Deafness and ADHD

1. Deafness and ADHD Presented by Amy Robinson

2. Attention Deficit Hyperactivity Disorder • Attention Deficit Hyperactivity Disorder (ADHD) is a chronic disorder in which the person displays inattentiveness, over-activity, impulsivity, or a combination. • Onset is prior to puberty and can impact an individual throughout his or her entire life.

3. Prevalence of ADHD • Though data varies, current rates range from 5%-10% of all children, with most studies finding ADHD in about 7%-8% of all children. • It is diagnosed more often in boys than girls. • There is limited research on Deaf and Hard of Hearing students with ADHD; the research indicates about the same rate of ADHD among this population.

4. Causes of ADHD • Though the exact cause of ADHD is still unknown, researchers know that neurotransmitters (the brain’s chemical messengers) are different in the brains of people with ADHD. There appears to be less activity in the areas of the brain that control attention and activity. • ADHD appears to be genetic. • Pregnant women who smoke, drink, or are exposed to toxins have an increased risk of having a child with ADHD. • Poor maternal nutrition and viral infections before birth also appear to contribute to the risk of ADHD.

5. Inattention Fails to pay close attention to details; makes careless mistakes Has difficulty sustaining attention Does not seem to listen, even when spoken to directly Does not follow through on instructions and fails to finish work Has difficulty organizing tasks and activities Often loses toys, homework, etc. Easily distracted Often forgetful in daily activities Hyperactivity/Impulsiveness Fidgets with hands/feet; squirms in seat Leaves seat when unexpected Runs or climbs in inappropriate situations Has difficulty playing quietly Often “on the go;” talks excessively Blurts out answers to questions Has difficulty awaiting turn Interrupts or intrudes on others ADHD Symptoms

6. Diagnosing ADHD • Parents should begin by consulting the family pediatrician, who may test the child or refer the family to a mental health professional. • The key to an accurate diagnosis is gathering as much information about the child as possible! • A variety of assessments are used: • Medical, family, and school histories • Medical exam • Interviews of teachers and other people who know the child well

7. Diagnosing ADHD • A diagnosis of ADHD requires a child to have 6 of the inattention symptoms and 6 of the hyperactivity/ impulsivity symptoms. These symptoms must be present for at least 6 months and in 2 or more settings. • ADHD - Specific Rating Scales: • Vanderbilt Questionnaire • Connors’ Rating Scales • Achenbach Child Behavior Checklist (CBCL)

8. Who can diagnose ADHD? • Pediatricians or Family Physicians • Psychiatrists • Psychologists • Neurologists

9. Inattention Symptoms 1. Fails to give close attention to details 2. Difficulty sustaining attention 3. Does not follow through on directions 4. Easily distracted Behaviors that can Result from a Hearing Loss 1. May lack necessary language competence on verbal and written language tasks 2. Fatigue from the strain of extended periods of communication may require a break 3. Auditory perception and a language deficit may prevent comprehension of directions 4. May be distracted by background noise, difficulty tuning out irrelevant auditory information, or using visual cues to scan the environment for information Why is difficult to diagnose Deaf or Hard of Hearing students with ADHD?Many symptoms of ADHD are similar to behaviors of Deaf and Hard of Hearing Children. We must be careful not to over-diagnose!

10. Treatment for ADHD • There is no cure for ADHD, but there is treatment to help control symptoms. Recent research indicates the best results are from a combination of the following: • Medication • Behavior Therapy • Social Skills Training

11. Medication • Most often, stimulants are used to treat ADHD. They may help the person’s ability to focus and concentrate, and decrease impulsivity and hyperactivity. The most common side effects are difficulty sleeping, headaches, and decreased appetite. Some common examples of this are: • Ritalin • Concerta • Dexedrine • Adderall • Daytrana • Non-stimulants, such as Strattera, are sometimes used to treat ADHD. Parents and caregivers are warned to look for signs of depression/suicide in children and teens taking this medication. • Antihypertensives, designed to treat high blood pressure, can sometimes help to control aggressive and impulsive behaviors in people. • Antidepressants may be used if stimulants to not improve symptoms.

12. Behavior Therapy and Social Skills Training • Behavior Therapy is a system that teaches and reinforces positive behavior in students with ADHD. • Token reward systems (with short-term goals) and time outs have proven effective. • Teachers and parents should model appropriate behaviors and allow time for the child to practice specific behaviors. • Adults give support for the child to self-monitor his or her own behavior. • Adults give practical assistance in organizing tasks, schoolwork (homework and notebooks), or dealing with emotionally charged events. • Social Skills Training helps children learn appropriate social behaviors. • Adults should directly teach appropriate social skills such as taking turns, sharing toys, asking for help, and responding to teasing.

13. Classroom Interventions • Physical Classroom Environment: • Make sure the auditory equipment is working properly. • Avoid close groups of students: try a horseshoe shape. This encourages communication, but is also less distracting than groups of students facing each other directly. • Give ADHD students preferential seating: near the teacher, but still included in the class. • Avoid placing the ADHD student in visually and auditorally distracting places: seat the student away from fans, heaters, windows, doors, and high traffic areas. • Give desk dividers or study carrels AS AN OPTION! Let the student use them if it helps him or her study, but never use as a punishment. • If it helps, provide a minute timer. Decide with the student on an amount of time he or she will work independently.

14. Classroom Interventions • Helping with Organization • Provide the student with organizational items such as folders, binder dividers, etc. • Establish a daily schedule and routine. • Divide longer assignments into sections and provide due dates for each section. • Give the students a homework folder and assignment notebook. • Leave five minutes at the end of the day to organize his or her desk and gather materials he or she will need to take home. • Graph paper may help ADHD students organize their work on paper. • Teach study skills such as underlining, outlining, and highlighting.

15. Classroom Interventions • Teaching a Lesson • Make lessons brief and engaging (use game-like activities, hands-on activities, vary the pace and medium of instruction). • Give ADHD students an outline of key vocabulary and concepts prior to teaching. • Remember to test knowledge and not attention span! Stress accuracy of work instead of the quantity of work. • Repeat the key concepts: use both visual and auditory cues. Include illustrations and demonstrations of the concept or desired task. • Maintain eye contact while providing instruction and directions. Ask the student to repeat the directions before sending him or her to work! • Avoid multiple commands- keep directions short and simple. • Give breaks and allow for physical activity. Allow the ADHD student to run errands to the office, write things on the board, and move around to different centers in the room. • Give extra time for assignments and tests. Monitor frequently with a positive attitude! • When giving tests or handouts, reduce the amount of items on a page. Eliminate all unnecessary information. Use dark black print.

16. Classroom Interventions • Managing Behavior and Social Skills • Clearly discuss rules and consequences for breaking (and following!) these rules in the beginning of the year. Post the rules and review often. • Develop a positive behavior plan. Include “out of class” people such as lunch aids, other teachers, principals, janitors, etc. Vary rewards so students do not get bored or uninterested. • Role play situations and appropriate responses before the ADHD student encounters them. For younger students, practice taking turns, handling disagreements, inhibiting intrusions on others. For older students, practice the skills and language involved in social problem solving. • Give a lot of feedback. Praise specific behavior. • Shorten recess time into small chunks, rather than one long recess.

17. Resources • O’Connell, Joanne and Kathleen Casale. “Attention Deficits and Hearing Loss: Meeting the Challenge.” The Volta Review. 104.4 (2004): 257-272. • Parasnis, Ila, Vincent J. Samar, and Gerald P. Berent. “Deaf Adults Without ADHD Display Reduced Perceptual Sensitivity and Elevated Impulsivity on the Test of Variables of Attention (T.O.V.A.).” The Journal of Speech, Language, and Hearing Research. 46 (Oct. 2003): 1166-1183. • www.addinschool.com/elementary.htm • www.asha.org/public/speech/disorders/ADHD.htm • www.everydayhealth.com/specialreport/adhd • www.healthline.com/galecontent/attention-deficit-hyperactivity-disorder-adhd • www.mayoclinic.com/health/adhd/DS00275/DSECTION=1