ADHD and Inclusion

1. ADHD and Inclusion By Carly Schwarmann EDSP 6644 (Summer 2009) The Exceptional Child and Inclusion August 15, 2009 Online Instructor: Vanessa Tucker, PhC.

2. Abstract/Introduction to group This Presentation is about ADHD and inclusion. I discuss the criteria for determining whether a child has ADHD, the definition, causes and effects. I reviewed three articles about ADHD and inclusion and list the pros and cons as well as recommendations and applications for the classroom. The articles were very interesting and informative. The first was about the over-diagnosis and alternative methods for dealing with ADHD. The second article was about the pros and cons of inclusion. The third article describes an effective inclusion program. I included an extra slide about the controversy of medication because it is such a hot topic.

3. ADHD criteria • ADD stands for Attention Deficit Disorder. ADHD is similar, but includes hyperactivity. • The American Psychiatric Association (APA) has determined that a person has ADD if they meet 8 qualifications from the following list. • Unable to remain seated when required • Easily distracted from the task at hand by external stimuli • Difficult to hold attention to an activity or task • Frequently hops from one activity to the next without completing the first • Fidgets or squirms • Difficulty waiting for a turn • Interrupts question to answer • Problems with job or chore follow through • Difficulty playing quietly • Impulsively jumps into physically dangerous activities • Easily loses things • Interrupts inappropriately • Talks impulsively or excessively • Doesn’t seem to listen (Bonilla, 1997)

4. ADHD statistics • ADHD diagnosis is based on clinical criteria. • It is described as chronic behavioral symptoms of inattention, impulsiveness and hyperactivity, that can significantly interfere with relationships, education, and occupational functioning. • APA has determined three main sub-types of ADHD • Mainly hyperactive/impulsive • Mainly inattentive • Combined hyperactive/impulsive and inattentive International prevalence rates range from 3 to 6 percent of children. Males outnumber females 3:1 Symptoms usually occur between the ages of 3 and 4, but the APA diagnostics criteria requires presence of symptoms before age 7. (Cooper, 2001). • Attention-deficit hyperactivity disorder (ADHD) is one of the most common disorders among children • inclusion provides the most appropriate education for students with ADHD in the least restrictive environment • the classroom teacher's involvement in the team process is important to success of the IEP (Nichols, 1996)

5. Causes of ADHD Theories of Causes Theories come from cognitive, neurological , and genetic research • Dysfunctional response inhibition system, located in the prefrontal cortical region of the brain, causing problems in inhibiting or delaying behavioral response. • Neurological problems of response inhibition lead to problems in executive functions in cognition including working memory, internalized speech, motivational appraisal, reconstitution, and behavioral synthesis • Neurological basis for cognitive dysfunctions similar to brain injuries in the pre-fontal cortex. • Abnormalities in development of brain regions • Common in biological relatives, especially parents and identical twins • Abnormalities in dopamine system • Biological causes of behavioral outcomes mediated by experiential and environmental factors • The early family unit plays a crucial role in shaping an individuals behavioral characteristics (Cooper, 2001)

6. Effects of ADHD • Hyperactivity • Problems in school • Social isolation • Road accidents • Psychological dysfunction • Incompetent • Disorganized • Aggressive • Lazy • Disruptive • Untrustworthy • Neglectful • Selfish • Accident prone • Low academic performance • Relationship problems • Marital breakdowns • Employment difficulty • Imprisonment (Cooper, 2001)

7. Medication • Students with ADHD are often on medications such as Ritalin, Cylert, Dexadrine or Adderol. (Messina, 2007) • Medication is a controversial topic. • 2 percent of all school-aged children in the US are prescribed some kind of medication for hyperactivity • Psycho stimulant medications in low and moderate doses are relatively effective in reducing the core symptoms of ADHD • Methylphenidate is a safe, non-addictive medication with mild side effects including loss of sleep and appetite, which can be avoided through adjusting the dosage. (Cooper, 2001)

8. Article reviews • This article includes two papers, the first is "Club MED: Diagnosis ADD/ADHD" (Lynne A. Phillips et al.), addresses drug therapy for children with ADHD. It discussed the over-diagnosis of ADD and alternative methods to medication. • The author points out that ADD has become a national phenomenon and is being over- labeled. Phillips notes that students with ADD can focus attentions in certain situations and often grow out of it when adults. • Phillips picks apart methods used to determine whether a child has ADD/ADHD. She also accuses teachers of jumping on the bandwagon to diagnose kids with ADD/ADHD. She claims parents also push the diagnosis to cover for poor performance. She points out misbehaviors can stem from other disorders and problems at home. She disapproves of the use of Ritalin because it often does not help attention span and can have severe side effects. • Phillips recommends alternatives to medications including strict discipline and EEG neurofeedback, where the child learns to read, understand and influence his own brainwave activity. The drawback is, it is expensive, and could take up to 80 sessions. She also suggests testing for other learning disabilities. • Bonilla raises the ethical question, Is it appropriate to medicate children without a clear diagnosis in hopes that it will improve their school work? The idea of using biofeedback to treat ADHD is very interesting. It makes me wonder why more people aren’t doing it and what other ailments it could benefit. Source: Bonilla, C., & Goss, J. (1997, January 1). Public (K-12) Education's Hot Jalapenos. Topics Picantes in Special Education. . (ERIC Document Reproduction Service No. ED405684) Retrieved August 15, 2009, from ERIC database.

9. Source: Bonilla, C., & Goss, J. (1997, January 1). Public (K-12) Education's Hot Jalapenos. Topics Picantes in Special Education. . (ERIC Document Reproduction Service No. ED405684) Retrieved August 15, 2009, from ERIC database. Article Review 2 • The second article, "Full Inclusion: One Size Fits All?" (Lisa Dondero et al.) describes successful implementation of inclusion as well as pros and cons. It concludes that a continuum of services are necessary to meet the individual needs of the child. • The article introduces the discovery program, which is an inclusion program that helps redesign classroom and modify teaching styles. This multi-age classroom has individualized instruction that is technology based, and uses hands-on activities that promote self-esteem. Students progress at their own rates within the class. Regular and special education teachers work together to create lessons. Classrooms are organized into learning centers and students can move freely to centers of their choice. • Some people believe social acceptance is more important than education. The supreme court ruled that public schools may not remove a disruptive or emotionally disturbed student from class for more than 10 days, even to protect others from physical assault. The author points out a classroom must feel safe for the teacher to teach and the students to learn. Dondero brings up the question, what about the rights of the other students in the class? • On the other hand, some parents fear full inclusion because they are afraid their child will lose the range of services. Determining the most appropriate and least restrictive environment should include the needs of the regular education student as well as the individual needs of the disabled student. One size does not fit all.

10. Article Review 3 • This article presents a rationale for why students with ADHD should be educated in the general education classroom, addresses problems in educating students with ADHD in the general education classroom, and introduces a program designed to address these problems. The Irvine Paraprofessional Program provides at-risk students with ADHD with short-term intensive intervention. The program uses in-class token system and collateral training in social skills. They use specially trained paraprofessionals (behavioral specialists) as interim instructional aides. The paraprofessional conducts twice-a-week skills training groups of six students or less. After 12-weeks, responsibility for the behavioral program is turned over to the classroom teacher. • Although students with ADHD typically are average or above average intelligence, they often have trouble performing at the quality and quantity of their grade level because of attention problems. Many students lack social skills due to a deficit or performance deficit. Placing them in the general education facilitates classroom generalization where they can learn social skills in context. • One of the problems with implementing inclusion is that school psychologists are not able to monitor programs, so there is a gap between development of a plan and effective implementation. Use of behavior modification is one of the more popular methods to support inclusion, unfortunately not everyone is properly trained to implement the program. Frequent feedback and reinforcement is crucial for ADHD students. Too often they are only given attention when their behavior is inappropriate. Source: Kotkin, R. (1995, March 1). The Irvine Paraprofessional Program: Using Paraprofessionals in Serving Students with ADHD. Intervention in School and Clinic, 30(4), 235-40. (ERIC Document Reproduction Service No. EJ499254) Retrieved August 15, 2009, from ERIC database.

11. Recommendations • Teacher modeling • Set clear policies • Firm boundaries • Have a good attitude • Stay informed • Keep in contact with parents, special education teachers, and counselors • Create a plan • Ask for help • Intensive teacher training and preparation (Adams, 2006) • Strong administrative leadership • Collaboration • Service supports for students • Parental and family involvement (Bonilla, 1997) • Provide additional, appropriate stimulation when needed • Foster student independence. • Provide scaffolding for organization-specific tasks • Pick your battles • Use ADHD students as an asset to motivate yourself to be multi-modal • Reinforce even tiny successes (Zelkowitz , 2009) • Involve other students • Differentiate instruction • Organize and break down directions into single steps. •  Break down long-term assignments or projects into individual chunks. Show examples from previous students. •  Give students a specific scoring guide so they know exactly how much each part of the project is worth. •  Review new vocabulary daily. Make sure everyone knows the words before moving onto the breadth of the concept. •  Keep a list of words and pages they can be found on in the classroom for quick reference for each topic. • Allow students to work in diverse groups (Young, 2006) Frequent feedback and reinforcement for performance (task completion, following classroom rules, following directions, peer relations etc.) Use a behavioral program to improve work (Kotkin, 1995)

12. Applications to classroom • Discipline should include rules, consequences and assertive communication • Use body language, eye contact and gestures to communicate directly • Provide work areas free from distraction • Break the task down into manageable segments and give frequent encouragement and support • Involve them in activities where they excel • Find avenues to channel excess energy in a positive way • Hold child accountable for behavior and decisions • Stress the stop and think approach • Use charts, graphs, and lists to provide structure and feedback • Maintain a consistent and predictable schedule • Help child use notebooks and charts to get organized • Accept that sustained concentration is difficult (Bonilla, 1997). • Let students know what items they will be responsible for presenting to the class ahead of time so they can focus and feel successful in front of their peers. This can be done by simply circling an item on an assignment sheet or indicating a number to them by holding up your fingers. • During testing read every question in the beginning of the period so students know what the questions say and can ask for clarification if needed. • Vary types of questions on the test. • Consider other types of assessments such as posters explaining a concept, diagrams or graphic organizers, and oral presentations explaining concepts to the rest of the class. • Hands-on labs and activities can be used as assessments. • Student logs and portfolios help keep track of assignments and monitor progress. • Help students set and keep track of goals • Have high expectations for ALL students in the class. Parents Can: • Help your children organize their schedules at home. • Break their studying down into 15-minute chunks each night so they are prepared for class the next day. • Encourage your children to complete as much of an assignment as possible and write a short explanation of what they did not understand about an assignment. • Communicate with the teachers about problems as soon as possible. (Young, 2006)

13. Pros to inclusion “Responsible inclusion means the child goes into regular classroom with the skills needed to participate.” “ Being treated fairly doesn't mean that everyone is treated the same.“ (Adams, 2006). • Least restrictive environment • Classroom support • Positive discipline • Children can experience success (Adams, 2006) • Positive peer models • Improved social acceptance (Cooper, 2001) • Social acceptance • Regular Education students benefit (Bonilla, 1997) “ Statistics show that some students with learning disabilities benefit more when placed in an inclusive program than when in a self-contained special education class.” (Young, 2006)

14. “Cons to InclusionThe rights of students with disabilities must be honored--but it can be a tough balancing act when behavior impacts the classroom.” (Adams, 2006). • Conflicts with teachers, parents, and students • Aggressive behavior • Disruptive behavior • Unsafe learning environment • Creating modifications • At risk of failure • Classroom may not be set up to meet child’s needs (Adams, 2006) • Learned helplessness • Low academic achievement • Inequality of separate education • Need of aides and a support system (Cooper, 2001) • Special education classes are smaller • More equipment is available in a special education classroom • General education teachers do not receive as extensive training as special education teachers do • Increases teacher workload • Cost is higher (about $6000 vs. $19,000) (Bonilla, 1997)

15. References Adams, C. (2006, January 1). When Is Challenging Behavior Too Much?. Instructor, 115(8), 25-27,. (ERIC Document Reproduction Service No. EJ792307) Retrieved August 15, 2009, from ERIC database. Bonilla, C., & Goss, J. (1997, January 1). Public (K-12) Education's Hot Jalapenos. Topics Picantes in Special Education. . (ERIC Document Reproduction Service No. ED405684) Retrieved August 15, 2009, from ERIC database. Cooper, P. (2001, January 1). Understanding AD/HD: A Brief Critical Review of Literature. Children & Society, 15(5), 387-95. (ERIC Document Reproduction Service No. EJ647717) Retrieved August 15, 2009, from ERIC database. Kotkin, R. (1995, March 1). The Irvine Paraprofessional Program: Using Paraprofessionals in Serving Students with ADHD. Intervention in School and Clinic, 30(4), 235-40. (ERIC Document Reproduction Service No. EJ499254) Retrieved August 15, 2009, from ERIC database. Messina, J (2007). Classroom Strategies for Inclusion of Students With Communication and Learning Disorders. Retrieved August 15, 2009, from Livestrong Web site: http://www.livestrong.com/article/14717-classroom-strategies-for-inclusion-of-students-with-communication-and-learning-disorders/ Nichols, W., & Others, A. (1996, April 1). Academic Diversity: Reading Instruction for Students with Special Needs. (ERIC Document Reproduction Service No. ED409551) Retrieved August 15, 2009, from ERIC database. Chicago/Turabian: Author-Date. Young, K (20006, January). Classroom Inclusion: What It Takes. Retrieved August 15, 2009, from ADHD and LD Support Web site: http://www.metrokids.com/january06/guesteducator0106.html. Zelkowitz , A (2009, March 9|). ADHDialogue. Retrieved August 15, 2009, from Strategies for Special Education & Inclusion Classrooms Web site: http://blogs.scholastic.com/special_ed/2009/03/adhdialogue.html.