ADHD: Attention Deficit/Hyperactivity Disorder

1. ADHD: Attention Deficit/Hyperactivity Disorder Cindy DollmanPeoria Public School District #150Comprehensive System of Student Support cindy.dollman@psd150.org

2. Attention Deficit/Hyperactivity Disorder • ADHD • Kinesthetic Learner • Strategies for the Teacher

3. Criteria According to the DSM-IV, individuals must have 6 or more characteristics from either the Inattention List of Behaviors and/or the Hyperactivity/Impulsivity List of Behaviors

4. 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. • 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 instructions).

5. INATTENTION (continued): • 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 (e.g. toys, school assignments, pencils, books, or tools). • Is often easily distracted. • Is often forgetful in daily activities.

6. 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). • Often has trouble playing or enjoying leisure activities quietly. • Is often "on the go" or often acts as if "driven by a motor". • Often talks excessively.

7. IMPULSIVITY: • Often blurts out answers before questions have been finished. • Often has trouble waiting one's turn. • Often interrupts or intrudes on others (e.g., butts into conversations or games).

8. Additional Criteria: • 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).

9. 3 Types of ADHD: • 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.

10. How many children have ADHD? Approximately 3-7% when diagnosed with the DSM criteria

11. Prevalence of ADHD (2003) • 4.4 million children between the ages of 4 and 17 have been diagnosed with ADHD • 2.5 million of these children are receiving medical treatment for their diagnosis • In Illinois, 6.23% of our students diagnosed with ADHD • 3.32% of students were receiving medical treatment for their ADHD

12. How is it diagnosed? • Physical Exam • Patient/Parent Interview • Family History • Behavior Rating Scales • Parent/Teacher Questionnaires • Psych Testing

13. Treatment • Medication • Stimulants: Ritalin (70%) • Amphetamine: Adderall • Psychosocial Therapy • Behavioral Therapy • Social Skill Training • Support Groups

14. Side effects of Medication: • Decreased appetite - often low in the middle of the day and more normal by suppertime. Good nutrition is a priority • Insomnia - may be relieved by taking the drug earlier in the day, or adding an antidepressant • Increased anxiety and/or irritability • Mild stomach aches or headaches • Tics (more rare)

15. Competing Characteristics with ADHD • Effects on peer relations • Increase chance of injuries • Upper respiratory infections • Speech/Language Difficulties • Anxiety • Depression/Self-Esteem Issues • Sleeping Problems

16. Comorbidities • Oppositional Defiant Disorder • Conduct Disorder • Learning Disability (1/2 students with ADHD also have LD)

17. Oppositional Defiant Disorder • Includes the following behaviors that begin before age 8: • Losing one’s temper a lot • Arguing with adults or refusing to comply with adults’ rules or requests • Often getting angry or being resentful or vindictive • Deliberately annoying others; easily becoming annoyed with others • Often blaming other people for one’s own mistakes or misbehavior

18. Conduct Disorder • aggression towards others in several settings that usually leads to delinquency or incarceration and requires the assistance of a mental health professional

19. Learning Style/Preference Learning styles are the different ways students learn. They are the different approaches we take to absorb information. • Visual Learner • Auditory Learner • Kinesthetic Learner

20. Kinesthetic Learner • Learn best by touching, doing, moving • Like hands-on activities • Like to explore and move about their environment • THINK: movement and touch • Takes notes, uses highlighters

21. Common phrases of the Kinesthetic Learner • That feels right to me. • I can’t get a grip on this… • Stay in touch. • Get in touch with… • That doesn’t sit right with me. • I have good feelings about this. • My gut is telling me… • I follow your drift.

22. Characteristics of the Kinesthetic Learner • Use activities that get the learners up and moving. • Play music, when appropriate, during activities. • Use colored markers to emphasize key points on flipcharts or white boards. • Give frequent stretch breaks (brain breaks). • Provide toys such as Koosh balls and Play-Dough to give them something to do with their hands. • To highlight a point, provide gum, candy, scents, etc. which provides a cross link of scent (aroma) to the topic at hand (scent can be a powerful cue). • Provide highlighters, colored pens and/or pencils. • Guide learners through a visualization of complex tasks. • Have them transfer information from the text to another medium such as a keyboard or a tablet.

23. ADHD vs. Kinesthetic Learner • There is no way to determine if a child has ADHD or is a Kinesthetic Learner • However, it is important to notice the similarities between the two and provide strategies to compensate for learning barriers

24. Strategies in the Classroom • Sit in the front of the classroom • Provide a role model • Keep away from noise and distractions • Provide opportunities for movement • Gain eye contact and attention prior to direct instruction • Have student repeat or write oral directions • Keep directions short, concise, and to the point • Pair students with a buddy • Reduce the amount of work required in one sitting • Segment work into chunks of 15 minutes with a 5 minute break • Sit children near a fan/white noise to limit distraction of classroom noise • Only punish major disruptions • Their perception is misconstrued – find cause and apologize • Provide appropriate fidgets • Praise, praise, praise! • Specify appropriate positive behavior • Review behavior expectations and routines weekly

25. Strategies for Academic Instruction:Lesson Introduction • Use advance organizers • Review previous lessons • Set learning expectations • Set behavior expectations • State needed materials • Explain additional resources • Simplify instructions, choices, scheduling

26. Strategies for Academic Instruction:During the Lesson • Be predictable • Support the student’s participation • Use audiovisual materials • Check student performance • Ask probing questions • Perform ongoing student evaluation • Help students correct their own mistakes • Help students focus • Follow-up Directions • Lower noise level • Divide work into smaller units • Highlight Key Points • Eliminate or reduce frequency of timed tests • Use cooperative learning strategies • Use assistive technology

27. Strategies for Academic Instruction:Concluding Lessons • Provide advance warnings • Check assignments • Preview the next lesson

28. Strategies for Academic Instruction:LANGUAGE ARTS & READING COMPREHENSION • Silent Reading Time • Follow-along Reading • Partner Reading Activities • Storyboards • Storytelling • Playacting • Word Back • Board games for comprehension • Computer games for comprehension • Recorded Books • “Backup” Materials for Home use • Summary Materials

29. Strategies for Academic Instruction:PHONICS • Mnemonics for phonics • Word families • Board games • Computer games • Picture-letter cards

30. Strategies for Academic Instruction:WRITING • Set standards for assignments • Recognizing parts of story • Post office • Visualize compositions • Proofread compositions • Tape recorders • Dictate writing assignments

31. Strategies for Academic Instruction:SPELLING • Provide everyday examples of hard to spell words • Frequently used words • Dictionary of misspelled words • Partner spelling activities • Manipulatices • Color-coded letters • Movement activities • Word Banks

32. Strategies for Academic Instruction:HANDWRITING • Individual chalkboards • Quiet places for writing • Spacing words on a page • Special writing paper • Structutred programs for handwriting

33. Strategies for Academic Instruction:MATH COMPUTATION • Teach patterns in math • Partner for math activities • Mastery of math symbols • Mnemonics for basic computation • Real-life experiences of money skills • Color coding arithmetic symbols • Calculators to check basic computation • Board games • Computer games • Magic minute drills

34. Strategies for Academic Instruction:SOLVING MATH WORD PROBLEMS • Reread the problem • Clue Words • Guiding questions for word problems • Real-life examples of word problems • Calculators to check word problems

35. Strategies for Academic Instruction:SPECIAL MATH MATERIALS • Number lines • Manipulatives • Graph paper

36. Organizational and Study Skills: • Designate a student advisor • Assignment notebooks • Color-coded folders • Work with a homework partner • Clean out desks and bookbags • Visuals aides as reminders

37. Time Management: • Use a clock or watch • Use a calendar • Practice sequencing activities • Create a daily schedule

38. Helpful Study Skills: • Adapt worksheets • Venn Diagrams • Note-taking skills • Checklist of frequent mistakes • Checklist of homework supplies • Uncluttered workspace • Monitor homework assignments

39. Strategies for Behavioral Intervention: • Define appropriate behavior during praise • Give praise immediately • Vary praise statements • Be consistent and sincere • Selectively ignore inappropriate behavior • Remove nuisance items • Provide calming manipulatives • Allow for “escape” outlets • Activity reinforcement

40. Strategies for Behavioral Intervention: Behavior Prompts & Instruction • Visual Cues • Proximity control • Hand Gestures • Social Skill Classes • Problem solving sessions

41. References: • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000. • http://www.cdc.gov/ncbddd/adhd/ • http://www.cdc.gov/index.htm • http://psychcentral.com/disorders/adhd/adhd_treatment.htm • http://www.adhdinfo.com/info/parents/about/par_how_is_adhd_diagnosed.jsp • http://www.ldpride.net/ • http://www.learning-styles-online.com/ • http://www.drphonics.com/