Including students with ADHD; strategies for the classroom and beyond ...

1. Including students with ADHD; strategies for the classroom and beyond ... By Gareth D Morewood Director of Curriculum Support, Priestnall School, Stockport Stockport NHS ADHD Conference - 19th April 2012

2. What is going to happen? • Give you a context where including young people with ADHD has recorded some success • Highlight some of the barriers to inclusion that need to be challenged • Offer some ideas on how to meet the challenges facing the inclusion of young people with ADHD in mainstream schools

3. Background • My own journey • My current context • Ranges of needs • Structure of Curriculum Support • Provision & Access Map • Supporting ADHD in mainstream schools

4. Does Every Child STILL Matter? • Being Healthy • Staying Safe • Enjoying and Achieving • Making a Positive Contribution • Economic Wellbeing

5. Peer Group Dismissal From Job ADHD Sexual Transmission of Disease TeenPregnancy Repetitionof year Peer Group AttemptedSuicide ADHD IntentionalInjury Incarceration Substance Abuse 0 10 20 30 40 50 60 % of Subjects Risks associated with ADHD in adolescents... © Eli Lilly 1998, Barkley RA 1998

6. Evidence from where… • Success of the young people • Parent/carer feedback • Student’s own views and thoughts • Views of other professionals • OFSTED (2004, 2008, 2011) • SEF and own monitoring and evaluation

7. A reminder - what is ADHD? Now to be considered as a disorder of age-inappropriate behaviour: Hyperactivity-Impulsivity (Inhibition – Executive Function) • Impaired verbal and motor inhibition • Impulsive decision making; cannot wait or defer gratification • Greater disregard of future (delayed) consequences • Excessive task-irrelevant movement and verbal behaviour • fidgeting, squirming, running, climbing, touching … • Restlessness decreases with age, becoming more internal, subjective by adulthood • Emotionally impulsive; poor emotional self-regulation

8. How do we manage ADHD? • We need to think about Risks and Resilience ... RESILIENCE RISK

9. Don’t forget families... • ADHD is not just about: • School • Medication • Brain • Community • Family have a KEY role to play too...

10. So what might you expect? Inattention Does not attend Fails to finish tasks Can’t organise Avoids sustained effort Loses things, is ‘forgetful’ Easily distracted Hyperactivity Fidgets Leaves seat in class Runs/climbs excessively Cannot play/work quietly Always ‘on the go’ Talks excessively Impulsivity Talks excessively Blurts out answers Cannot wait their turn Interrupts others Intrudes on others DSM-IV – Diagnostic and Statistical Manual, 4th Edition (American Psychiatric Association, 1994). ICD-10 – International Classification of Diseases, 10th Edition (World Health Organisation, 1993).

11. What characteristics may we expect? • NEGATIVE • Short attention span • but with periods of intense focus • Distractible • Poor planning/impulsive • Disoriented sense of time • Impatient • Day-dreamer • POSITIVE • High levels of environmental awareness • Responds well when highly motivated • Flexible – ready to change strategy readily • Tireless when motivated • Goal orientated • Imaginative

12. Unproven and Miss-truths.... • Elimination Diets – removal of sugar, additives, etc. (weak evidence) • Megavitamins, Anti-oxidants, Minerals (no compelling proof or have been disproved) • Omega 3 Fatty Acids (Fish Oil) – one recent study with mixed results (effects at home on parent ratings, no effect at school on teacher ratings) • Sensory Integration Training (disproved) • Chiropractic Skull Manipulation (no proof) • Play Therapy, Psycho-therapy (disproved) • Self-Control (Cognitive) Therapies for Children (disproved) • Social Skills Therapies for Children (in clinic) • Better for Inattentive (SCT) Type and Anxious Cases

13. ADHD – in summary... • ADHD is probably a disorder of self-regulation and executive functioning • ADHD persists to adulthood in 65+% of cases • ADHD largely results from neuro-genetic factors • Impairments exist in most domains of major life activities • Co-morbidity is very common (80%+) • Many advances in treatment occurred in the past decade, especially in medications • ADHD can be successfully managed leading to improved life course and outcomes

14. So lets consider Case Studies...

15. Re-cap on characteristics... • Inattention • Hyperactivity • Impulsivity

16. The ADHD-Friendly Classroom... • Seating • Eye contact • Small chunk tasks • Limit instructions/repeat back to you • Visual aids • Keep away from stimulations • Routines

17. Praise • Class rules on wall - consistency • Systems for tracking work • Immediate rewards • Avoid singling out…name the behaviour

18. Self-help... On-line identification? • http://pediatrics.about.com/cs/adhd/l/bl_adhd_quiz.htm Financial support? • http://www.governmentallowances.co.uk/?gclid=CJ-tgrmFtqACFdkB4wodRWGpUA Useful websites and downloads: • http://www.chadd.org/ • http://www.adhdtraining.co.uk/downloads.php

19. Homework [if we have to!!!]... • Home-school diary. • Bring any homework finished or unfinished into school. • Home-work clubs. • Check that they hand homework in. • Use an exchange system i.e. homework/sticker. • Discuss any homework issues with parents/carers. • Use homework trays – three different trays, colour coded. - Red – did not understand it at all. - Amber – did it, but not fully understood. - Green – understood it completely.

20. Friendships... • Use circle time/SEAL to promote positive friendships • Allow the child/young person ‘cooling down’ time following play times • Effective use of lunchtime assistants – supervision and scaffold – designated places/rooms • Organised games at break time/play times • Encourage shared tasks with peers • Model appropriate behaviours • Encourage and support positive friendships • If the child/young person displays problem behaviours, identify the problem

21. Inattention... • Inattentive Behaviour • What to try?

22. Impulsivity... • Impulsive Behaviour • What to try?

23. Hyperactivity... • Hyperactive Behaviour • What to try?

24. New Thinking? • Professor Peter Tymms research: ‘There was a 9 month advantage in reading and maths for those (students) who blurted out answers compared with those who never did so but had similar levels of inattention.’ http://www.dur.ac.uk/research/news/item/?itemno=13826

25. A thought on medication... • See medication in schools policy • If the child/young person needs to take medication in school, discreetly prompt them to go to the school office [or designated place] at the appropriate time • Avoid singling out the child/young person or repeatedly asking them, ‘have you had your tablet?’ • Doctors try and use long acting medication where possible to avoid students needing to take medication in school

26. Triangulation of support...

27. Stockport – local offer • Aspirations • Central Youth • Signpost Young Carers • Stockport Women's Centre • Parenting Team • Aiming High • Parent Partnership • Stockport Services for Young People • Mosaic • Primary Jigsaw • Secondary Jigsaw • Beacon counselling • Relate • YOT

29. Books and Further Information... www.addiss.co.uk Teaching the tiger by Dornbush and Pruitt Attention Deficit Hyperactivity Disorder by Russell A. Barkley How to teach and manage children with ADHD by Fintan O’Regan Hot stuff to Help Kids Chill Out: The Anger Management Book by Jerry Wilde

30. And finally.... Working with young people who have ADHD is extremely challenging. Above all – remember to be adaptable, innovative, empathetic, and ... open minded, And remember that not one strategy fits all...

32. Thanks for listening... Gareth D Morewood Director of Curriculum Support [SENCo] Priestnall School, Stockport www.gdmorewood.com