ADD and ADHD

1. ADD and ADHD By Clare Paronich, Allison Pfeiffer, Ashleigh Carlucci and Samantha Esposito

2. Definitions • Attention Deficit Disorder: • Is a syndrome usually diagnosed in childhood, characterized by a persistent pattern of impulsiveness, a short attention span and interfering especially with academic, occupational and social performance. • Attention Deficit Hyperactivity Disorder: • Is attention deficit disorder in which hyperactive behavior is present.

3. Prevalence • The American Psychiatric Association states in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR) that 2%-7% of school-aged children have ADHD. • As of 2007, parents have reported that approximately 9.5% of children ages 4-17 have been diagnosed with ADHD.       • Rates of ADHD diagnosis have increased an average of 5.5% per year from 2003 to 2007.         • ADHD affects up to 1 in 20 children in the USA, which has led to the impression that ADHD is largely an American disorder and is much less prevalent in other countries.

4. Video • http://youtu.be/Rcy2jF1EXjk

5. Inattentive vs. hyperactive Inattention symptoms of ADHD include: • Not paying attention to detail • Making careless mistakes • Failing to pay attention and keep on task • Not listening • Being unable to follow or understand instructions • Avoiding tasks that involve effort • Being distracted or forgetful • Losing things that are needed to complete tasks

6. Inattentive vs. Hyperactive Hyperactivity-impulsivity symptoms of ADHD include: • Fidgeting • Squirming • Getting up often when seated • Running or climbing at inappropriate times • Having trouble playing quietly • Talking excessively or out of turn • Interrupting

7. Combinations of inattentive and hyperactive 1. ADHD, Combined Type: Both inattention and hyperactivity-impulsivity symptoms 2.ADHD, Predominantly Inattentive Type: Inattention, but not enough (at least 6 out of 9) hyperactivity-impulsivity symptoms 3. ADHD, Predominantly Hyperactive-Impulsive Type: Hyperactivity-impulsivity, but not enough (at least 6 out of 9) inattention symptoms

8. Characteristics of ADD and ADHD • Hyperactivity, fidgetiness and/or squirming. • Impulsivity (difficulty staying focused on an immediate task because other thoughts often intrude and race through the mind. • Inattention for “boring” or “unexciting” mental activity (school work or formal learning experiences) • Walking slowly or being disorganized and/or grumpy in the morning unless anticipating high excitement activity.

9. Characteristics (cont.) • Difficulty remaining seated when required to do so • Difficulty waiting for a turn in tasks, games, or group situations • Blurting out answers before questions have been completed • Shifting from one unfinished activity to another • Loosing things necessary for tasks/activties • Difficulty delaying gratification

10. Characteristics (cont.) • Falling asleep slowly and with great difficulty at night. • Episodic explosiveness (also referred to as emotional outburst or temper tantrums) manifest as verbal violence and/or hitting, biting, kicking etc. • Unexplained and unreasonable emotional negativity. • Spatial dyslexia • Writing mirror imagine reversals of letters, difficulty with left-right discrimination, and difficulty properly sequencing letters, words or numbers.

11. Myths vs. Facts Activity • Only kids who are hyper have ADHD/ADD. ________ • Bad parenting does not cause ADHD. _________  • ADD/ADHD affects a person’s intelligence. _________ • ADHD/ ADD can be found in adults and teenagers, as well as children. ______  • Children can outgo ADHD/ADD. _________  • Children on ADHD or ADD medicine are more likely to take drugs when they get older. _________  • Children with ADHD/ADD have trouble sleeping at night. _________  • Children with ADHD/ADD are just poorly disciplined. ________  • Ritalin can temporarily effect a child’s height. _________  • Children with ADD/ADHD will never amount to anything. ­ _________ 

12. Assessment • There is no single medical or physical test for diagnosing ADD/ADHD. • A doctor or health professional will have to get involved in order to diagnosis a child. • A checklist of symptoms • Answer to questions about past or present problems. • Medical exam to rule out other causes for symptoms • Learning disabilities and emotional issues have similar symptoms as ADD/ADHD

13. Assessment • Important factors to consider when diagnosis or evaluating for ADD/ADHD • How severe are the symptoms? • When did the symptoms start? • How long have the symptoms been bothering you or your child? • When and where do the symptoms appear?

14. Etiology • Exact cause is unknown. • Experts know that there is a strong genetic component. • Although in some cases there is no genetic link. • High frequency of ADD/ADHD occur when one or more family members has ADHD. • At least 1/3 of all fathers or mothers who had ADHD in their youth, have children with ADHD. • Some brain changes can cause ADHD. • Children or adults who have abnormal functioning, or deregulation, of neurotransmitters. • There also tends to be abnormal functioning in the nerve pathways that regulate behavior.

15. Placement • According to the Individuals with Disabilities Education Act, ADD and ADHD does not fall under the thirteen qualifying categories of learning disabilities. • Therefore this means the child is not granted automatic entry into special education.

16. PlacementSteps to take as a parent: If a parent feels that their child’s ability to learn is being adversely affected, they can ask the school for a student study team meeting. • If the SST team believes that the child could have a specific learning disability, they may recommend a formal special education evaluation. • If the IEP/SST team feels that modifications are appropriate for the child to be successful they can be implemented through a 504 plan. • If the parents still feels the child’s disorder is severe enough to warrant a placement in special education, they can request a special education evaluation. But a general education class with a 504 plan would be first step.

17. Related Services • On an IEP, ADD/ADHD is classified as an Other Health Impairment, and in order to classify for special education services in public schools under the category of OHI, the health impairment must affect the child’s educational performance • Decisions about the need for special/related services for students with ADD/ADHD are made on an individual basis depending on the level of severity

18. Related Services (cont) • A student whose disability is categorized as ADD/ADHD or OHI on their IEP has no mandated services according to state laws • If they are categorized for another disability in addition to ADD/ADHD, such as a Learning Disability, they may qualify for: • Occupational Therapy • Physical Therapy • Speech/Language Therapy • Reading Specialist • Counseling

19. Academic Instruction • Prepare the students for the days lesson- briefly explain what you will be doing • review, new info, activities • Review previous lessons • remind children what you did yesterday & practice before moving on • Set learning expectations • what are students expected to learn? • Set behavioral expectations • can they talk to their neighbor, is it independent, where they should be sitting • State all materials that will be needed • Explain additional resources • Where can students look for help?

20. Academic Instruction (cont.) • Be predictable • structure and consistency is best minimal rules and choices are most effective • Support student participation in class • silent cues/warnings, avoid sarcasm and criticism • Use lots of visuals • Assess student performance throughout the lesson • Help students correct their own mistakes • do not do it for them! • Provide written and oral follow-up directions • page numbers on board, repeat directions • Provide advance warnings

21. ELA & Reading ComprehensionInstructional Strategies • Silent Reading • Partner reading (pair child with stronger reader • Storytelling • Role-play • Board games • Recorded books

22. Instructional Strategies for Phonics • Mnemonics • “when two vowels go walking, the first does the talking” • Word families • Board games • Picture-letter charts Instructional Strategies for Handwriting: • Quiet places with little distraction • classroom office • Spacing between words • Lined paper • Shoe line, writing line, belt line, hat line

23. Instructional Strategies for Writing • Establish standards for acceptable written work • Storyboard • describe different parts of the story you are writing • Classroom post office • encourage students to write letters to one another and teacher Instructional Strategies for Spelling • Use everyday examples for hard to spell words- if a student is having a sandwich for lunch, practice spelling it • Spelling words- frequent words • Keep a dictionary of frequently misspelled words • Partner spelling- quiz • Movement activities- jump rope and spell, dances, songs

24. Instructional Strategies for Math: • Teach students to recognize patterns (hundreds chart) • Mnemonics (PEMDAS • Use real life examples and students names! • Color code symbols (+,-,x,÷) • Board games • Highlight key words in word problems • Number lines, manipulatives, graph paper,

25. Accommodations • Children and youth with ADD and ADHD often have serious problems in school. Inattention, impulsiveness, hyperactivity, disorganization, and other difficulties can lead to unfinished assignments, careless errors, and behavior which is disruptive to one's self and others. Through the implementation of relatively simple and straightforward accommodations to the classroom environment or teaching style, teachers can adapt to the strengths and weaknesses of students with ADD. Small changes in how a teacher approaches the student with ADD or in what the teacher expects can turn a losing year into a winning one for the child.

26. Accommodations for Inattention • seat student in quiet area seat • student near good role model seat student near "study buddy" • increase distance between desks • allow extra time to complete assigned work • shorten assignments or work periods to coincide with span of attention; • use timer break long assignments into smaller parts so student can see end to work • require fewer correct responses for grade • reduce amount of homework • instruct student in self-monitoring using cueing

27. Accommodations for Mood • look for opportunities for student to display leadership role in class • conference frequently with parents to learn about student's interests and achievements outside of school • send positive notes home • provide reassurance and encouragement • frequently compliment positive behavior and work product • speak softly in non-threatening manner if student shows nervousness • review instructions when giving new assignments to make sure student comprehends directions

28. Accommodations • if written language is weak: accept non-written forms for reports (i.e. displays, oral, projects); accept use of typewriter, word processor, tape recorder; do not assign large quantity of written work; test with multiple choice or fill-in questions • if math is weak: allow use of calculator; use graph paper to space numbers; provide additional math time; provide immediate correctness feedback and instruction via modeling of the correct computational procedure • if reading is weak: provide additional reading time; use "previewing" strategies; select text with less on a page; shorten amount of required reading; avoid oral reading • if oral expression is weak: accept all oral responses; substitute display for oral report; encourage student to tell about new ideas or experiences; pick topics easy for student to talk about

29. Accommodations for Impulsiveness • attend to positive behavior with compliments etc.. • acknowledge positive behavior of nearby students • seat student near role model or near teacher • ignore minor, inappropriate behavior increase immediacy of rewards and consequences • use time-out procedure for misbehavior • supervise closely during transition times • use "prudent" reprimands for misbehavior (i.e. avoid lecturing or criticism)

30. Organization Planning • supervise writing down of homework assignments • send daily/weekly progress reports home • regularly check desk and notebook for neatness, encourage neatness rather than penalize sloppiness • ask for parental help in encouraging organization, • provide organization rules • encourage student to have notebook with dividers and folders for work • provide student with homework assignment book

31. Accommodations for Motor Activity • allow student to stand at times while working • provide opportunity for "seat breaks" i.e.run errands, etc. • provide short break between assignments • supervise closely during transition times • remind student to check over work product if performance is rushed and careless • give extra time to complete tasks

32. Accommodations for Compliance • seat student near teacher • set up behavior contract • implement classroom behavior management system • praise compliant behavior • provide immediate feedback • ignore minor misbehavior • use teacher attention to reinforce positive behavior

33. Accommodations for Socialization • prompt appropriate social behavior either verbally or with private signal • Encourage cooperative learning tasks with other students • provide small group social skills training • praise appropriate behavior • monitor social interactions • set up social behavior goals with student and implement a reward program.

34. ADD/ADHD Simulator Activity • http://youtu.be/xfo1tZ95Ypk

35. Materials/Equipment • Assistive Technology is defined as "Any item, piece of equipment, or product system, whether acquired commercially or whether off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of people with disabilities" (Technology-Related Assistance for Individuals with Disabilities Act of 1988). • help to improve certain skills and deficits and increase self reliance • ranges from low-tech, to high tech, to  no tech.

36. Low-Tech Assistive Technology • Highlighter: • draw out the main ideas from a reading passage • receive a copy of notes and highlight important/emphasized sections so the student can stay at the same pace as the rest of the class without losing content and information due to slow writing or processing skills. • Pointers: - visually track written words on a page (bookmarks)

37. Low-tech (continued) • Porcupine pens: •  decorated with fabric: students who need tactile feeling.  • students stay focused instead of tapping pencils or tearing paper • Stress ball: (binder clips) • Students who need tactile items

38. Low-tech (continued) • Graphic Organizers: • Can be used in all subject areas and grade levels • make material less intimidating • help provide direction • help students to organize content and pick out the essential information • Timers: • Help track student progress during lesson • No surprises when you say to clean up if they are not yet finished

39. High-tech assistive technology • Livescribe Pen: • WIFI smart pen • Records audio that you can (tap on notes and plays back) • Transferred wirelessly to computer • http://www.livescribe.com/en-us/smartpen/wifi-smartpen/ • WordQ: • Reads aloud any text you can highlight • Helps with comprehension and proofreading • http://www.goqsoftware.com/products/

40. Strategies in the classroom Behavior Management Strategies • Give your attention to appropriate behaviors. • Provide opportunities for physical movement • Use progress charts and other visual records of behavior to encourage more appropriate behavior.  • Assign a capable "study buddy" who can remind and assist the active or disorganized student. • Assign duties that require self-control (e.g., line leader, materials distributor).  • Teach self management of behavior

41. Strategies in the classroom Modifications To The Classroom Environment • Assign the student to a seat that best allows him/her to observe you while avoiding distractions (e.g., away from doors, windows, pencil sharpeners). • Eliminate excessive noise. • Eliminate excessive visual stimuli and clutter that might distract the youngster. • Employ study carrels or seat the student in the area of the classroom with the least distractions, and/or face the desk toward the wall.  • Keep directions and commentary short and to the point.  Avoid "overloading" the student with too much verbiage.

42. Strategies in the classroom Starting Your Lesson • Provide "do now" activities for other students tob focus the ADD/ADHD student. • Be sure you have the pupil's attention before you start. • Use alert cues to get the student's attention before giving directions. • Use more than one modality when giving directions.  Supplement verbal instructions with visual ones. • Repeat and simplify the directions. • Place instructions on an audio tape that can be replayed by the student as needed. • To ensure understanding, have the student repeat the directions in his/her own words. • Have the student underline or highlight directions. 

43. Strategies in the classroom Making Lessons More Interesting • Give a general overview first.  Let the student(s) know what will be learned and why it is important in life. • Devise interesting activities. • Use examples that capitalize on the student's interests. • Ensure that your style of presentation is enthusiastic and interesting. • Use game formats to teach and/or reinforce concepts and material. • Use concrete objects to assist in keeping the student's attention. • Incorporate movement into lessons. 

44. Strategies in the classroom Transitions • Set up routines that prepare the youngster for upcoming transitions. • Set expectations for behavior BEFORE an activity or event. • Provide checklist of things one may need to transition to next class on desk so they can refer to it. • Keep unstructured time to a minimum. • Seat student next to appropriate models.

45. Strategies in the classroom Testing Accommodations • Use oral testing if that format will keep the student's attention and better assess his/her knowledge. • Use performance testing.  Have the student do something or make something. • Provide extended time to finish. • Assign the test grade based on performance on different aspects of the assessment (i.e., organization, writing mechanics, subject knowledge displayed). • To increase reflection and concentration, have the student identify the correct answer AND cross out incorrect answers on multiple choice tests.  Inform the student that there may be more than one correct answer. 

46. Metacognition in the classroom • Ask metacognitive questions throughout the day. • What strategies will you use to study for the test? • What strategies worked best for you? • What will you do differently? • Use models to have students evaluate their work. • Have students repeat directions in their own words.

47. Metacognition in the classroom • Give assignments that require evaluative skills. • Asking students what grade they deserve on assignment. • Demonstrate thinking aloud during lessons. • Students will use your thought process as a model when completing assignments • Praise students that use metacognitive skills.

48. Post-Secondary Vocational Schools • More and more high school students with disabilities are planning to continue their education in postsecondary schools, including vocational and career schools, two- and four- year colleges, and universities. • Students with ADD/ADHD have unlimited options. It is really the individual’s choice whether he or she would like to continue schooling after high school. • Many students with ADD/ADHD choose to go to two year schools, four year colleges or universities, or trade schools.

49. Recreational Programs • Children with ADD/ADHD often have energy to burn. Organized sports and other physical activities can help them get their energy out in healthy ways and focus their attention on specific movements and skills • Teachers should encourage parents to involve their child in sports!

50. Continued.. • The benefits of physical activity are endless: it improves concentration, decreases depression and anxiety, and promotes brain growth. Most importantly for children with attention deficits, however, is the fact that exercise leads to better sleep, which in turn can also reduce the symptoms of ADD/ADHD. • Children with ADD/ADHD may also benefit from martial arts training, tae kwon do, or yoga, which enhance mental control as they work out the body.