Transcript ADHD Workshop

Exploring
Attention Deficit Hyperactivity Disorder
(ADHD)
...Secondary-phase-specific workshop
Concordia Education & Training LLP
[email protected]
Yourselves
Take some sweets please
Introduce yourself to your neighbour using the sweets:
Number of sweets = number of facts
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Blue = family
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Green = school
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Yellow = friends
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Red = hobbies
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Brown = music/movies
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Orange = wild card
Looking at:
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Is it a thing?
Signs & Symptoms
Feel like?
Difficulties with school?
Strategies to help
1. Is it a thing?
“Why have we created a medical condition to
excuse our spoiled brats?”
Leo McKinstry Daily Express 2nd March 2005 p. 12.
“ADHD doesn't exist & drugs do more harm
than good”
Dr Richard Saul Daily Mail Online 11th March 2014
Group Task: Discuss & Feedback!
 Parents to blame?
 Benefits scam – maybe eligible for allowance?
 Is it a thing or an excuse?
Definitely a Thing!
“ We cannot overemphasize the point that, as a
matter of science, the notion that ADHD does not
exist is simply wrong. All of the major medical
associations & government health agencies
recognize ADHD as a genuine disorder because the
scientific evidence indicating it is so overwhelming
….there is no doubt that ADHD leads to impairments
in major life activities, including social relations,
education, family functioning, occupational
functioning, self-sufficiency, & adherence to social
rules, norms, & laws.”
International Consensus Statement on ADHD January 2002 in Clinical Child &
Family Psychology Review, Vol. 5, No. 2, June 2002
ADHD is one of the most misunderstood
disorders
Facts & figures
ADHD = a neurobiological condition
 No single cause yet established : strong evidence = largely genetic
influence with other factors
 Current thinking: imbalance of neurotransmitter chemicals e.g.
dopamine & noradrenalin which control ‘executive functions’ in the
prefrontal cortex may cause the core symptoms of ADHD:
 Hyperactivity
 Impulsiveness
 Inattention
At significant risk of anxiety & depression
Causes particular & exceptional difficulties with:
 managing frustration
 restraining outbursts
 planning/ organizing
 problem solving
 memory recall
 sustaining effort
 keeping focused
Thought to affect around 5% of school population about 1 in 20
pupils – very likely 1 or possibly 2 in each class – not all diagnosed
Evidence: 3 x as many boys v. girls
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2. Signs & Symptoms
ADDISS:
National Attention Deficit Disorder Information
& Support Service.
“The best description for ADHD is that a child who
suffers from this condition shows disruptive
behaviours, which cannot be explained by any other
psychiatric condition & are not in keeping with those
of the same-aged people with similar intelligence &
development. These behaviours are usually first
noticed in early childhood & are more extreme than
simple “misbehaving”. Children with ADHD have
difficulty focussing their attention to complete a
specific task. Additionally they can be hyperactive &
impulsive & can suffer from mood swings & ‘social
clumsiness’ ”
Different Types & Degrees of Severity
Varying degrees: mild, moderate & severe
3 main types recognized:
1. Predominantly hyperactive-impulsive
2. Predominantly inattentive – known as ADD mostly
girls daydreaming/ anxious
3. Combined all of the above! = most common!
Diagnosis difficult:
 only by professionals usually child psychiatrist or
paediatrician
 no single specific test or standardised assessment
but diagnostic evaluation
 ADHD services underfunded & overloaded so
diagnoses may be delayed
Group Task: See Handbook for Diagnostic Guide
Never rains but it pours!!!
Research shows: over 50% also have one or more of:
(Jensen Martin & Cantwell 1997)
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Specific learning difficulties
Conduct disorder -repetitive & persistent pattern of
antisocial behaviour
Oppositional defiant disorder
Affective disorder – mood disorder e.g. bipolar;
anxiety disorder & depression
Substance abuse
Developmental language delay
Obsessive compulsive disorder
Asperger syndrome
Tic disorder
Tourette's syndrome
3. Feel like?
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Red Bull & caffeine!!!
ADHD sufferers may have difficulty filtering impulses
& try respond to them all
Rather than failing to pay attention, they pay more
attention to more cues than the average person &
are unable to stop the relentless flow of information.
Researchers recognize that ADHD doesn’t impair
the ability to pay attention but the ability to control
what you pay attention to
What does this feel like?
Group Task: Left to right up down & turn game & see
how many objects you can remember
4. Difficulties with school?
Group Task:
What skills do you need to succeed in school?
Space in handbooks & Feedback
 Memory
 Listening
 Communication
 Organisation & time management
 Follow instructions & prioritising
 Concentration
 Sitting still for long periods of time
 Not disrupting / shouting out
 Reading & mathematical functioning
 Speaking & listening
 Complete work / Meet deadlines
 Social skills
Is it a wonder they struggle? Square peg / round hole?
Not the wrong weather just the wrong clothing!
Now …….
Task:
Your pupils specific difficulties? In one colour itemise
their difficulties- matchstick man in handbooks
Group Task:
Compare with Problems: Academic & Social in
handbooks
N.B. Secondary school possible even harder than
primary school as there is more:
 demand for independent work
 less structure
 more pressure to multi-task
 more subjects & subject teachers
 more change
5. Strategies to help
We can make a difference & help them overcome their
challenges, raise their self esteem & reach their full
potential! When people with ADHD find something that
they’re passionate about-can dedicate themselves totally
 Tend to relax when they know they are supported
Group Task: Who am I?
 Focus on their strengths – build on what they can do help them grow as confident independent learners
 Pupils with ADHD may be some of the most challenging!
But also some of the most loving, caring, delightful &
enthusiastic!
May be:
 Bright /Creative/ Imaginative/ Blue sky big picture thinkers
 Articulate/ Quick to put learning into practice/ Curious
 Spontaneous / Fun/ Humorous/Artistic/ Energetic
Group Task: Return to matchstick pupil & add strengths in
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a different colour - capitalise on these?
Vital to Make a Difference:
Through:
A. Medication
B. Understand & Get to know them
C. Management:
 Behavioural intervention : STOP & START
 Educational Strategies & Support
A. Medication
Not major on but need to understand:
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Can be highly effective but not for everyone
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Not usually preschool:1st line = parent education
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School age children - medication for severe cases
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Psycho-stimulants – change levels of brain
chemicals (e.g. Ritalin & Dexedrine)
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Psycho-stimulants are stimulants NOT sedatives
that help concentration. Have almost immediate,
observable effects & wear off around 4 hours so
need number of doses/ slow release form
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Tricyclic antidepressants also used
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If required during the school day, school’s agreed
procedures must be followed. Pupils may be
embarrassed – respect needed
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Side effects are possible: monitor & report
B. Understand & Get to Know Them
1. Understand ADHD
2. Understand parent power – work with them inform of positive
changes too! Use home-school diary
 Use IEPs / IBPs - identify difficulties / set targets /devise
strategies
3. Understand the pupil & how ADHD affects them – all unique
Get to know them & build warm, friendly, positive, professional,
respectful, safe relationships
Group Task: Getting to know you alphabet game: pool things
beginning with each letter of the alphabet
N.B. Give them chance to talk – ask them how you can help them
Group Task:
Return again to matchstick pupil & add all you know e.g.
personality; motivators; likes; dislikes; learning style; other special
need; windows of opportunity; social; emotional in a third colour
Vital to Engage & Motivate use motivators/ interests; preferred
learning style – see handbook
Think: Anything you need to find out?
C. Management: Behavioural intervention
Behaviour & learning are linked!
Pupils with ADHD need boundaries ++
 ADDISS highly recommended: 1 2 3 Magic
behavioural intervention programme for ages
2 -12 but principles same for older pupils
Books:
 1 2 3 Magic for Teachers
 1 2 3 Magic for Parents
Divides behaviour into Stop & Start - different
strategies
1-2-3 Magic
STOP - Must decide:
1. ADHD behaviour or ‘choice’ behaviour?
2. Just annoying & can be tactically ignored
3. If tackling - prioritise & tackle systematically 1 or 2 at a time
NO TALKING – NO EMOTION RULE
Strategy: Counting = Simple, direct & effective
Must agree & teach beforehand: A pupil stuck on a maths problem?
Then – Count:
 1 give 5 seconds to comply
 2 & wait
 3 say take 5 = sanction e.g. time out / Can go straight to 3
After sanction: NO TALKING – NO EMOTION – NO APOLOGIES
Needs practise for you & them!
Benefits?
1. Energy saving: breath & aggravation
2. Gives time for positive: more attention/ fun
3. It works!
Reaction: Immediate compliers & immediate testers
START: Energy goes into this – rewards/ incentives better than
sanctions – catch them being good – give them a reason to behave
C. Management: Educational Strategies & Support
Group Task:
See General Strategies: Proactive NOT Reactive in
handbook
Before look at specific problems need to think:
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Respect
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Have high expectations: Halperin ‘reason not an
excuse’ – best that they can be!
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Ownership & independence where possible – help
them to help themselves
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Think on your feet & keep sense of humour
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Give dedicated undivided attention
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Teach/ model/ praise/ practise skills that are
needed to succeed e.g. listening
Group Task: There’s no need to shout/ Never ever..
Over to you: Group Brainstorm
Give a man a fish …. Reflective practitioner
Think child think problem think solution
Group Task: Lucky Dip!
Brainstorm: Tips & Tricks; Strategies & Games/
Activities – Head Fake!
1. Giving & Following Instructions
2. Concentration & Memory
3. Hyperactivity
4. Organisation
5. Peer problems
Feedback
1. Giving & Following Instructions
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Working in groups: Get them into groups before giving
instructions!
Stand/ sit near them
Attract attention & gain eye contact
Be specific & brief
Communicate clearly – tell them personally
Short sequences of instructions then if necessary give
one instruction at a time
Check understanding & ask to repeat back to you
Use additional reminders e.g. Write down use colour /
use recording devises e.g. talk buttons
Model – walk through
During tasks, make frequent checks to ensure that
pupils are on task & following instructions correctly.
Games/ activities: Digital scavenger hunt/ cookery / blind
drawing
2. Concentration
Concentration = prerequisite for memory
 Actively involve / Engage & Motivate – use interests
 Use variety & pace / concentration windows / attention
training – personal bests / stress toy/ time out zone/
cards
 Allow short breaks between tasks – rule of thumb timing
– 1 minute for ever year+ 2 minutes
 Share targets: WALTS & WILFS & success criteria
 Set short achievable tasks: chunking & clustering
1. Chunking: whole steak at once? Tasks: manageable bits
2. Clustering: wouldn’t eat rice one grain at a time!
 Develop prompt rewards for work/ homework completion
 Use timers to indicate a period of concentrated work
 Follow a difficult/ set task with a preferred task
 Emphasize quality of work rather than quantity
 Use alternative methods of recording (diagrams/ tape
recorders; ICT etc)
Memory
Many have working memory issues = ability to hold
information long enough to accomplish a specific task
 Some have problem with retrieval of stored information
 Use memory tricks
1. Visualisation & Colour: Memory= enhanced by
exaggeration of emotion action & colour - draw or create
vivid pictures to enhance memory
Researchers: Minnesota University found colour
Increased motivation; willingness to learn & participation
by 80% & retention by 75%+
2. Teach strategies e.g. Mnemonics/ Acrostics /Stories/
Chunking etc.
3. Make it musical- Songs/ Rhymes/ Rap
4. Quickly review /consolidate learning
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Games & activities for memory/ concentration: DVD;
Where’s Wally/ A Picture paints a thousand words
3. Hyperactivity
Allow movement within agreed boundaries
 Plan in movement / practical tasks
 Provide opportunities for movement (handing out books)
 Allow alternative seating e.g. straddle chair horse-back
style = more difficult to swing or tip a chair
 Set shortened assignments – remember timings
 Reduce distractions – seat wisely – near Teacher away from
visual & auditory distractions - windows when on task & move
to social seating when not
 Seat near positive role models - opportunities for cooperative
working & enable to learn from their peers.
 Calm space - colours matter
 Listen to soft music through headphones aids concentration &
filters other auditory distractions
 Remove unnecessary objects from desk / Use desk dividers /
study carrels to reduce visual distractions
 Support adult needs to be near & use respectful alerts if they
are off-task
 Stress toys – justify use
 Be fair – injustice can lead to explosions
Games/ activities: Guess 2 minutes/ Attention training – PBs
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4. Organisation
Need help with organisation of resources & time management:
 Teach & Model Organisation – visible thinking
 Set aside special times to tidy folders etc.
 Colour coding books & folders / Chunking
 To do lists/ checklists/ planners/ calendars / diaries/ mind maps
 Provide regular reminders of daily tasks/ print-outs of homework
& course-work requirements (including submission dates)
 Visual timetables
 Keep worksheet/ instruction sheet format simple
 Organised buddy - If possible, find something that the pupil with
ADHD can help them with in return: respect & equality
 Enlist help from home where possible.
 Reward tidiness & organisation
 Have times of amnesty when long-forgotten work can be
handed in & organized without penalty
 Repeat expectations each time a piece of work is set
 Summarize instructions in writing/ talk button
 Develop a clear system for keeping track of completed/
uncompleted work
Games/ Activities: Plan a party/ Event; Order of Birthday, height
etc
5. Peer problems
“The children who need love the most will always ask for it in the
most unloving ways” Russel Barkley
Use PHSE role-play and drama to teach concepts/ skills
of communication, participation, cooperation, turn-taking,
listening, empathy etc.
 Teach & Model social rules
 Encourage/ facilitate inclusion of pupil in friendship
groups
 Use cooperative learning activities where tasks require all
members of are required to fulfil their role to ensure group
success
 Reward appropriate social behaviour
 Involve parents
 Assign the pupil responsibility in their peer group to
increase respect
 Increase self esteem
Games & activities: Big bad wolf freestanding newspaper
shelter for group/ outfit for the races / Balloon master: sticky
tape
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Useful organisations
ADDISS: Registered charity providing information &
resources about ADHD for parents, sufferers,
teachers & health professionals – have local support
groups
www.addiss.co.uk/ e-mail: [email protected]
Phone: 020 8952 2800 / Fax: 020 8952 2909
 ADDitude: provides expert guidance & inspiring life
stories from the experts in the field & from parents &
adults offering advice & inspirational stories.
Magazine: www.additudemag.com/
Expert webinars/podcasts:
www.additudemag.com/webinars/
Free downloads:
www.additudemag.com/resources/free-downloads/
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Have we…..???
1.
2.
3.
4.
5.
Is it a thing?
Signs & Symptoms
Feel like?
Difficulties with school?
Strategies to help
Thank you for your time &
participation