Attention ( Deficit/Hyperactivity ) Disorder : How can educators help children and parents?

1. Attention (Deficit/Hyperactivity) Disorder:How can educators help children and parents? “But he can focus on video games for HOURs!”

2. Norrine L. Russell, Ph.D.Developmental psychologist Russell Coaching & Consulting www.norrinerussell.com • Mother • Educator • Psychologist • Advocate • Coach

3. Have You Ever. . . • Thought a child was lazy because they seemed to never start an assignment? • Gotten mad at the child who kept getting out of their seat? • Become so frustrated with the child in the back of the room banging his pencil on his desk over and over and over again? • Reminded a child to bring home their book at least five times and then they still forget it? • Been in the middle of a lesson when a child blurts out some random information irrelevant to the lesson? Had a child listen to you talk and then not know whatyoujust said?

4. If You Answered Yes. . . • You are not alone. • Today, in every classroom across the country there are several students who are diagnosed with ADHD. • It is vital for teachers to understand ADHD to minimize feelings of being frustrated, upset, or defeated and increase the likelihood of student success.

5. What we all need to understand • “If they could, they would.” • Ross Greene • The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children

6. What we’ll cover today • What are the statistics and myths of ADHD? • What is ADHD? • How is it diagnosed and what is the teachers role? • What causes ADHD? • What are Executive Functions? • What deficits do children with ADHD have? • What can a teacher do to help children with these deficits? • What medication should teachers know about? • Where can help be found about ADHD?

7. Statistics • The Diagnostic and Statistical Manual of Mental Disorders Fourth Edition suggests that ADHD affects 3 to 5% of school aged children. • This adds up to 1.46 to 2.46 million children in schools today • ADHD is the most commonly diagnosed childhood psychiatric disorder • 4 to 13% of the United States Population is affected by ADHD • Boys are 4 to 9 times more likely to be diagnosed than girls • 1/4 to 1/3 of ADHD students also have learning disabilities • Symptoms in a child may change as that child grows older but that does not mean that the child will grow out of their ADHD diagnosis • ADHD children are at higher risk for unintentional injuries, delinquency, and anti-social behavior

8. ADHD Myths Busted • As published on ADDitude Magazine’s website, these are the most common ADHD myths: #7: People with ADHD are stupid and lazy. #6: ADHD children on medication will abuse drugs as teenagers. #5: ADHD is the result of bad parenting. #4: ADHD affects only boys. #3: Children with ADHD often outgrow the condition. #2: Children given ADHD accommodations are given an unfair advantage. #1: ADHD is not a real medical disorder. From: www.additudemag.com

9. What is ADHD?

10. What is ADHD? annoying

11. Well, this is usually what you’ll hear…

13. Diagnostic Criteria • A: Six or more of the previously noted symptoms persisting for 6 months or longer qualifies for a diagnosis of ADHD in either the inattentive category or hyperactivity-impulsive category. If both inattentive and hyperactive-impulsive symptoms are present then a combined type diagnosis is given. Please see chart on previous screen. • B: One of the symptoms needs to have been present before the age of 7. • C: Some impairment from the symptoms is present in two or more settings, such as school or home. • D: There must be clear and significant evidence of a social, academic, or occupational impairment. • E: The symptoms are not better accounted for by another mental disorder. Note: Taken from American Psychiatric Association DSM-IV (1994, p. 83-85)

14. What do current experts think adhd is? • A Deficit in • Self-Regulation

15. Reasons ADHD Students Misbehave • Frustration because they have a different perception of the situation. • Lack of structure. • They act the role of being “bad.” • They don’t know how to ask to get what they need so they act out. • The classroom is full of distractions. • The child feels misunderstood. • Hunger. • They feel overwhelmed with tasks assigned. • They feel criticized. • They are stuck in the “victim cycle.” Note: From Appelbaum Training Institute’s How to Handle the Hard-to-Handle Student Resource Handbook, (2005).

16. What Educators Need to Remember: • According to Schuck & Crinella (2005), “the most worrisome deficits of children with ADHD are not the product of low IQ, but rather of instability of control processes that govern everyday applications to the environment” (p. 275). • The ADHD student is not dumb, lazy, or out of control. They are children who need our help to gain the proper strategies to be successful. • YOU can be the one to make a lifelong difference.

17. Remember… • “If they could, they would.” • Ross Greene • The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children

18. What Can An Educator Do If Some Symptoms Appear To Be Present? • Maintain behavior logs citing observations of behaviors and situations. Remember to include inventions used and their efficiency. • Inform parents of behavioral concerns and discuss behaviors at home. • Request child study or equivalent meeting with parents, special education teachers, school psychologist, etc. to discuss classroom behaviors. This can lead to diagnosis from a doctor and then an IEP for the student. • If needed, rating scales may be given to teachers and parents. Diagnosis and identification of ADHD needs to come from a complete evaluation, preferably from a doctor, psychologist, or psychiatrist. The most helpful thing teachers can do is to observe the child and find interventions that work to make that child successful and support the parents. Note: From Vaughn, Bos, & Schumm (2006).

19. What Causes ADHD? • Average heritability of .80 - .85 • Environmental factors are not the cause, but may contribute to the expression, severity, course, and comorbid conditions • Dysfunction in prefrontal lobes • Involved in inhibition, executive functions • Genes involved in dopamine regulation • Dopamine transporter (DAT1) gene implicated • 7 repeat of dopamine receptor gene (DRD4) implicated • Gene x environment interactions • Possible differences in size of brain structures • Prefrontal cortex, Corpus callosum, caudate nucleus • Abnormal brain activation during attention & inhibition tasks

20. What we know about the neurobiology of adhd Compared to someone without ADHD, children with ADHD have: • Differences in brain chemicals (neurotransmitters) • Differences in the size of parts of the brain – Caudate nucleus; striatum; globuspallidus; corpus callosum • Less activity in parts of the brain – Right prefrontal region • Most of these differences are located in the prefrontal cortex – The “conductor” of the brain

21. Adhd and neurotransmitters • Neurotransmitter differences, particularly in levels of: • Dopamine • Norepinephrine • Epinephrine • Serotonin • Dopamine has been associated with approach and pleasure-seeking behaviors • Norepinephrine plays a role in emotional/behavioral regulation

22. Executive functioning Wait, the kid I’m thinking of doesn’t seem like an executive

23. What Are Executive Functions? • An executive function is “a neuropsychological concept referring to the cognitive processes required to plan and direct activities, including task initiation and follow through, working memory, sustained attention, performance monitoring, inhibition of impulses, and goal-directed persistence.” (Dawson & Guare, 2004, p. vii)

24. Taxonomy of Executive skills • Organization • Time Management • Goal-directed Persistence • Flexibility • Metacognition • Response Inhibition • Working Memory • Emotional Control • Sustained Attention • Task Initiation • Planning/Prioritization

25. Why Are Executive Functions Important? • These skills allow us to “organize our behavior over time and override immediate demands in favor of longer-term goals” (Dawson & Guare, 2004, p. 1). • They also allow for the management of emotions and effective thought monitoring.

26. Executive skills and learning:How does a lack of executive functioning create a problem in the classroom?

27. Deficit: Response Inhibition • This is “the capacity to think before you act” (Dawson & Guare, p. 47). • Children with this deficit tend to be impulsive. They will say things without thinking about what it is that they are saying.

28. Deficit: Working Memory • This is “the ability to hold information in mind while performing complex tasks” (Dawson & Guare, p. 49). • Students with this deficit tend to forget easily. They may forget their homework or books at school on a regular basis.

29. Deficit: Self-Regulation Of Affect • This is “the ability to manage emotions in order to achieve goals, accomplish tasks, or control and direct behavior” (Dawson & Guare, p. 50). • These students tend to become upset quickly with situations, unable to control their emotions. These students tend to have outbursts that disrupt daily functioning.

30. Deficit: Sustained Attention • This is “the capacity to maintain attention to a situation or task in spite of distractibility, fatigue, or boredom” (Dawson & Guare, p. 52). • Students with this deficit tend to have a hard time getting started and staying productive with a task or project. These students will get up often when a task is given. They talk to other students when they shouldn’t.

31. Deficit: Task Initiation • This is “the ability to begin a task without undue procrastination, in a timely fashion” (Dawson & Guare, p. 54). • These students tend to put off doing work that they need to complete. They lack the processes to start the task.

32. Deficit: Planning • This is “the ability to create a roadmap to reach a goal or to complete a task. It also involves being able to make decisions about what’s important to focus on and what’s not important” (Dawson & Guare, p. 55). • These students tend to wait till the last minute to complete tasks and then not know what to do when they go to complete them.

33. Deficit: Organization • This is “the ability to arrange or place things according to a system” (Dawson & Guare, p. 58). • These students tend to have messy desks or cubbies. They lose papers often and frequently shove papers instead of placing them in appropriate spots.

34. Deficit: Time Management • This is “the capacity to estimate, allocate, and execute within time constraints” (Dawson & Guare, p. 60). • These children get work done at the last minute and frequently ask for assignment extensions. They underestimate how long work will take. Sometimes we refer to children with ADHD as time-blind.

35. Deficits: Goal-Directed Persistence • This is “the capacity to have a goal, follow through to the completion of the goal, and not be put off by or distracted by competing interests” (Dawson & Guare, p. 62). • These students are able to create goals for themselves but are not able to achieve them. They are not able to understand the necessary steps to reach a goal and often become distracted with outside stimuli negatively impacting their task completion.

36. Deficit: Flexibility • This is “the ability to revise plans in the face of obstacles, setbacks, new information, or mistakes” (Dawson & Guare, p. 63). • These students have difficulty in transitions and new situations. These students struggle longer than others at the beginning of each year. They also are thrown off by changes in daily schedules. These students have limited problem solving strategies.

37. Deficit: Metacognition • This is “the ability to stand back and take a bird’s-eye view of oneself in a situation. It is an ability to observe how you problem solve. It also includes self-monitoring and self-evaluative skills” (Dawson & Guare, p. 65). • These students make careless mistakes frequently. They also will complete one step then stop, instead of finishing the series of steps. For example, these students may add instead of subtract over and over again while failing to review their work and realizing their mistake. Also, these students will do one step of long division and then stop, not reflecting on the whole process needed to complete the task.

38. But what do iDO?

39. Provide help for deficits at the moment it is needed, not negative feedback when it is already too late. Unfortunately, the simple reality is that punishment does not usually teach the needed behaviors.

40. This is because many children with ADHD have difficulty “doing what they know,” not “knowing what to do.” They already “know,” for example, that they should come to class prepared.

41. Once we understand that punishment has not been working, we are ready to provide relief for their disabilities by guiding them at the moment guidance is needed—rather than continued disbelief that they did it wrong again.

42. Teach this process1. stop2. think3. plan4. do

43. Response Inhibition • Reduce situations where the child can get into trouble • Use Proximity Control: Increase supervision of the child • Demonstrate impulse control by modeling appropriate behavior • To teach the skill: • Explain the skill and behaviors • Model behaviors • Discussion situations to use the skill • Reinforce the skill • Ignore inappropriate behavior Note: From Dawson & Guare, (2004).

44. Working Memory • Enforce use of assignment books consistently • Utilize checklists and to-do lists • Use cue devices such as verbal reminders, alarm clocks, and Post-Its • To teach the skill: • Explain the skill • Give options to the child for cues and checklists to use • Create a monitoring system for the child to monitor their own skill usage Note: From Dawson & Guare, (2004).

45. Self-Regulation Of Affect • Prepare child for problem situations • Give child scripts for problem situations and practice regularly • Structure environment to avoid situations that can lead to problems • Give breaks to child during tasks as needed • Teach child I-statements • Use social stories that teach emotional control • To teach this skill: • Explain the skill • Provide coping strategies • Practice with the child • Reinforce child when strategies are used • Discuss real life situations of using the strategy Note: From Dawson & Guare, (2004).

46. Sustained Attention • Write start and stop times on assignments • Use incentive systems • Break down tasks into steps • Make tasks interesting for students • Give child something fun to do when task is completed • Provide attention and praise when student is remaining on task • To teach the skill: • Discuss attention time with the student • Teach them to break down tasks on their own • Help them make work plans for completing tasks • Reinforce them when they use the plan Note: From Dawson & Guare, (2004).

47. Task Initiation • Use verbal cues to get child started • Create a visual cue to prompt child to get started, such as a note on their desk • Walk through the first part of the task to help child get started • Have child tell you when they will begin the task and cue them when the time arrives • To teach the skill: • Teach the child to create a written plan for starting the task including time and type of task • Teach child to break down the task if needed • Teach child to use cue such as alarm clock to start task • Reinforce child when no additional cues are needed • Fade supervision Note: From Dawson & Guare, (2004).

48. Planning • Plan a schedule for the child • Use rubrics • Break long assignments into smaller pieces with deadlines for each piece • Create planning sheets with due dates • Use assignment planners • To teach the skill: • Walk through the planning process with the child • Have child model the planning process • Tell student to create roadmaps for tasks • Ask questions such as “What do you have to do first?” Note: From Dawson & Guare, (2004).

49. Organization • Maintain an organized classroom • Create schemes for organizing backpacks and folders • Color-code folders, notebooks, and papers for classes • To teach the skill: • Teach child to separate papers and categorize them • Have them create their own organization plan • Get the plan in writing • Have them implement the plan Note: From Dawson & Guare, (2004).

50. Time Management • Give child a schedule to follow • Prompt student with each step of a task • Impose time limits for assignments • Provide frequent reminders for remaining time to complete task • Use cueing devices such as alarm clocks • To teach the skill: • Help child understand what the task involves • Have child think of distractions that may be present when completing task • Create an estimated time for completion; compare estimated time to actual time • Find strategies to decrease distractions Note: From Dawson & Guare, (2004).