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Attention (Deficit/Hyperactivity) Disorder: How can educators help children and parents?


Title: Attention Deficit Hyperactivity Disorder: Teacher Basics to Help in Your Classroom Author: Ann M Schave Last modified by: nrussell Created Date – PowerPoint PPT presentation

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Title: Attention (Deficit/Hyperactivity) Disorder: How can educators help children and parents?

Attention (Deficit/Hyperactivity) DisorderHow
can educators help children and parents?
  • But he can focus on video games for HOURs!

Norrine L. Russell, Ph.D.Developmental
  • Russell Coaching Consulting
  • Mother
  • Educator
  • Psychologist
  • Advocate
  • Coach

Have You Ever. . .
  • Thought a child was lazy because they seemed to
    never start
  • an assignment?
  • Gotten mad at the child who kept getting out of
    their seat?
  • Become so frustrated with the child in the back
    of the room
  • banging his pencil on his desk over and over
    and over again?
  • Reminded a child to bring home their book at
    least five times
  • and then they still forget it?
  • Been in the middle of a lesson when a child
    blurts out some random
  • information irrelevant to the lesson?

Had a child listen to you talk and then not know
what you just said?
If You Answered Yes. . .
  • You are not alone.
  • Today, in every classroom across the country
    there are several students who are diagnosed with
  • It is vital for teachers to understand ADHD to
    minimize feelings of being frustrated, upset, or
    defeated and increase the likelihood of student

What we all need to understand
  • If they could, they would.
  • Ross Greene
  • The Explosive Child A New Approach for
    Understanding and Parenting Easily Frustrated,
    Chronically Inflexible Children

What well cover today
  • What are the statistics and myths of ADHD?
  • What is ADHD?
  • How is it diagnosed and what is the teachers
  • What causes ADHD?
  • What are Executive Functions?
  • What deficits do children with ADHD have?
  • What can a teacher do to help children with these
  • What medication should teachers know about?
  • Where can help be found about ADHD?

  • The Diagnostic and Statistical Manual of Mental
    Disorders Fourth Edition suggests that ADHD
    affects 3 to 5 of school aged children.
  • This adds up to 1.46 to 2.46 million children in
    schools today
  • ADHD is the most commonly diagnosed childhood
    psychiatric disorder
  • 4 to 13 of the United States Population is
    affected by ADHD
  • Boys are 4 to 9 times more likely to be diagnosed
    than girls
  • 1/4 to 1/3 of ADHD students also have learning
  • Symptoms in a child may change as that child
    grows older but that does not mean that the child
    will grow out of their ADHD diagnosis
  • ADHD children are at higher risk for
    unintentional injuries, delinquency, and
    anti-social behavior

ADHD Myths Busted
  • As published on ADDitude Magazines website,
    these are the most common ADHD myths
  • 7 People with ADHD are stupid and lazy.
  • 6 ADHD children on medication will abuse drugs
    as teenagers.
  • 5 ADHD is the result of bad parenting.
  • 4 ADHD affects only boys.
  • 3 Children with ADHD often outgrow the
  • 2 Children given ADHD accommodations are given
    an unfair advantage.
  • 1 ADHD is not a real medical disorder.

What is ADHD?
What is ADHD?
Well, this is usually what youll hear

Inattention Hyperactivity Impulsivity
Fails to give close attention to details Difficulty sustaining attention in tasks Does not seem to listen when spoken to directly Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace Often has difficulty organizing tasks and activities Often loses things necessary for tasks or activities Is often easily distracted Often forgetful in daily activities Often fidgets with hands or feet or squirms in seat Often leaves seat in classroom or in other situations in which remaining seated is expected Often runs about or climbs excessively Often has difficulty playing or engaging in leisure activities Often is on the go or as if driven by a motor Talks excessively Often blurts out answers before questions are completed Has difficulty awaiting turn Interrupts or intrudes on others
Diagnostic Criteria
  • A Six or more of the previously noted symptoms
    persisting for 6 months or longer qualifies for a
    diagnosis of ADHD in either the inattentive
    category or hyperactivity-impulsive category. If
    both inattentive and hyperactive-impulsive
    symptoms are present then a combined type
    diagnosis is given. Please see chart on previous
  • B One of the symptoms needs to have been
    present before the age of 7.
  • C Some impairment from the symptoms is present
    in two or more settings, such as school or home.
  • D There must be clear and significant evidence
    of a social, academic, or occupational
  • E The symptoms are not better accounted for by
    another mental disorder.

Note Taken from American Psychiatric
Association DSM-IV (1994, p. 83-85)
What do current experts think adhd is?
  • A Deficit in
  • Self-Regulation

Reasons ADHD Students Misbehave
  1. Frustration because they have a different
    perception of the situation.
  2. Lack of structure.
  3. They act the role of being bad.
  4. They dont know how to ask to get what they need
    so they act out.
  5. The classroom is full of distractions.
  6. The child feels misunderstood.
  7. Hunger.
  8. They feel overwhelmed with tasks assigned.
  9. They feel criticized.
  10. They are stuck in the victim cycle.

Note From Appelbaum Training Institutes How to
Handle the Hard-to-Handle Student Resource
Handbook, (2005).
What Educators Need to Remember
  • According to Schuck Crinella (2005), the most
    worrisome deficits of children with ADHD are not
    the product of low IQ, but rather of instability
    of control processes that govern everyday
    applications to the environment (p. 275).
  • The ADHD student is not dumb, lazy, or out of
    control. They are children who need our help to
    gain the proper strategies to be successful.
  • YOU can be the one to make a lifelong difference.

  • If they could, they would.
  • Ross Greene
  • The Explosive Child A New Approach for
    Understanding and Parenting Easily Frustrated,
    Chronically Inflexible Children

What Can An Educator Do If Some Symptoms Appear
To Be Present?
  • Maintain behavior logs citing observations of
    behaviors and situations. Remember to include
    inventions used and their efficiency.
  • Inform parents of behavioral concerns and discuss
    behaviors at home.
  • Request child study or equivalent meeting with
    parents, special education teachers, school
    psychologist, etc. to discuss classroom
    behaviors. This can lead to diagnosis from a
    doctor and then an IEP for the student.
  • If needed, rating scales may be given to teachers
    and parents.
  • Diagnosis and identification of ADHD needs to
    come from a complete evaluation, preferably from
    a doctor, psychologist, or psychiatrist.
  • The most helpful thing teachers can do is to
    observe the child and find interventions that
    work to make that child successful and support
    the parents.

Note From Vaughn, Bos, Schumm (2006).
What Causes ADHD?
  • Average heritability of .80 - .85
  • Environmental factors are not the cause, but may
    contribute to the expression, severity, course,
    and comorbid conditions
  • Dysfunction in prefrontal lobes
  • Involved in inhibition, executive functions
  • Genes involved in dopamine regulation
  • Dopamine transporter (DAT1) gene implicated
  • 7 repeat of dopamine receptor gene (DRD4)
  • Gene x environment interactions
  • Possible differences in size of brain structures
  • Prefrontal cortex, Corpus callosum, caudate
  • Abnormal brain activation during attention
    inhibition tasks

What we know about the neurobiology of adhd
  • Compared to someone without ADHD, children with
    ADHD have
  • Differences in brain chemicals
  • Differences in the size of parts of the brain
  • Caudate nucleus striatum globus pallidus
    corpus callosum
  • Less activity in parts of the brain
  • Right prefrontal region
  • Most of these differences are located in the
    prefrontal cortex
  • The conductor of the brain

Adhd and neurotransmitters
  • Neurotransmitter differences, particularly in
    levels of
  • Dopamine
  • Norepinephrine
  • Epinephrine
  • Serotonin
  • Dopamine has been associated with approach and
    pleasure-seeking behaviors
  • Norepinephrine plays a role in emotional/behaviora
    l regulation

Executive functioning
  • Wait, the kid Im thinking of doesnt seem like
    an executive

What Are Executive Functions?
  • An executive function is a neuropsychological
    concept referring to the cognitive processes
    required to plan and direct activities, including
    task initiation and follow through, working
    memory, sustained attention, performance
    monitoring, inhibition of impulses, and
    goal-directed persistence. (Dawson Guare,
    2004, p. vii)

Taxonomy of Executive skills
  • Response Inhibition
  • Working Memory
  • Emotional Control
  • Sustained Attention
  • Task Initiation
  • Planning/Prioritization
  • Organization
  • Time Management
  • Goal-directed Persistence
  • Flexibility
  • Metacognition

Why Are Executive Functions Important?
  • These skills allow us to organize our behavior
    over time and override immediate demands in favor
    of longer-term goals (Dawson Guare, 2004, p.
  • They also allow for the management of emotions
    and effective thought monitoring.

Executive skills and learningHow does a lack of
executive functioning create a problem in the
Deficit Response Inhibition
  • This is the capacity to think before you act
    (Dawson Guare, p. 47).
  • Children with this deficit tend to be impulsive.
    They will say things without thinking about what
    it is that they are saying.

Deficit Working Memory
  • This is the ability to hold information in mind
    while performing complex tasks (Dawson Guare,
    p. 49).
  • Students with this deficit tend to forget easily.
    They may forget their homework or books at
    school on a regular basis.

Deficit Self-Regulation Of Affect
  • This is the ability to manage emotions in order
    to achieve goals, accomplish tasks, or control
    and direct behavior (Dawson Guare, p. 50).
  • These students tend to become upset quickly with
    situations, unable to control their emotions.
    These students tend to have outbursts that
    disrupt daily functioning.

Deficit Sustained Attention
  • This is the capacity to maintain attention to a
    situation or task in spite of distractibility,
    fatigue, or boredom (Dawson Guare, p. 52).
  • Students with this deficit tend to have a hard
    time getting started and staying productive with
    a task or project. These students will get up
    often when a task is given. They talk to other
    students when they shouldnt.

Deficit Task Initiation
  • This is the ability to begin a task without
    undue procrastination, in a timely fashion
    (Dawson Guare, p. 54).
  • These students tend to put off doing work that
    they need to complete. They lack the processes
    to start the task.

Deficit Planning
  • This is the ability to create a roadmap to reach
    a goal or to complete a task. It also involves
    being able to make decisions about whats
    important to focus on and whats not important
    (Dawson Guare, p. 55).
  • These students tend to wait till the last minute
    to complete tasks and then not know what to do
    when they go to complete them.

Deficit Organization
  • This is the ability to arrange or place things
    according to a system (Dawson Guare, p. 58).
  • These students tend to have messy desks or
    cubbies. They lose papers often and frequently
    shove papers instead of placing them in
    appropriate spots.

Deficit Time Management
  • This is the capacity to estimate, allocate, and
    execute within time constraints (Dawson Guare,
    p. 60).
  • These children get work done at the last minute
    and frequently ask for assignment extensions.
    They underestimate how long work will take.
    Sometimes we refer to children with ADHD as

Deficits Goal-Directed Persistence
  • This is the capacity to have a goal, follow
    through to the completion of the goal, and not be
    put off by or distracted by competing interests
    (Dawson Guare, p. 62).
  • These students are able to create goals for
    themselves but are not able to achieve them.
    They are not able to understand the necessary
    steps to reach a goal and often become distracted
    with outside stimuli negatively impacting their
    task completion.

Deficit Flexibility
  • This is the ability to revise plans in the face
    of obstacles, setbacks, new information, or
    mistakes (Dawson Guare, p. 63).
  • These students have difficulty in transitions and
    new situations. These students struggle longer
    than others at the beginning of each year. They
    also are thrown off by changes in daily
    schedules. These students have limited problem
    solving strategies.

Deficit Metacognition
  • This is the ability to stand back and take a
    birds-eye view of oneself in a situation. It is
    an ability to observe how you problem solve. It
    also includes self-monitoring and self-evaluative
    skills (Dawson Guare, p. 65).
  • These students make careless mistakes frequently.
    They also will complete one step then stop,
    instead of finishing the series of steps. For
    example, these students may add instead of
    subtract over and over again while failing to
    review their work and realizing their mistake.
    Also, these students will do one step of long
    division and then stop, not reflecting on the
    whole process needed to complete the task.

But what do i DO?
  Provide help for deficits at the moment it is
needed, not negative feedback when it is already
too late. Unfortunately, the simple reality is
that punishment does not usually teach the needed
  This is because many children with ADHD have
difficulty doing what they know, not knowing
what to do. They already know, for
example, that they should come to class prepared.
Once we understand that punishment has not been
working, we are ready to provide relief for their
disabilities by guiding them at the moment
guidance is neededrather than continued
disbelief that they did it wrong again.
Teach this process1. stop2. think3.
plan4. do
Response Inhibition
  • Reduce situations where the child can get into
  • Use Proximity Control Increase supervision of
    the child
  • Demonstrate impulse control by modeling
    appropriate behavior
  • To teach the skill
  • Explain the skill and behaviors
  • Model behaviors
  • Discussion situations to use the skill
  • Reinforce the skill
  • Ignore inappropriate behavior

Note From Dawson Guare, (2004).
Working Memory
  • Enforce use of assignment books consistently
  • Utilize checklists and to-do lists
  • Use cue devices such as verbal reminders, alarm
    clocks, and Post-Its
  • To teach the skill
  • Explain the skill
  • Give options to the child for cues and checklists
    to use
  • Create a monitoring system for the child to
    monitor their own skill usage

Note From Dawson Guare, (2004).
Self-Regulation Of Affect
  • Prepare child for problem situations
  • Give child scripts for problem situations and
    practice regularly
  • Structure environment to avoid situations that
    can lead to problems
  • Give breaks to child during tasks as needed
  • Teach child I-statements
  • Use social stories that teach emotional control
  • To teach this skill
  • Explain the skill
  • Provide coping strategies
  • Practice with the child
  • Reinforce child when strategies are used
  • Discuss real life situations of using the strategy

Note From Dawson Guare, (2004).
Sustained Attention
  • Write start and stop times on assignments
  • Use incentive systems
  • Break down tasks into steps
  • Make tasks interesting for students
  • Give child something fun to do when task is
  • Provide attention and praise when student is
    remaining on task
  • To teach the skill
  • Discuss attention time with the student
  • Teach them to break down tasks on their own
  • Help them make work plans for completing tasks
  • Reinforce them when they use the plan

Note From Dawson Guare, (2004).
Task Initiation
  • Use verbal cues to get child started
  • Create a visual cue to prompt child to get
    started, such as a note on their desk
  • Walk through the first part of the task to help
    child get started
  • Have child tell you when they will begin the task
    and cue them when the time arrives
  • To teach the skill
  • Teach the child to create a written plan for
    starting the task including time and type of task
  • Teach child to break down the task if needed
  • Teach child to use cue such as alarm clock to
    start task
  • Reinforce child when no additional cues are
  • Fade supervision

Note From Dawson Guare, (2004).
  • Plan a schedule for the child
  • Use rubrics
  • Break long assignments into smaller pieces with
    deadlines for each piece
  • Create planning sheets with due dates
  • Use assignment planners
  • To teach the skill
  • Walk through the planning process with the child
  • Have child model the planning process
  • Tell student to create roadmaps for tasks
  • Ask questions such as What do you have to do

Note From Dawson Guare, (2004).
  • Maintain an organized classroom
  • Create schemes for organizing backpacks and
  • Color-code folders, notebooks, and papers for
  • To teach the skill
  • Teach child to separate papers and categorize
  • Have them create their own organization plan
  • Get the plan in writing
  • Have them implement the plan

Note From Dawson Guare, (2004).
Time Management
  • Give child a schedule to follow
  • Prompt student with each step of a task
  • Impose time limits for assignments
  • Provide frequent reminders for remaining time to
    complete task
  • Use cueing devices such as alarm clocks
  • To teach the skill
  • Help child understand what the task involves
  • Have child think of distractions that may be
    present when completing task
  • Create an estimated time for completion compare
    estimated time to actual time
  • Find strategies to decrease distractions

Note From Dawson Guare, (2004).
Goal-Directed Persistence
  • Give students goals and have them keep track of
    their progress
  • Goals need to have motivational interest to the
  • Include students in establishing goals
  • Create reasonable goals
  • To teach the skill
  • Follow a coaching process
  • Hold a goal setting session where a goal is set,
    obstacles are discussed and a plan is written
  • Hold daily coaching sessions where goal is
    re-discussed and progress is assessed by asking

Note From Dawson Guare, (2004).
  • Give advance warning for new schedules or
  • Allow student to practice new schedules or
  • Provide rubrics to follow
  • Read social stories to teach coping strategies in
    problem situations
  • Offer positive reinforcement and step by step
    assistance with difficult problems
  • To teach the skill
  • Teach students what inflexibility is and how to
    recognize it
  • Teach and model coping strategies with plans and
  • Create strategies to fall back on
  • Teach relaxation strategies

Note From Dawson Guare, (2004).
  • Ask child to explain how they solved the problem
    or if they can think of another way to solve the
  • Create buddy systems for students to check work.
  • Give assignments where students can evaluate
    their work ethic and give a grade.
  • Use rubrics.
  • To teach the skill
  • Define the skill and what is needed to use the
    skill appropriately
  • Practice the skill
  • Create error-monitoring checklists
  • Teach children to ask themselves self-monitoring
    questions while tasks are being completed

Note From Dawson Guare, (2004).
Teach this process1. stop2. think3.
plan4. do
Classroom Setup To Accommodate ADHD
  • Seat ADHD student away from distractions,
    preferably front and center (
  • Seat student near a good role model
  • Increase distance between desks to decrease
    distractions (
  • Create a cool-down area (National Education
    Association, 2005).
  • Play quiet music (Appelbaum Training Institutes
    How to Handle the Hard-to-Handle Student Resource
    Handbook, (2005).
  • Create a stage for announcements in the classroom
    (Appelbaum Training Institutes How to Handle the
    Hard-to-Handle Student Resource Handbook, (2005).

Other Solutions To Helping The child with
executive functioning challenges
  • Make lessons very clear
  • Use lots of visuals
  • Pair students together to complete assignments
  • Provide hand signals
  • Play beat the clock
  • Use behavioral contracts
  • Use sticker charts
  • Provide study carrels or private offices
  • Allow students to move around
  • Allow more time for tests
  • Put luggage tags on book bag to remind students
    of what to bring home
  • Put sponges or mouse pads on desks for students
    who like to tap
  • Have special highlighters for students to use
  • Use picture mats or file folders cut into thirds
    to chunk assignments
  • Provide headphones for students to use
  • Use manipulatives such as Koosh balls or hand
    exercisers for students

Note From Appelbaum Training Institutes How to
Handle the Hard-to-Handle Student Resource
Handbook, (2005).
Successive behavioral interventions are
  • Intensive
  • Consistent
  • Immediate
  • Reinforcing

Teach this process1. stop2. think3.
plan4. do
ADHD Stimulant Treatment
  • Pharmacological treatment usually involves
  • Methylphenidate products
  • Dextro-amphetamine/amphetamine products
  • CNS stimulants highly effective
  • Reduce core symptoms of inattention,
    hyperactivity, and impulsivity in 75 to 90 of
    children with ADHD

ADHD Stimulant Treatment
  • Research has shown that stimulants
  • Are highly effective in reducing ADHD symptoms in
    the short term
  • Decrease disruption in the classroom
  • Increase academic productivity and on-task
  • Improve teacher ratings of behavior

ADHD Stimulant Treatment
  • Common side effects
  • Insomnia, decreased appetites, dysphoric mood
  • Irritability, reduced motor activity
  • Headaches, G-I complaints
  • Tics
  • Decreased frequency of social interactions

Limitations of Stimulant Treatment
  • Individual differences in response
  • Not all children respond (approximately 80)
  • Limited impact on domains of functional
  • Primary reason for treatment seeking
  • Does not normalize behavior
  • Family problems beyond the scope of medication
  • No long-term effects established
  • Long-term use rare
  • Limited parent/teacher satisfaction
  • Some families are not willing to try medication

  • One thing to remember
  • Pills dont teach skills

  • American Medical Association (AMA)
  • encourages the use of individualized therapeutic
    approacheswhich may include pharmacotherapy,
    psycho-education, behavioral therapy,
    school-based and other environmental
    interventions, and psychotherapy, as indicated by
    clinical circumstances and family preferences.

  • American Academy of Pediatrics (AAP)
  • the clinician should recommend medication
    (strength of evidence good) and/or behavior
    therapy (strength of evidence fair), as
    appropriate, to improve target outcomes in
    children with ADHD (strength of recommendation
    strong) (p. 1037)

  • American Academy of Child Adolescent Psychiatry
  • Treatment may consist of pharmacological and/or
    behavior therapy but that pharmacological
    intervention for ADHD is more effective than a
    behavioral treatment alone and that behavioral
    intervention alone might be recommended as an
    initial treatment if the patients ADHD symptoms
    are mild with minimal impairmentor parents
    reject medication (p.902)if a child has a
    robust response and shows normative
    functioningthen psychopharmacological treatment
    alone is satisfactory (p. 912)
  • If the child does not show a robust response to
    all FDA-approved medications, the clinician
    should consider behavior therapy and/or the use
    of medications not approved by the FDA for
    treatment of ADHD (p.907)

What works best?Medication behavioral
  • ADHD is a highly prevalent, brain-based disorder
    which is associated with lifelong impairment in
  • Environmental factors can contribute to the
    expression, severity, course, and comorbid
  • Long-term developmental outcomes for individuals
    with ADHD can include serious substance abuse,
    chronic criminality, depression and suicide
  • Stimulant medications and behavior therapy are
    currently the only established evidence-based
    treatments for ADHD
  • Combined behavioral-pharmacological treatment has
    the greatest impact on functional outcomes, is
    preferred by parents and teachers, and is most
    likely to result in normalization of behavior

  • ADHD is not a problem with knowing what to do
    it is a problem of doing what you know.
  • -Barkley, 2006
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