Attention Deficit Disorder (ADD)/ Attention Deficit Hyperactivity Disorder (ADHD)

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Attention Deficit Disorder (ADD)/ Attention
Deficit Hyperactivity Disorder (ADHD)

• A condition of the brain that makes it difficult
  for children to control their behavior in school
  and social settings.
• It is one of the most common chronic conditions
  of childhood and affects between 4 and 12 percent
  of all school-age children. About three times
  more boys than girls are diagnosed with ADHD.

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ADD ADHD

• ADD - Used by the U.S. Department of Education
  and many of the schools
• ADHD is taken from the diagnostic criteria in
  the Diagnostic and Statistical Manual of Mental
  Disorders, fourth edition (DSM-IV)

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Characteristics of ADD/ADHD

• Attention deficit disorder is a chronic
  neurological condition characterized by
  developmentally inappropriate attention skills,
  impulsivity, and in some cases, hyperactivity.

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Characteristics of ADD/ADHD

• Inattention is the inability to concentrate on
  a task
• Impulsivity is the tendency to respond quickly
  without thinking through the consequences of an
  action
• Hyperactivity refers to behavior that is
  described as a constant, driving motor activity
  in which a child races from one endeavor or
  interest to another

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Characteristics of ADD/ADHD

• Children with ADD/ADHD have difficulty staying
  on task, focusing attention, and completing their
  work. They are easily distracted, rushing from
  one idea or interest to another, and they may
  produce work that is sloppy and carelessly
  executed. They give the impression that they are
  not listening or have not heard what they have
  been told. Children with attention deficit
  disorder have attention problems and/or problems
  with hyperactivity, displaying symptoms of
  age-inappropriate behavior.

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Symptoms of ADD/ADHD

• Symptoms must meet the following criteria,
  according to the American Psychiatric
  Association
• Severity. The symptoms must be more frequent and
  severe than are typical of other children at
  similar developmental levels
• Early Onset. At least some of the symptoms must
  have appeared before the child reaches age 7.
• Duration. The childs symptoms must have
  persisted for at least six months prior to the
  diagnosis

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ADD/ADHD

• ADD/ADHD affects children in all areas,
  disrupting the childs home life, education,
  behavior, and social life. At home, children
  with this condition have difficulty accommodating
  to home routines and parent expectations. They
  may resist going to bed, refuse to eat, or break
  toys during play.

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ADD/ADHD

• At school, they have trouble completing their
  class work, often missing valuable information
  because of their problems paying attention. They
  speak aloud out of turn and find themselves in
  trouble for their behavior. Their social
  interactions may be undermined by their
  impulsivity, hyperactivity, and inattention,
  hampering their ability to make and keep friends.
  In terms of gender, more boys than girls are
  diagnosed with ADD/ADHD.

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Eligibility for Services

• The condition of attention deficit disorder is
  not listed as a separate category of disability
  in the special education law, IDEA 1997.
  However, because of the hard work of parents and
  professionals concerned about children with ADD,
  two significant laws have been passed that allow
  children with ADD to be eligible for special
  education services under existing categories of
  disabilities.

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Two Laws for Eligibility

• 1991 Clarification of Policy to Address the
  Needs of Children with Attention Deficit
  Disorders within General and/or Special Education
• 1999 The Regulations for the Individuals with
  Disabilities Education Act of 1997 (IDEA 1997)

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Subtypes of ADHD in the DSM-IV

1. ADHD-IA Symptoms of Inattention
2. ADHD-HI Symptoms of Hyperactivity and
   Impulsivity
3. ADHD-C Combined Type

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ADHD-IA Symptoms of Inattention

• Fails to give close attention to details, makes
  careless mistakes
• Has difficulty sustaining attention
• Does not seem to listen
• Does not follow through or finish tasks
• Has difficulty organizing tasks and activities
• Avoids or dislikes tasks requiring sustained
  effort
• Loses things needed for tasks
• Is easily distracted by extraneous stimuli
• Is often forgetful in daily activities

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ADHD-HI Symptoms of Hyperactivity and
Impulsivity

• Hyperactivity
• Fidgets with hands or feet, squirms in seat
• Leaves seat in classroom or in other situations
• Runs about or climbs excessively
• Has difficulty playing or engaging in leisure
  activities quietly
• Talks excessively
• Acts as if driven by motor and cannot sit still
• Impulsivity
• Blurts out answers before questions are completed
• Has difficulty waiting in line or awaiting turn
  in games or activities
• Interrupts or intrudes on others

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ADHD-C Combined Type

• Symptoms of both IA and HI
• Inattention
• Hyperactivity
• Impulsivity

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Legal Protections for Students with ADD

• Children with ADD may be eligible under the
  category of other health impaired
• A child with attention deficit disorder may be
  eligible for special education services under the
  existing disability category of other health
  impaired (OHI). A child with ADD/ADHD may also be
  eligible for services under other existing
  categories of disability under IDEA 1997 if he
  or she meets the applicable criteria for those
  disabilities. Thus, children with ADD/ADHD may
  be eligible for services under other health
  impaired, learning disabilities, or emotional
  disturbance.

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Legal Protections for Students with ADD

• Children with ADD may receive services under the
  legislation of Section 504.
• The Department of Education further indicates
  that a child with ADD/ADHD may be eligible for
  services in the general education classroom under
  Section 504 of the Rehabilitation ACT of 1973,
  even if that child does not qualify for special
  education and related services. Section 504
  mandates that any agency receiving federal funds
  must provide reasonable accommodations for people
  with disabilities.

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Legal Protections for Students with ADD

• The disability of ADD/ADHD is listed as a
  specific condition under other health impaired
  (OHI).
• The 1999 Regulations are written policies
  designed so that schools can implement the
  Individuals with Disabilities Education Act for
  1997 (IDEA 1997). In the Regulations, ADD and
  ADHD are specifically listed as conditions that
  could render a child eligible for services under
  the other health impaired (OHI) category of
  IDEA 1997.

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Treatments for ADD/ADHD
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Treatment

• Many different kinds of treatments are
  prescribed for children with attention deficit
  disorder, including medication, alternative
  therapies, education, and counseling. It is
  important to stress that medication must be only
  one part of a broader treatment plan. A
  multimodal plan of treatment combines education,
  effective instruction, behavior management
  strategies, family and child counseling, and good
  parenting and home management.

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Treatment

• Many students with attention deficit disorder
  receive medication to improve their attention and
  to control their hyperactive behavior. In fact,
  the National Institutes of Health found that
  medication is prescribed in 96.4 percent of all
  cases of ADD/ADHD. The ideal medication should
  control hyperactivity, increase attention span,
  and reduce impulsive and aggressive behavior
  without inducing insomnia, loss of appetite,
  drowsiness, or other serious toxic effects.

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Medications
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First-Tier Medications Psychostimulants
First-Tier Medications

• These medications are usually tried first. As
  the most widely used type of medication
  prescribed for attentional and hyperactivity
  disorders, they are very effective for most
  patients. More than 75 percent of individuals
  with ADD improve with psychostimulants. The
  psychostimulant medications include Ritalin,
  Dexedrine, Cylert, Adderall, and Concerta.

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First-Tier Medications

• Research on ADD/ADHD suggests that the
  psychostimulant medication affects the brain in
  these individuals by increasing the arousal or
  alertness of the central nervous system.

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First-Tier Medications

• It is thought that these individuals do not
  produce sufficient neurotransmitterschemicals
  within the brain that transmit messages from one
  cell to another across a gap, or synapseand that
  the psychostimulants work by stimulating the
  production of the chemical neurotransmitters
  needed to send information from the brain stem to
  the parts of the brain that deal with attention.
  The psychostimulant medications appear to
  lengthen the childrens attention spans, control
  impulsivity, decrease distractibility and motor
  activity, and improve visual-motor integration

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First-Tier Medications

• The duration of effect for Ritalin and Dexedrine
  is three to five hours. Consequently, unless a
  second dose is taken during the school day, the
  effects of a morning dose of either of these two
  medications will wear off during the course of
  the day. The psychostimulants Cylert and
  Adderall are taken in one daily dosage, and their
  effects are long-lasting. Concerta, a newer
  medication which contains Ritalin, is purported
  to last eight to twelve hours because it is
  released throughout the day.

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Second-Tier Medications Antidepressants and
Other Medications

• As noted, about 75 to 85 percent of children with
  ADD/ADHD show general improvement with
  psychostimulant medications. For those who do
  not improve, second-tier medications,
  antidepressant medications (Norpramin, Tofranil,
  Elavil, Prozac, Pamolar, and Wellbutrin), can be
  used. Also, an antihypersentive medication
  (clonidine) may be prescribed.