The Effects of Attention Deficit Hyperactivity Disorder on Mathematics Learning

1. The Effects of Attention Deficit Hyperactivity Disorder on Mathematics Learning National Council of Teachers of Mathematics Southern Regional Conference Birmingham, AL October 22, 2005

2. The Effects of Attention Deficit Hyperactivity Disorder on Mathematics Learning Presenter Information: Kay Haralson, Associate Professor of Developmental Mathematics haralsonk@apsu.eduwww.apsu.edu/haralsonk Loretta Griffy, Associate Professor of Mathematics Nancy Matthews, Adjunct Professor of Education Austin Peay State University Clarksville, TN 37044

3. What is ADHD? (www.nichcy.org) • ADHD is a complex, neurobiochemical disorder involving differences in brain activity and structure in the prefrontal cortex, the basal ganglia, and the cerebellum. These areas are know to help to inhibit behavior, sustain attention, and control mood. • ADHD is considered a behavioral and mental health disorder.

4. Possible Causes of ADHD(www.nichcy.org, www.ezinearticles.com) • PET (positron emission tomography) or brain scans, indicate less activity and blood flow in the part of the brain that inhibits impulsivity. • Studies have shown there to be an insufficient availability of the neurotransmitters dopamine and norepinephrine in the central nervous systems of children with ADHD. These brain chemicals are needed for paying attention and controlling behavior. • Current investigations being done to identify abnormalities in the dopamine-transporter gene support the theory that ADHD can be genetically inherited.

5. Diagnostic Criteria for ADHD(Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, TextRevision, 2000, DMV-IV-TR, American Psychiatric Association, www.cdc.gov/ncbddd/adhd/symptoms.htm) I. Either A or B: A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level: Inattention • Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities. • Often has trouble keeping attention on tasks or play activities. • Often does not seem to listen when spoken to directly.

6. Diagnostic Criteria for ADHD(DSM-IV-TR) • Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand directions). • Often has trouble organizing activities. • Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework). • Often loses things needed for tasks and activities. • Is often easily distracted. • Is often forgetful of daily activities.

7. Diagnostic Criteria for ADHD(DSM-IV-TR) B. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level: Hyperactivity • Often fidgets with hands or feet or squirms in seat. • Often gets up from seat when remaining in seat is expected. • Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).

8. Diagnostic Criteria for ADHD(DSM-IV-TR) • Is often “on the go” or often act as if “driven by a motor”. • Often has trouble playing or enjoying leisure activities quietly. • Often talks excessively. Impulsivity • Often blurts out answers before questions have been finished. • Often has trouble waiting one’s turn. • Often interrupts or intrudes on others.

9. Diagnostic Criteria for ADHD(DSM-IV-TR) • Some symptoms that cause impairment were present before age 7 years. • Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home). • There must be clear evidence of significant impairment in social, school, or work functioning. • The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

10. Subtypes of ADHD(DSM-IV-TR) Based on these criteria, three types of ADHD are identified: • ADHD, Combined Type: if both criteria 1A and 1B are met for the past 6 months • ADHD, Predominantly Inattentive Type: If criterion 1A is met but criterion 1B is not met for the past six months • ADHD, Predominantly Hyperactive-Impulsive Type: if Criterion 1B is met but Criterion 1A is not met for the past six months

11. Prevalence(DSM-IV-TR, www.adhdsupportcompany.com ) • 3%-7% of children suffer from ADHD. • ADHD is diagnosed approximately three times more often in boys than in girls. • As many as half of those with ADHD also have other mental disorders. • Over half of the children diagnosed with ADHD carry the disorder into adulthood. • A large number of adults who were never diagnosed as a child show clear symptoms of ADHD. • AMA’s Special Council Report showed little evidence of widespread over-diagnosis of ADHD or over-prescription of medication for ADHD. (www.nichcy.org)

12. Identifying ADHD and Subtypes ( www.nimh.nih.gov, www.ets.org) The diagnosis of ADHD and the subtypes of ADHD should be made by a professional with training in the evaluation of ADHD or in the diagnosis of mental disorders. Such as: • Child psychiatrists and psychologists • Developmental/behavioral pediatricians • Behavioral neurologists • Neuropsychologists • Clinical teams with educational, medical, and counseling professionals with training in the evaluation of ADHD

13. ADHD in Adults (www.addresources.org, www.akrongeneral.org) Symptoms of ADHD in adults are similar to the diagnostic criteria for children, but may be displayed in different ways. Inattention • Poor listening skills • Easily distracted, forgetful, daydreaming • Difficulty with making decisions • Trouble maintaining an organized work/living area • Easily overwhelmed by tasks of daily living • Spends excessive time at work because of inefficiency • Frequently losing or misplacing things • Need for others to organize you

14. ADHD in Adults (www.addresources.org, www.akrongeneral.org) Hyperactivity • Frequently late or rushed • Easily bored; intense need for excitement • Difficulty with falling asleep or waking up alert • Difficulty estimating how much time something will take • Poor handwriting • Performs worse under pressure • Thoughts jump from one topic to the next • Strong need to control or have things your way • An internal sense of anxiety and restlessness

15. ADHD in Adults (www.addresources.org, www.akrongeneral.org) Impulsivity • Impulsive spending and money management problems • Frequent, impulsive job changes • Very impatient, low frustration tolerance • Tactless, tendency to embarrass others • Frequent traffic violations • Trouble with authority • Mood swings • Prone to hysterical outbursts • Tendency to seek conflict, be argumentative

16. ADHD in Adults (www.addresources.org, www.akrongeneral.org) Symptoms that can develop after years of living with ADHD • A sense of failure, not living up to one’s potential • A sense of being different, unconventional • Very sensitive to being told to do something or to being criticized • A tendency to worry needlessly and endlessly • Difficulty with personal or work relationships • A tendency toward addictions • Personal or family history of substance abuse, depression, or anxiety

17. Effects of ADHD on Math Achievement • In mathematics attention to details is critical. Overlooking or misreading mathematical symbols, key words, or instructions leads to careless mistakes. • Poor organization skills hinder students from getting paper, pencil, book, and assignment together in one place. • If students are distracted while completing math problems, they lose their focus, skipping problems or steps in problems. • Constant movement of hands, feet, pencils, etc. gets the student “off track”.

18. Effects of ADHD on Math Achievement • Math homework takes a lot of mental effort for a long period of time. Students with ADHD learn to avoid these types of activities. • The excessive amount of time it takes for them to complete assignments increases their frustration level. • Underestimating the time needed to complete assignments means that some go unfinished. • Students procrastinate and put off completing assignments until it is too late.

19. Effects of ADHD on Math Achievement • Students show inconsistent performance. Information learned one day, seemingly mastered, may be missing the next day. • Performance is worse under pressure. • Students have difficulty retrieving information on demand, even when thoroughly studied. • Students become angry with themselves and their teachers when they are criticized or when they do not do well.

20. Treatment Options (www.hawaii.edu/medicine/pediatrics/pedtext/s01c10.html) The American Academy of Pediatrics guidelines for treatment of ADHD requires understanding of four aspects: • ADHD is a chronic condition. Parental, medical, and educational support should be provided into adulthood. • Target symptoms need to be addressed. Set realistic goals for improvement in specific areas. • Medication and behavior strategies are important. A combined approach has been shown to be more effective than either strategy alone. • Close follow-up of target symptoms and medication use. Reevaluations and monitoring should be done periodically and consistently.

21. Treatment Options(www.nichcy.org) A joint study by the NIMH (National Institute of Mental Health) and the (OSEP) U.S. Department of Education’s Office of Special Education Programs indicated that a multi-modal treatment approach had the greatest positive effect on reducing ADHD symptoms. The recommended multi-modal treatment approach consists of four core interventions: • patient, parent, and teacher education about the disorder; • medication (usually from the class of drugs called stimulants); • behavioral therapy; and • other environmental supports, including an appropriate school program.

22. Multi-modal Treatment (www.nichcy.org) • Patient, parent, and teacher education about the disorder: • Learn about ADHD and the nature of the challenges it presents. • Understand that the child has troubles and is not the cause of the troubles. • Children with ADHD should learn to be self-advocates but parents and teachers can also be strong advocates for the child

23. Multi-modal Treatment (www.nichcy.org) • Medication (usually stimulants) • Since ADHD is neuro-biochemically-based it stands to reason that medication that gets to the core of the problem would be effective. • These medications work to make the brain’s systems work more efficiently, improving attention, memory, executive functions, and inhibition. • The result is better concentration, increased working memory capacity, greater recall, less hyperactivity, and more impulse control.

24. Multi-modal Treatment(www.nichcy.org) • Behavioral Therapy • Parents and teachers need to be the executives in the child’s life, providing structure, routines, assistive devices, external supports and guides. • Develop behavior management strategies. Use positive attention, rules, consequences, and formal systems such as contracts and charts. The main goal is to increase the child’s appropriate behavior and decrease inappropriate behavior. • Teach problem solving. Develop skills in the art of negotiation, give and take, and conflict resolution through peaceful means. • Use good communication skills. Say what you mean in a firm, loving way.

25. Multi-modal Treatment(www.nichcy.org; Quinn, 1994; Nadeau, 1994; Murphy, 1995; Amen, 1997) • Education Intervention Provide a structured environment • preferential classroom seating • pair student with good role models • create a classroom with limited distractions • give a detailed plan of the course activities and requirements, avoid changes in routine • design tasks of low to moderate frustration level, challenge but don’t overwhelm • provide frequent reminders of due dates of assignments and tests dates

26. Multi-modal Treatment(www.nichcy.org; Quinn, 1994; Nadeau, 1994; Murphy, 1995; Amen, 1997)) • Education Intervention Enhance organization skills • encourage the use of a daily/weekly planners • use a tape recorder for class lectures • make directions clear and concise, provide direct one-on-one instruction • give out only one task at a time • monitor work frequently, provide feedback • use handouts to minimize the need for note taking • provide an outline of material on the overhead • maintain frequent communication between home and school with daily/weekly progress reports

27. Multi-modal Treatment (www.nichcy.org; Quinn, 1994; Nadeau, 1994; Murphy, 1995; Amen, 1997) • Education Intervention Allow accommodations in assessment • extend time to complete tests • provide a distraction free environment for taking tests • alter the response format of tests • allow tests to be taken over a period of time in short intervals • expect no less from students with ADHD, but give them alternative ways to demonstrate their competencies

28. Multi-modal Treatment (www.nichcy.org; Quinn, 1994; Nadeau, 1994; Murphy, 1995; Amen, 1997) • Education Intervention Be sensitive to the students’ emotional needs • be aware of their low frustration tolerance and stress tolerance • be aware that if they have outbursts of anger, it is generally toward themselves and not toward you • recognize secondary problems such as depression, anxiety, and other emotional problems

29. Mathematics Individualized Instructional Practices (Teaching Children with Attention Deficit Hyperactivity Disorder: Instructional Strategies and Practices, 2004) • teach students to recognize patterns when performing operations on whole numbers • use mnemonics for basic computation • color code arithmetic symbols to provide visual cues • use calculators to check basic computation • provide real-life examples of money skills • teach mastery of math symbols, e.g. – or minus means to take away • use computer tutorial games for basic computation

30. Mathematics Individualized Instructional Practices (Teaching Children with Attention Deficit Hyperactivity Disorder: Instructional Strategies and Practices, 2004) • use number lines for computing whole number operations • use manipulatives in basic computation skills • use graph paper to help organize columns when performing basic computations • teach students to look for clue words that indicate specific operations • use guiding questions to talk students through the steps of problems

31. References ADHD Support Company, (2005) Adult ADHD. Available Internet: www.adhd.supportcompany.com Akron General Medical Center. (2004). Attention deficit disorder in adults (ADD). Available Internet:www.akrongeneral.org/psychiatry/psychiatry_add.asp Allen, T. (2005). Attention deficit hyperactive disorder . . . A teacher’s perspective. Available Internet: http://ezinearticles.com Amen, D. G. (2001). Attention, Doctors. Newsweek. February 26, 2001. Amen D. G. (1997). Windows in the A.D.D. mind: Understanding and treating attention deficit disorders in the everyday lives of children, adolescents, and adults. Fairfield CA: MindWorks Press. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington DC: American Psychiatric Association.

32. References Attention Deficit Disorder Resources. (2005). Available Internet: www.addresources.org Baker, K. B. (2001). Attention deficit hyperactivity disorder and reading achievement. Queensland Journal of Educational Research. 17. Available Internet: education.curtin.edu.au/iier/qjer/qjer17/baker.html Barabasz, A,, Barabasz, M. (1995). Attention deficit hyperactivity disorder: Neurological basis and treatment alternatives. Journal of Neurotherapy. 1(1). Available Internet: www.snr-jnt.org/journalnt/jnt(1-1)1.html. Fowler, M. (2004). Attention-deficit/hyperactivity disorder, Washington, DC: National Dissemination Center for Children with Disabilities. Available Internet: www.nichcy.org Kid Source Online. (2000). Teaching children with attention deficit disorder. Available Internet: www.kidsource.com/kidsource/content2.add.html

33. References Murphy, K. R., LeVert, S. (1995). Out of the fog: Treatment options and coping strategies for adult attention deficit disorder. New York, NY: Skylight Press. Nadeau, K. G. (1994). Survival guide for college students with ADD or LD, New York, NY: Magination Press. National Center on Birth Defects and Developmental Disabilities. (2005). Attention-deficit/hyperactivity disorder. Available Internet: www.cdc.gov/ncbddd/adhd National Institute of Mental Health. (2003). Attention deficit hyperactivity disorder. Available Internet: www.nimh.nih.gov/Publicat/ADHD.cfm Okamoto, J. K. (2002). Chapter I.10.Attention deficit/hyperactivity disorder. Department of Pediatrics, University of Hawaii. Available Internet: www.hawaii.edu/medicine/pediatrics/pedtext/s01c10.html

34. References Quinn, P. O. (Ed.). (1994). ADD and the college student: A guide for high school and college students with attention deficit disorder. New York, NY: Magination Press. The Office of Disability Policy Educational Testing Service. (1999). Policy statement for documentation of attention-deficit/hyperactivity disorder in adolescents and adults. Available Internet: www.ets.org/disability/adhdplcy.html U.S. Department of Education, Office of Special Education and Rehabilitative Services, Office of Special Education Programs. (2004). Teaching children with attention deficit hyperactivity disorder: Instructional strategies and practices. Washington, D.C

35. The Effects of Attention Deficit Hyperactivity Disorder on Mathematics Learning To obtain a copy of this power point presentation go to: www.apsu.edu/haralsonk and click on ADHD or e-mail Kay at haralsonk@apsu.edu Thank you for your attention!