Transcript No Slide Title

ADHD
Bridget Connolly
ADHD- Diagnosis-Criteria-Symptoms
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Attention Deficit Hyperactivity Disorder is a
neurobehavioral disorder characterized by pervasive
inattention and/or hyperactivity-impulsivity and
resulting in significant functional impairment.
Predominately Inattentive
 Hyperactive-Impulsive
 Combined Type
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This is a picture of a comparing the brain of an ADHD child and a
non-ADHD child (PET scan) http://www.adhd.org.nz/neuro1.html
Diagnostic Criteria of ADHD
 6 symptoms of inattention and/or 6 symptoms of
hyperactive-impulsive behavior (high frequency)
 At least 6-month duration of symptoms
 Onset of symptoms before age 7
 Symptoms occur across two or more settings
 Symptoms have a significant negative impact on social,
academic, or occupational functioning
 Another psychiatric disorder (e.g. autism, mood disorder,
anxiety disorder, psychotic disorder) is not the primary cause
of symptoms
DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition)
Common Symptoms for ADHDPredominately Inattentive
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Avoids tasks that require sustained attention
Daydreams (tends to stare into space)
Delays initiation or completion of tasks
Has difficulty listening to or following instructions
Does not pay close attention to details
Displays inconsistent academic performance
Forgets or loses materials
Demonstrates a slow speed of cognitive processing
(www.CHADD.org)
Common Symptoms for ADHDHyperactive-Impulsive
 Acts before thinking
 Begins work before directions are
given
 Has difficulty delaying gratification
 Makes careless mistakes in
schoolwork
 Does not wait turn in games or
activities
 Engages in risk-taking/dangerous
behavior
 Grabs things from others
 Interrupts or intrudes on others
 Blurts out comments in class
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Runs or climbs excessively
Has difficulty remaining seated
Fidgets with nearby objects
Taps pencil, feet, or fingers
Shifts position in seat frequently
Talks excessively
Experiences rapid changes in
mood
 Overreacts to negative situations
(www.CHADD.org)
Prevalence Estimates
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ADHD-Predominately Inattentive Type
-1.3% of school-aged children are diagnosed
- ratio for boys to girls = 1:1
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ADHD- Hyperactive-Impulsive Type
- most children identified are of preschool age
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ADHD- Combined Type
- ~4% of school-aged children are diagnosed
- ratio for boys to girls = 3:1
(www.CDC.org)
Associated Problems
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~80% have achievement problems
~20–40% are diagnosed with learning disabilities
(more common with ADHD- Inattentive)
~40% exhibit oppositional behavior in childhood
(more common with ADHD- Combined)
~65% exhibit oppositional behavior as adolescents
(more common with ADHD- Combined)
 ~25% engage in antisocial behavior (truancy,
physical aggression, stealing- most often ADHD- Combined)
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~50% have impaired social relationships
~25% experience co-morbid emotional disorders
(www.CDC.org)
ADHD in Schools
 As an adolescent, a student may display any of the
following characteristics:
- Displays poor organizational skills
- Underachieves academically
- Exhibits impulsive or risk-taking behavior
- Engages in temper outbursts
- Sometimes experiences legal difficulties
School-Based Assessment of ADHD
Symptoms
PURPOSE
 To gather information for a potential medical diagnosis
 To determine the extent to which attentional problems
are interfering with a child’s academic, affective, and
social needs
 To perform a functional analysis of target behaviors for
intervention
Assessment Methods
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Parent and teacher interviews
 Information should be obtained from multiple adults
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Standardized behavior rating scales
 Provides a normative perspective to assist in determining
symptom severity
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Direct observation
 Systematic on-task observation and assessment of
environmental and instructional variables
ADHD Treatment -Ineffective Interventions
 Herbal supplements/vitamins
 Biofeedback-although there is growing research
regarding its effectiveness with ADHD, depression
and anxiety
 Elimination diet (unless there is a sensitivity to food)
 Caffeine (may work in short run, but in long run
decreases blood flow to brain)
(www.adhd.com)
ADHD Treatment -Effective Interventions
Comprehensive Treatment Approach
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Education/Parent Support Groups
Medication
Behavior Management at Home & School
Counseling--Individual & Family
Social Skills Training
School and Home Support Strategies
Physical Activity
(www.CHADD.org)
ADHD Medications
Effective for 70-90%
Stimulants
Ritalin
Dexedrine
Adderall
Concerta
Cylert
(www.adhdnews.com)
Stimulant Side Effects
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Decreased appetite
Weight loss
Growth inhibition
Insomnia/sleep disturbance
Irritability/weepiness
Abdominal pain
Headaches
Dizziness/drowsiness
Tics
(www.adhdnews.com)
ADHD: Treatment in Schools
Behavior Management
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Clear, simple rules & consequences
Consistency
Eliminate emotion, talking/arguing
Giving directions--get attention, be firm, have repeat back to
you, give time limits
Visual reminders
Break down assignments and homework
Keep on task with timer, stop-watch
Behavior Management, cont.
Encouraging Good Behavior
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Immediate Feedback, Frequent Rewards/Incentives & Praise
Frequent Change in Reward (Mystery Motivator)
Immediate Consequences for Selected Behavior (time-out, loss of privilege
or points)- make them predictable
Positive Rewards Before Consequences
Priorities--Choose Battles
Don’t Personalize Problems
Provide clear expectations for appropriate behavior
 Post classroom rules
 Use behavior contracts as needed
Provide specific and frequent verbal feedback
 Name the specific behavior that was performed well or should be
performed
Use if/then statements
 If you continue to …, then…
Provide brief, matter-of-fact redirections
Suggested Classroom Modifications
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Provide preferential seating
Give only one or two-step directions at a time
Break assignments down in to smaller segments
Use a timer to monitor/ improve timely work completion
Vary instructional style and incorporate opportunities for
active participation
Minimize visual distractions
Ensure a correct match between the difficulty
level of the curriculum and the student’s abilities
Establish non-verbal communication
Parents & Teachers Working
Together
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Communication
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Weekly or daily progress reports
Assignment notebooks signed by both
Phone calls/e-mail
Checklists
Homework support
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Regular time
Quiet place
Break down assignments/Set timer
Breaks--physical activity
Materials available
Monitor closely & reward good homework behavior
Check assignment books regularly
(www.CHADD.org)
ADHD and 504
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Consider a 504 plan for the
student who has a medical
diagnosis of ADHD and:
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Needs regular, ongoing
general ed modifications
or
Needs regular positive
behavioral support or
Takes medication at
school
ADHD and IDEA
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Can a student with ADHD have an
IEP?
 OHI Category
 Significant impact on classroom
performance
 Consider if:
 Student demonstrates
competency on criterion tests,
but has failing grades
 Student does not have a
diagnosable processing
disorder at the root of failure
 Ongoing general ed
modifications are not
providing enough support for
successful access to the
curriculum
Behavior Intervention Plans
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Describe the target behavior and its severity
Describe the function of the target behavior
Clearly describe the desired positive behavior
Identify how the environment can be changed to
decrease negative behavior
Identify reinforcers to maintain positive behavior
Describe the method for monitoring the behavior plan
and who will be responsible
Resources
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ADDA (Attention Deficit Disorder Association)
www.add.org
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ADHD News – Drug Side Effects
www.adhdnews.com
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Behavioural Neurotherapy Clinic
www.adhd.com
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Center for Disease Control (Attention Deficit-Hyperactivity Disorder)
www.cdc.gov/ncbddd/adhd/
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CHADD (Children and Adults with Attention Deficit Disorder)
www.chadd.org
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LIDA (Learning Disabilities Association)
www.ldanatl.org
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National Resource Center on ADHD
www.help4adhd.org