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Copyright © Allyn & Bacon 2008Chapter 6: Students with Attention Deficit-Hyperactivity Disorder

STUDENTS WITH ATTENTION DEFICIT- HYPERACTIVITY DISORDER

Chapter 6

Copyright © Allyn & Bacon 2008


Definition of ADHDA pervasive pattern of inattention, impulsivity, and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development. (American Psychological Association, 2000)


Attention-Deficit/Hyperactivity Disorder A. Either (1) or (2): (1) inattention: six (or more) of the following symptoms of inattention have persisted for at least 6 months

to a degree that is maladaptive and inconsistent with developmental level: (a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other

activities (b) often has difficulty sustaining attention in tasks or play activities (c) often does not seem to listen when spoken to directly (d) often does not follow through on instructions and fails to finish school work, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions) (e) often has difficulty organizing tasks and activities (f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) (g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools) (h) is often easily distracted by extraneous stimuli (i) is often forgetful in daily activities

(2) hyperactivity-impulsivity: six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

(a) often fidgets with hands or feet or squirms in seat (b) often leaves seat in classroom or in other situations in which remaining seated is expected (c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) (d) often has difficulty playing or engaging in leisure activities quietly (e) is often "on the go" or often acts as if "driven by a motor" (f) often talks excessively

Impulsivity (g) often blurts out answers before questions have been completed

(h) often has difficulty awaiting turn (i) often interrupts or intrudes on others (e.g., butts into conversations or games)

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.

C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).

D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorders, or a Personality Disorder).

http://www.behavenet.com/pervasive-developmental-disorders

http://www.behavenet.com/schizophrenia

http://www.behavenet.com/mood-disorder

http://www.behavenet.com/anxiety-disorders

http://www.behavenet.com/dissociative-disorders

http://www.behavenet.com/personality-disorder


3 Types of ADHD Predominately

inattentive Predominately

hyperactive/impulsive Combined


Prevalence

3-5% of the population

2-3 times as many boys identified as girls

No difference in frequency among races

Caucasian children more likely to receive medication for ADHD


Key elements of ADHD Neurological Developmental Chronic Not situational Production deficits, not

acquisition deficits


Causes of ADHD Physiological causes

Heredity Brain differences

Environmental Causes Lead poisoning Maternal prenatal

smoking and alcohol consumption

Copyright © Allyn & Bacon 2008Chapter 6: Students with Attention Deficit-Hyperactivity Disorder“Copyright© Allyn & Bacon 2006”

Causation


Cognitive Characteristics Problems with Executive Functioning

Issues with ability to control impulses Working memory is not efficient Self-directed speech not utilized

effectively Difficulty controlling emotions or

motivation Reconstitution – the ability to break

down what is observed and to combine parts to carry out new actions


Academic Characteristics Some students are very successful

academically Other students consistently achieve

below their potential Academic self-concept is important


Social/Emotional Characteristics Self-esteem is a problem for some, but

not all, students with ADHD Students often have problems coping

with social functioning Developing and maintaining

friendships Rejection by peers


Behavior Characteristics Failure to attend to details Make careless mistakes in work Failure to complete schoolwork Failure to listen when spoken to directly Difficulty organizing tasks and

materials Avoidance of tasks that require

sustained mental effort


Comorbidity with Other Disorders ADHD may occur simultaneously with

other disorders such as: Learning disabilities Tourette’s syndrome Emotional disabilities Autism Traumatic brain injury Psychiatric disorders Sleep disorders Substance abuse problems


Initial Referral for Eligibility Medical Diagnosis

Pediatrician, family physician, psychiatrist

Diagnosis may occur before child enters school

Educational referrals may come from Child’s classroom teacher Special education teacher


Assessments May Include:

Medical assessment Continuous performance tests DISC IV (Diagnostic Interview Schedule

for Children) Parent rating scales and checklists Teacher rating scales and checklists Samples of student’s work Anecdotal information


Gifted or ADHD?

Inability to regulate behavior

Question rules and create their own

Problems with Rules

Primary characteristic of ADHD

Good judgment lags behind intellectual development

Impulsivity

Difficulty in most situations

Only in specific situations, e.g., when bored

Poor sustained attention

ADHDGifted StudentsBehavior


Eligibility for IDEA Services Does the ADHD “adversely affect”

the student’s educational performance?

Not all students with ADHD are eligible

Students who are not eligible for IDEA may qualify for accommodations under Section 504

Students may be eligible because they also have a learning or emotional disability


Early Childhood Education Diagnosis at an early age

is difficult. If children’s symptoms of

ADHD are severe, early intervention is crucial.

Children may need a highly structured environment, immediate and consistent feedback, and age-appropriate rewards.


Elementary and Secondary School Services

Many students receive their education in general education classrooms.

Professionals must collaborate with parents to find effective techniques for students with ADHD.


Transition and Adulthood

66% of students with ADHD continue to have the disorder into adulthood

Many adults with ADHD are disorganized, impulsive, and have poor work skills

Students need to have a clear understanding of their disorder and learn to advocate for themselves


Medication is the Most Clearly Effective Intervention The use of medication is controversial. The decision to prescribe medication

only indirectly involves school personnel.

Medication is helpful for many (70-80%) students for whom it is prescribed.

Medication alone is not sufficient to improve academic performance


Psychostimulants Ritalin Concerta Focalin Adderall Strattera


Best Educational Practices Parent and professional education Environmental supports for students Behavior interventions

Rewards Token economy systems Structure Quick Pace Variety


Supporting Parents of Children with ADHD

Have realistic expectations of parents

Encourage parents to be good role models

Help parents have realistic expectations

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