At the end of this presentation you should be able to: Describe the characteristics of attention deficit/hyperactivity d

1. ADD/ADHD Chapter 5 Objectives At the end of this presentation you should be able to: • Describe the characteristics of attention deficit/hyperactivity disorder. • Understand the different terminology and probable causes of ADHD. • Understand the characteristics of ADHD and it’s educational implications. • Describe the educational strategies that are commonly used with this population. Chapter Objectives

2. Definition • Neurological condition • Failure of brain circuitry that monitors inhibition and self-control • Impairs ability to defer immediate rewards for later gain • Inattention • Hyperactivity/impulsivity • Excessive motor activity which may be seen as non-compliance • Developmentally inconsistent with age of child • Runs in families

3. Case Study • Attention video • http://www.pbs.org/wgbh/misunderstoodminds/attention.html • Nate’s story • http://www.pbs.org/wgbh/misunderstoodminds/meetnathanS.html

4. Subtypes • ADHD (with hyperactivity) • easier to diagnose • move continuously • trouble sitting still • poor impulse control • temper outbursts • ADHD without hyperactivity (impulsive and inattentive form) • withdrawn or "spaced-out" • poor academic achievers • occur concurrently with Learning Disabilities • excessive anxiety or shyness

5. DSM-IV • Three sub-types • Predominantly inattentive • Predominantly hyperactive-impulsive • Combined types

6. DSM-IV • Must exhibit several characteristics • Severity • Early onset • Duration • Impact • Settings • At least 6 symptoms of one or both of the following: • Inattention • Hyperactivity

7. Symptoms • Inattention • Lacks of attention to detail, careless • Has difficulty sustaining attention • Does not appear to be listening when spoken to directly • Is not able to follow through on instructions • Difficulty organizing • Avoids tasks requiring mental effort • Often loses things • Easily distracted • Forgetful

8. Symptoms • Hyperactivity • Fidgets/squirms • Difficulty remaining seated • Runs or climbs excessively • Difficulty playing quietly • “On the go” • Talks excessively • Blurts out answers • Difficulty awaiting turn • Interrupts or intrudes on others

9. Causes • Inability of brain to filter competing sensory inputs • Inability to inhibit impulsive motor responses to sensory inputs • Possible genetic and/or biological • Certain portion of brain (basal ganglia) is smaller in some children • Area which regulates impulses • Non-genetic factors • Prematurity • Maternal chemical use • Exposure to lead • Prenatal neurological damage • Influence of environment

10. Incidence • Symptoms apparent before 7 years of age • Symptoms present in two or more settings • Significant impairment in social, academic, or occupational functioning • Symptoms not occurring exclusively during a course of a mental health condition

11. Incidence • 1.5-2.5 million in U.S. • Boys - 4-9 times more likely to be diagnosed • Found in all cultures • 1/3 identified with LD • 40-60% co-exist with other conditions

12. Historical Account • ADHD has been known by many names over the last century: • Hyperactive Impulse Disorder • Hyperactive Child Syndrome • Developmental Hyperactivity • Hyper-kinetic Syndrome • Minimal Brain Dysfunction • Minimal Brain Damage Syndrome • Moral Control Deficit • Organic Drivenness (1930)

13. Historical Account • 2500 years ago, the great physician-scientist, Hippocrates described a condition that seems to be compatible with what we now know as ADHD. • He described patients who had.... "quickened responses to sensory experience, but also less tenaciousness because the soul moves on quickly to the next impression". • Hippocrates attributed this condition to an "overbalance of fire over water". His remedy for this "overbalance" was "barley rather than wheat bread, fish rather than meat, water drinks, and many natural and diverse physical activities". From Hippocrates: Aphorisms. In The Genuine Works of Hippocrates (Translated from greek by Fancis Adams).

14. Diagnosis • mental health professionals • parents and teachers observations of child • rate behavior using specific questionnaires

15. Evaluation • Behavioral • Questionnaires and rating scales • Educational • Impact on educational progress • Classroom observation • Measurement of productivity • Medical • Medical exam • Questionnaires • DSM-IV criteria • Assessment of co-existing conditions

16. Legal/Educational Requirements • Free and Appropriate Public Education (FAPE) • IDEA • Section 504 of Rehabilitation Act of 1973 • Categorical placement • “other health impaired” • Limits strength, vitality, or alertness (response to environmental stimuli) • Significant impact on educational performance

17. Treatment Options • Behavioral approach • Modify physical and social environment to alter behavior • Behavioral training • Pharmacological approach • Most common and controversial • Prescribing is responsibility of qualified health care provider • Psychostimulants • Antidepressants • Anti-anxiety medications • Antipsychotics • Mood stabilizers

18. Treatment Options • Multimodal approach • Combination of approaches • Educational approach • http://www.pbs.org/wgbh/misunderstoodminds/attentionstrats.html#suggestions • Mental energy • Processing • Production

19. Discussion • Parent perspective • http://www.pbs.org/wgbh/misunderstoodminds/attentionbasics.html • Does AD/HD exist? • http://www.pbs.org/wgbh/misunderstoodminds/attentiondiffs.html • Medication debate • http://www.pbs.org/wgbh/misunderstoodminds/attentionstrats.html

20. Educational Implications • Consistent failure to understand or follow school rules • Frequent classroom interruptions • Poor academic performance • Lower daily grades • Failed courses • Expulsions • Increased dropout rates • Low rate of college-bound students

21. Inattention • Missing important details • Daydreaming • Difficulty organizing materials/assignments

22. Hyperactivity • Verbal or physical disruptions • Constant movement • Blurting/interrupting

23. Impulsivity • Careless errors • Giving answers before thinking • Attending only to entertaining or novel activities

24. Approach to AD/HD in the classroom • Collaborate between home and school • Develop a behavior plan • Feedback on response to medications • Positive behavioral intervention plan • Student input • Work on most difficult concepts early in the day • One assignment at a time • Vary pace and types of activities • Structure student environment

25. Approach to ADHD at home • Discreet rewards and consequences • Daily routine • Time-out from reinforcing behaviors • Use tangible reminders • Be consistent when responding to inappropriate behaviors • Avoid surprise consequences

26. Activity • http://www.pbs.org/wgbh/misunderstoodminds/attention.html