Transcript ADHD

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.
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)
Characteristics of ADD/ADHD
• Attention deficit disorder is a chronic
neurological condition characterized by
developmentally inappropriate attention
skills, impulsivity, and in some cases,
hyperactivity.
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
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.
Symptoms of ADD/ADHD
Symptoms must meet the following criteria,
according to the American Psychiatric
Association:
1. Severity. The symptoms must be more frequent
and severe than are typical of other children at
similar developmental levels
2. Early Onset. At least some of the symptoms
must have appeared before the child reaches age
7.
3. Duration. The child’s symptoms must have
persisted for at least six months prior to the
diagnosis
ADD/ADHD
• ADD/ADHD affects children in all areas,
disrupting the child’s 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.
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.
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.
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)
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
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
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
ADHD-C: Combined Type
Symptoms of both IA and HI:
Inattention
Hyperactivity
Impulsivity
Legal Protections for Students with ADD
1. 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.
Legal Protections for Students with ADD
2. 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.
Legal Protections for Students with ADD
3. 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.
Treatments for ADD/ADHD
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.
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.
Medications
First-Tier Medications
First-Tier Medications:
Psychostimulants
• 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.
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.
First-Tier Medications
• It is thought that these individuals do not produce
sufficient neurotransmitters—chemicals within the
brain that transmit messages from one cell to
another across a gap, or synapse—and 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 children’s attention spans, control impulsivity,
decrease distractibility and motor activity, and
improve visual-motor integration
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.
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.