic?” ~ Kathleen Nadeau PhD author of Help4ADD@ High School

Things teachers can do to contribute to student misbehavior

  • Neglect to create a positive, personal relationship between the student and teacher.
  • Create class rules that are unclear.
  • Create vague expectations of students.
  • Allow too little structure or routine in the classroom
  • Quickly and without warning transition from one activity to another
  • Create work that is too difficult and/or takes too long to complete
  • Offer too little feedback
  • Create work that is not high interest or novel (boring, repetitive, not meaningful)
  • Create assignments that do not hook or maintain a student’s attention
  • Place student near distractions (the door, hamster cage, pencil sharpener)

An "ADHD-friendly teacher" is:

  • A teacher who is excited about a subject, and works in creative ways to get students excited also.
  • A teacher who is flexible, and tries to work with students instead of rigidly sticking to "the rules."
  • A teacher who encourages, rather than lectures, when students are having difficulties.
  • A teacher who understands that ADHD can cause forgetfulness, even when students are trying really hard to remember.
  • A teacher who is organized and clear about what is required in the course.
  • A teacher who is fun, interesting, and seems to enjoy the class.

From “Is your teacher ADD-Friendly or ADD-Toxic?”~ Kathleen Nadeau PhD author of Help4ADD@ High School

Teacher Attitudes and Beliefs: Things we can do to help students with ADHD

Accept characteristics of ADHD, especially inconsistent performance.
Recognize that students with ADHD perform at their best in a safe environment—academically, emotionally and socially. Sarcasm, bringing attention to deficits, and unkind criticism are to be avoided at all times. Children with ADHD respond significantly better when they are encouraged and feel safe to make mistakes.
Attend in-service sessions and read material regarding ADHD. Learn as much as possible about how stimulant medication works, and avoid any derogatory comments about the student’s use of medicine or of the medicine itself. Be flexible in your teaching and your classroom management plans.
Recognize that medication is only a part of the answer and does not address a student’s comprehensive needs all by itself.
Recognize that no two students with ADHD are alike and that there are multiple approaches to working with each student that can and will be different from student to student. Do not attribute all behavior and school work to ADHD. Recognize that ADHD is neurological and beyond the control of the student.
Accept poor handwriting and printing.
Realize that school can be very ADHD unfriendly. Schools contain elements that are possibly toxic to ADHD students: fatigue, boredom, day is too long, you have to sit still, too much listening, too many distractions, the day is controlled, too many rules, not enough high interest activities, too many things to remember and organize, too much homework, “ADHD Toxic Teachers.”

from “Teaching Teens with ADD and ADHD: A quick reference guide for teachers and parents” ~ Chris A. Zeigler Dendy, M.S. ISBN: 1-890627-20-8

Ideas for reframing common ADHD behaviors

BOSSINESS: “leadership” (albeit carried too far)

HYPERACTIVE: “energetic”/ “high energy”/ “does ten projects at one time”/ “works long hours”

STRONG-WILLED: “tenacious”

DAY DREAMER: “creative”/ “innovative”/ “imaginative”

DARING: “risk taker”/”willing to try new things”

LAZY: “laid back”/ “Type B personalities live longer”

INSTIGATOR: “initiator”/ “innovative”

MANIPULATIVE: “delegates”/ “gets others to do the job”

AGGRESSIVE: “assertive”/ “doesn’t let people take advantage of him”

QUESTIONS AUTHORITY: “independent”/ “free thinker”/ “makes own decisions”

ARGUMENTATIVE: “persuasive”/ “may be attorney material”

POOR HANDWRITING: “maybe she’ll be a doctor one day”

from Teaching Teens with ADD and ADHD: A quick reference guide for teachers and parents ~ Chris A. Zeigler Dendy, M.S. ISBN: 1-890627-20-8

Text Box: “When you know better, you do better.”   ~ Maya Angelou

Text Box: “Fair is providing students with what they need, not treating them all the same.”  ~A. Turnbull, R. Turnbull, M. Shank and D. Leal, 1999

 

Test Your Knowledge About ADHD

1. T or F ADHD is more prevalent in females than males.

2. T or F Stimulants have been found to improve ADHD symptoms in children, adolescents, and adults.

3. T or F ADHD is present in other cultures.

4. T or F ADHD is a learning disability.

5. T or F ADHD is caused by diets rich in food additives and sugar.

6. T or F Most individuals with ADHD are of gifted intelligence.

7. T or F Children with ADHD usually outgrow the disorder by adolescence or adulthood.

8. T or F According to DSM-IV criteria, all individuals with ADHD have problems with attention, impulsivity, and hyperactivity.

9. T or F Individuals with ADHD often have coexisting learning difficulties.

10. T or F Individuals with ADHD are at greater risk for dropping out of school and typically complete fewer years of education than their non-ADHD peers.

11. T or F ADHD is caused by poor parenting.

12. T or F Children with ADHD perform best on assignments that are detailed and complex.

13. T or F Peer tutoring can improve academic productivity and decrease off-task behavior of children with ADHD.

14. T or F Stimulants have the opposite effect on individuals with ADHD compared to their effect on those without ADHD.

15. T or F ADHD is caused by a chemical imbalance in the brain.

16. T or F Most individuals with ADHD are highly creative.

17. T or F Children with ADHD are automatically eligible for special education services.

18. T or F Ritalin is over-prescribed by physicians on a nationwide level.

19. T or F Increasing numbers of college students are requesting special services on an ADHD diagnosis.

20. T or F Individuals with ADHD can lead successful and productive lives.

From: An ADHD Primer by Lisa L. Weyandt, ISBN: 0-205-30900-3

Answers

Additional Resouces
Websites

Attention Deficit Disorder Association website.

ADHD News.com: Support Group for ADHD Children and ADHD Adults

Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) website.

Psychiatric Rating Scales for Attention Deficit Hyperactivity Disorder

The Attention Center

One ADD Place - A virtual neighborhood consolidating in ONE PLACE information and resources relating to Attention Deficit Disorder (A.D.D.), AD/HD and Learning Disorders (LD)

Council of Educators for Students with Disabilities, Inc. Section 504 information.

Healthline: ADD/ADHD Learning Center.

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