Transcript reflection questions

Current Issues
with
ADHD,
504 Plans,
and IEPs
Exerpts taken from the NSSEO
ADHD presentation given October 21, 2003
by Neuropsychologist Dr. Frye, Arlington Heights, IL
“Underdiagnosed and misdiagnosed,
overtreated and undertreated, attention
deficit disorder has become a medical
nightmare.
Chicago Tribune, September 2000
Keep in mind...
Inattention is a basis for the sign of a
problem versus a diagnosis of ADHD.
Diagnostic Criteria for
ADHD:
• No medical test makes the
diagnosis.
• Symptoms are demonstrated before
the age of seven
• Symptoms are seen across all
settings.
• The following symptoms have been
present and persistent for at least six
months to a degree that is maladaptive
and inconsistent with developmental
level.
Inattention:
Student makes careless mistakes and often
fails to give close attention to details.
Student has difficulty sustaining attention in
tasks or play activities.
Student does not seem to be listening
when spoken to.
Student often fails to complete homework
or chores at home.
Student is easily and often distracted by
extraneous stimuli.
Hyperactivity:
Student frequently fidgets with hands or feet or squirms
in seat.
Student has difficulty remaining in seat when it is
expected.
Student appears restless. Younger students may climb
excessively or run about when it is not appropriate to do
so.
Student has difficulty engaging in leisure activities
quietly.
Student is “on the go” or appears as if “driven by a
motor”.
Student often talks excessively.
Impulsivity:
Student often blurts out answers before
question has been completed or before
being called upon.
Student has difficulty waiting his or her
turn.
Student often interrupts or intrudes on
others. Student may butt into
conversations or games.
Types of ADHD in DSM IV
ADHD Combined Type:
Inattention and Hyperactivity are
present.
ADHD Predominantly Inattentive
Type: Symptoms of inattention
with little signs of impulsivity or
hyperactivity.
ADHD Predominantly
Hyperactive-Impulsive Type:
Primarily symptoms of
hyperactivity and impulsivity.
Medications most commonly
used to treat ADHD
Stimulants
•Short Acting:
Ritalin, Adderall, Focalin,
Methylphenidate
•Long Acting:
Concerta, Ritalin SR,
Adderall XR, Metadate
or Methylin
Non-stimulants
•Strattera
Antidepressants
•Wellbutrin, Tofranil
Comorbidity is the RULE, not the
exception.
• Comorbid - more than one
diagnosis is present.
• It is estimated that 40-60% of all
people diagnosed with ADHD have
comorbid diagnoses.
• Most common comorbid diagnoses
-Tourette’s Syndrome
-Learning Disabilities
-Oppositional Defiant Disorder
-Bipolar Disorder
-Autistic Spectrum Disorder
ADHD and LD
Students with ADHD are at a higher risk to
have specific learning disabilities
Fine motor skills are poor
Poor reading comprehension is common
Many academic issues are secondary to deficits
in executive functioning
What is Executive Functioning?
• Collection of interrelated functions that are
responsible for purposeful, goal-directed, problemsolving behavior.
• Control or self-regulatory functions that
organize and direct all cognitive activity, emotional
response, and overt behavior.
• Functions that allow students to say to
themselves, “Now is the time for me to ...”
• Functions that allow students to self-monitor
time management.
• Regulation of thought, behavior, and
emotions.
Executive Function dysfunction is
apparent in many disorders including:
ADHD
Autistic Spectrum Disorders
Traumatic Brain Injury
Tourette’s Syndrome
Nonverbal Learning Disability
Specific Learning Disabilities
Mood Disorders
Behavioral Definition for EF Subdomains
• Self-monitor: Checking on one’s own
actions during, or shortly after finishing a task
or activity to assure appropriate attainment of
a goal.
• Emotional Control: Controlling one’s own
emotional response in order for it to be
appropriate to the situation or stressor.
• Working memory: Holding information in
mind for the purpose of completing a specific
related task.
• Initiation: Beginning a task or activity.
• Inhibition: Resisting an impulse or not
stopping activity at the proper time.
• Shift: Freely moving from one situation,
activity, or aspect of a problem to another as
the situation demands.
• Plan: Developing appropriate steps ahead
of time in order to carry out an associated task
or activity; anticipating future events, setting
goals.
• Organize: Carrying out a task in a
systematic manner; establishing or
maintaining order in an activity or place.
School Related Consequences of EF Dysfunction
disorganization, loss of materials, poor task initiation,
seen as unmotivated/lazy, underactive
becomes increasingly apparent in middle school due
to higher demands of academic expectations and the
assumptions of the presence of appropriate executive
functioning
math and language arts most acutely affected due to
the reliance of working memory and organization for
successful completion of these types of tasks
subset of children who have been considered as
having ADHD but do not meet criteria for attention,
hyperactivity, or impulsivity
What is a 504 plan?
What is an IEP?
What is the difference
between them?
504 Plan
• Section 504 of Rehabilitation Act of 1973
• Individual with a disability includes any
person who has a “physical or mental
impairment which substantially limits one or
more major life activities .”
• Major life activities include:
caring for oneself, performing manual
tasks, walking, seeing, hearing,
speaking, breathing, and learning as
these activities pertain to education and
the school setting
• Regular education initiative to provide
regular ed students with in-class
accommodations and modifications they
need to be successful in a regular ed
class. Regular ed teachers are to
implement the accommodations and
modifications.
• A plan that documents what the
accommodations and/or modifications
the student needs in the regular ed class
setting.
Some common diagnoses for
which 504 Plans are written:
• ADHD
• Visual Disorders
• Asthma
• Tourette’s Syndrome
• Seizure Disorders
SO...
What’s the difference between
a student with a 504 plan
who has ADHD and a student
with ADHD who has an OHI IEP?
504 Plan
Students’ needs can be met in the regular ed classroom
with accommodations or modifications that can be made by
the regular ed teacher. Special ed services are not
provided.
OHI with an IEP
OHI = Other Health Impaired
Student’s medical condition warrants enough academic
services that his or her academic needs cannot be met in the
regular ed environment without special ed services. An IEP is
written to determine academic needs, goals and objectives.
Direct special ed services are provided by a special ed
teacher.
The Handy List of
ADHD DOs and DON’Ts
for Educators
Don’t...
• speculate diagnosis as a teacher. The cost of an
evaluation will be the district’s responsibility if it is
recommended by district personnel.
• fill out rating scales without first consulting the
PPS team. It will be decided by the team how to
proceed with concerns about students.
• use the term ADHD. It is a medical diagnosis
and cannot be speculated by school personnel.
Do...
• go straight to the PPS team if you have any student
concerns regarding attention.
• be careful about what you say to parents - “You
say, you pay”
• use concrete facts when describing behavior to
parents.
• implement all accommodations or interventions
for ADHD students on 504/IEP plans.
Follow this link to find more specific activities and
strategies to use with students that might need
accommodations.
http://www.behavioradvisor.com/AddStrats.html
REFLECTION QUESTIONS
Please email your responses to: [email protected]
Explain the steps you would take if a student was
having trouble in school and you suspected
attention issues.