Understanding ADHD: Symptoms, Impact & Management

1. Part 4: Attention Deficit Hyperactivity Disorder/ Learning Disabilities

2. ADHD • Two ADHD children (11%) in every classroom in USA (Cleveland Clinic) • 4.1% American adults over 18 years old, 9% of American children ages 13-18 (DSM-V) • Most common: • Behavioral referral to health care professional • Referral/diagnosis in special education • Behavior problem in classes • Diagnosis in child MH facilities:

3. ADHD – Academics • 33% have academic problems (special ed, probation, drop out, held back) vs. 2% of controls • 48% have at least 1 year of special ed placement vs. 3% of controls • 12% have been held back a grade vs. 5% of controls • 9% drop out vs. 1% of controls • ADHD adolescents a full grade lower than controls, with twice the rate of absences • Source: Center for Children & Families, Florida International University

4. Costs to Society • Education: $14.7 billion • Healthcare: $11.6 billion • Parental work costs: $2.3 billion • Crime/delinquency: $11.4 billion • Annual cost per child: $4900 • Total: $40 billion annually • Source: Dr. Greg Fabiano, University at Buffalo

5. Complications of ADHD • ADHD has been linked to: • Poor school performance • Trouble with the law • Alcohol and Drug Use • Frequent Car accidents or other accidents • Unstable relationships • Financial Stress • Poor Physical and Mental Health

6. ADHD – Inattention • Often fails to give close attention to details, makes careless mistakes • Often has difficulty sustaining attention in tasks or play • Often does not seem to listen to what is being said to him/her • Often does not follow through on instructions, fails to finish schoolwork • Often has difficulty with organizing

7. ADHD – Inattention • Often avoids or has difficulty engaging in tasks that require standard mental effort • Often loses things necessary for tasks or activities • Often easily distracted by extraneous stimuli • Often forgetful in daily activities

8. ADHD – Hyperactivity/Impulsivity • Often has difficulty playing or engaging in leisure activities quietly • Is always on-the-go, acts as if driven by a motor • Often talks excessively • Often blurts out answers to questions before question has been completed

9. ADHD – Hyperactivity/Impulsivity • Often has difficulty waiting in lines or waiting for their turn in games or group situation • Often interrupts or intrudes on others • Often runs about or climbs inappropriately • Often fidgets with hands or feet, squirms in seat • Leaves seat when remaining in seat is expected

10. ADHD – Adulthood • 65% will persist into adulthood • Higher rates of motor vehicle accidents (more serious and more deaths) • Adolescents and driving: • 2-6 times more speeding violations • 4-5 times more overall violations • 2-4 times more accidents • 3 times more accidents with injury • 6 times more license suspensions • Source: Barkley, R.A., Guevremont, D.C., Anastopoulos, A.D., DuPaul, G.J. &Shelton, T.L. (1993). Driving—Related risks and outcomes of attentiondeficit hyperactivity disorder in adolescents and young adults: A 3- to 5-year follow-up survey. Pediatrics, 92(2): 212–218

11. ADHD – Adulthood • Symptoms which can be very disruptive • Individuals who do not have the level of patience needed to deal with frustration • Persons who are unable to think carefully through the consequences of their actions

12. Identifying ADHD Traits in Criminal Activity • Often create elaborate and unconvincing scenarios for what has occurred • Difficulty keeping stories straight • Trouble keeping secrets • Not good at lying • Source: Hurley, Patrick J., and Eme, Robert. ADHD and the Criminal Justice System. 2008.

13. Impulsivity & the Link to Criminal Offending • Many plan poorly, if at all, before engaging in criminal activity • More likely to try running from the police • When arrested, may be more uncooperative, openly disrespectful or noncompliant • Behavior tends to be more inconsistent and unpredictable • If prone to violent behavior, their actions may be difficult to anticipate from moment to moment • Source: Hurley, Patrick J., and Eme, Robert. ADHD and the Criminal Justice System. 2008.

14. ADHD Antisocial Activities: Criminality Source: Mannuzza S et al. Arch Gen Psychiatry 1989;48:1073-1079. Mannuzza S and Klein RG. Child and Adolescent Psychiatric Clinics of North America 2000;9(3);711-726

15. Oppositional Defiant Disorder (ODD) • Actively does not follow adults requests • Angry and resentful of others • Argues with adults • Blames others for own mistakes • Has few/no friends, has lost friends • Is in constant trouble in school • Loses temper • Spiteful or seeks revenge • Touchy, easily annoyed

16. Oppositional Defiant Disorder (ODD) • Pattern must last at least 6 months and be more than normal childhood misbehavior. • Defiance must interfere with the child’s ability to function in school, home, or community. • Defiance can’t be result of another disorder, such as more serious conduct disorder, depression, anxiety, sleep disorder. • 80% co-morbid with ADHD. • Source: Dr. Russell Barkley, Clinical Professor of Psychiatry and Pediatrics at the Medical University of South Carolina in Charleston

17. Emotional Disturbance • A condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child’seducational performance: • An inability to learn that cannot be explained by intellectual, sensory, or health factors • An inability to build or maintain satisfactory interpersonal relationships with peers and teachers • Inappropriate types of behavior or feelings under average circumstances • A general pervasive mood of unhappiness or depression • A tendency to develop physical symptoms or fears associated with personal or school problems • Source: Individuals with Disabilities Education Act (IDEA)

18. What Professionals Say… • No rationality for emotions • Lack of accountability • Disconnect with reality • Poor impulse control, does not think about consequences • Lack of social behavior norms

19. Learning Disability • “Learning Disabilityisa disorder that affects people’s ability to either interpret what they see and hear or to link information from different parts of the brain. These limitations can show up in many ways – as specific difficulties with spoken and written language, coordination, self-control, or attention. Such difficulties extend to schoolwork and can impede learning to read or write, or to do math.” • Source: National Institute of Mental Health, 1993

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21. Learning Disability – Numbers Skills most often affected: reading, writing, listening, speaking, reasoning and math. Impact of LD without supports or services: • 35% of students with LD drop out of high school • National Longitudinal Transitional Study (Wagner, 1991) • Up to 60% of adolescents in treatment for substance abuse have LD • Hazelton Foundation (Minnesota, 1992) • 31% of adolescents with LD will be arrested 3-5 years out of high school • Aspen Education Group, Learning Disabilities Fact Sheet, 2012

22. Learning Disability – Numbers • Estimates range from 40% to 65% or even higher for inmates and parolees who have learning disabilities, mild intellectual disability, ADHD, and psychiatric or addictive disorders, or some combination thereof. • As many as 65% of the children incarcerated in juvenile correctional facilities prove to be eligible for special education services. Source: National Longitudinal Transition Study (Wagner, 1991); Hazelton Foundation (Minnesota, 1992)

23. Dr. Robert Brookes, Harvard University

24. “The jails are full of your failures – all of you. Your state didn’t ask you to be a teacher. You came and offered yourself as a teacher. And I want to challenge the right of any person to be a teacher of another unless that person will exhaust every resource to be a better and better teacher. If these men and women had had the kind of teachers that this government expected them to have, I question whether the jails would be full…It is a race between destruction and education. I am a teacher, and destruction shall never win.” • Elizabeth Farrell

25. Recognize Identify Response Approach Interaction • Interaction • Learning Disability • Minimal if any changes to your standard approach • ADHD • Approach should be direct • Beware of reactions and they may resist arrest • Recognition • Learning Disability: • If asked to read something, they may respond that they can’t • ADHD: • Argumentative or combative • Identify: • Both may not be identifiable • ADHD: • Poor or Dangerous driving • Poor self-control, (very) impulsive • Approach: • Standard Approach Response: Standard

26. Among the Learning Disabled • Cher • Sir Richard Branson • Henry Winkler • Charles Schwab • Tom Cruise • WhoopieGoldberg • Justin Timberlake • Thomas Edison • Nelson Rockefeller • General George Patton • Woodrow Wilson • Babe Ruth • Harvey Cushing, MD