Transcript Understanding Students with Attention Deficit Disorder

Attention Deficit Disorder
ESE 380
February 26, 2009
Classification
• Other Health Impairment
• limited strength, vitality, or alertness, including a
heightened alertness with respect to the educational
environment, that
is due to chronic or acute health
problems such as asthma, attention deficit disorder or
attention deficit hyperactivity disorder, diabetes, epilepsy,
a heart condition, hemophilia, lead poisoning, leukemia,
nephritis, rheumatic fever, and sickle cell anemia; and
adversely affects a child’s educational performance.
(34 Code of Federal Regulations § 300.7[c][9])
Eligibility
• A student who qualifies as having attention
deficit disorder, and who requires an
individualized education plan must:
• Meet the criteria under the general category of
Other Health Impairment, and
• Have a medical diagnosis of attention deficit
disorder or attention deficit hyperactivity disorder
• Medical doctors
• Psychologists
• psychiatrists
Three Types of Attention Deficit
Disorder
• Inattentive
• Impulsive/hyperactive
• Combined
Inattentive Type
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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:
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often fails to give close attention to details or makes careless mistakes in schoolwork,
work, or other activities
often has difficulty sustaining attention in tasks or play activities
often 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 (not due to oppositional behavior or failure
to understand instructions)
often has difficulty organizing tasks and activities
often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental
effort (such as schoolwork or homework)
often loses things necessary for tasks or activities (e.g., toys, school assignments,
pencils, books, or tools)
is often easily distracted by extraneous stimuli
is often forgetful in daily activities
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Impulsive/Hyperactive Type
• six (or more) of the following symptoms of hyperactivity and/or
impulsivity have persisted for at least 6 months to a degree that is
maladaptive and inconsistent with developmental level:
Hyperactivity
• 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 in situations in which it is
inappropriate (in adolescents or adults, may be limited to subjective
feelings of restlessness)
• often has difficulty playing or engaging in leisure activities quietly
• is often "on the go" or often acts as if "driven by a motor"
• often talks excessively
Impulsive/Hyperactive Type
• six (or more) of the following symptoms of hyperactivity
and/or impulsivity have persisted for at least 6 months to
a degree that is maladaptive and inconsistent with
developmental level:
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Impulsivity
• often blurts out answers before questions have been
completed
• often has difficulty awaiting turn
• often interrupts or intrudes on others (e.g., butts into
conversations or games)
Additional Criteria
• Some hyperactive-impulsive or inattentive
symptoms that caused impairment were present
before age 7 years.
• Some impairment from the symptoms is present
in two or more settings (e.g., at school [or work]
and at home).
• There must be clear evidence of clinically
significant impairment in social, academic, or
occupational functioning.
True or False?
• People eventually outgrow AD/HD.
• AD/HD stems from a lack of will or any effort at
self-control.
• AD/HD is caused by parents who don’t discipline
their children.
• AD/HD results from children watching too much
television or playing too many video games.
• Dietary issues such as too much sugar cause
AD/HD.
• AD/HD results from living in a fast-paced,
Executive Functioning
• Non-verbal working memory
• the ability to retrieve auditory, visual, and other sensory
images of the past
• Internalization of speech
• planning what to do and say, and recognizing when it is
appropriate to speak thoughts
• Self-regulation of affect, motivation, and arousal
• less objective and more emotional in responding to
events, have difficulty understanding the effect of
behavior on others, and often cannot generate the
energy and enthusiasm to carry out behavior
• Reconstitution
• the skill of analyzing and synthesizing behaviors
What’s the Issue?
• Carl is in fifth grade, and has been sent to
the office on multiple occasions for
disrupting class with his constant
interrupting. Each time, Carl expresses
remorse for his behavior, and says that he
won’t do it again.
• What executive functioning is Carl having
trouble with?
What’s the Issue?
• Paula is in your sixth grade class. You have assigned ten
spelling words for the week, and Paula missed six of
them on the pre-test. You give her some exercises and
activities to do to help her practice them for the test on
Friday.
• When she is beginning to do her exercises on Thursday
night, her friend calls to tell her that the long-anticipated
season debut of Paula’s favorite TV show is starting.
Paula drops her spelling work and watches the show,
then goes to bed.
• What executive functioning is paula struggling with?
Another Look at ADD
• Dr. Daniel Amen
• Dr. Russell Barkley
• Use of brain imaging
The Research
• Joel Lubar, University of Tennessee
• Children and adolescents under
concentration tasks show increased rate of
“slow brain wave” activity.
• Reduced amount of dopamine in the
frontal lobes
• The justification for stimulant medication
Intervention Strategies
Multi-modal Approach
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Motivation
Medication
Classroom management (FBA/BIP)
Peer and adult mentoring/coaching
Counseling
Extra-curricular involvement
The “No Brainers”
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Keys to Motivating Students
Relevance
Novelty
Variety
Choices
Activity
Challenge
Feedback
Stimulant Medications
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Stimulants
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Medications Used with Attention Deficit and Attention Deficit Hyperactivity Disorder
Stimulants
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Ritalin
Dexadrine
Cylert
Adderall
Concerta
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Implications
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increase attentiveness
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reduce distractibility
enhance concentration
decrease motor restlessness
Anti-Depressant Medications
• Norpramin
• Tofranil
• Wellbutrin
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Implications
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Increase the ability to direct and maintain attention
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Reduce distractibility
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Produce a calming effect
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decrease impulsive behavior
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stop temper tantrums
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regulate frequent mood shifts
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increase reading and learning abilities.
SPECT Imaging
• Dr. Daniel Amen
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Seven Types of ADD
Combined Type
Inattentive
Over-focused
Temporal Lobe
Limbic
Ring of fire
Trauma-Induced
• www.brainplace.com
Combined Type
• 1. AD/HD, combined type with both symptoms of
inattention and hyperactivity-impulsivity. SPECT Brain
imaging typically shows decreased activity in the basal
• ganglia and prefrontal cortex during a concentration task.
This subtype of ADD typically responds best to
psychostimulant medication.
Characteristics of Combined Type
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inattentive,
distractible,
disorganized,
hyperactive,
restless and impulsive
Very similar to combined type from DSM
Characteristics of Inattentive Type
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Sluggish
Slow
Preoccupied
Uninterested
Poorly motivated or simply bored
Difficulty in listening and registering the
content of conversation
Characteristics of Over-focused
Type
• Have trouble shifting attention from one subject
to another
• Oppositional and argumentative
• Worry excessively or senselessly
• Strong tendency to get locked into negative
thoughts
• May hold grudges for a long time
• Have difficulty in viewing other options; therefore
may get locked into one course of action
Characteristics of Temporal Lobe
type
• inattention and impulsivity along with…
• Periods of unprovoked outbursts of anger
• Tendency to become increasingly irritable until
They explode and then withdraw
• Periods of "spaciness" and mental confusion,
• May have periods of panic or unexplained fear
• May be overly sensitive and somewhat paranoid
• Tend to misinterpret innocent comments and
remarks of others
Characteristics of Limbic Type
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Inattention, along with…
tendency for moodiness,
negativity,
isolation and
depression
tendency for sleep problems (sleeping too little or too
much)
feelings of guilt,
hopelessness
personal worthlessness
likely to be mistaken as suffering from chronic
depression
Ring of Fire Images
• many of the children
and teenagers who
present with
symptoms of ADD
have the "ring of fire"
pattern on SPECT.
They often do not
respond to
psychostimulant
medication and in
many cases are made
worse by them. They
Characteristics of Ring of Fire Type
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severe oppositional behavior
distractibility
irritability
temper problems
mood swings.
oppositional or aggressive
often very hyper or hyperverbal
easily distracted or has too many thoughts moodiness
cyclic behavioral changes hypersensitivity to light,
sound, taste or touch.