Transcript Characteristics of ADHD Powerpoint

Characteristics of
Attention Deficit
Hyperactivity
Disorder
(AD/HD)
Presented by Connie
McDonald Brookins
Developed by Renee B.
Leach,
Consultants
Upper Cumberland Special
Education Cooperative
Definition of ADHD
• ADHD (attention deficit hyperactivity
disorder) is “a condition characterized by
severe problems of inattention,
hyperactivity, and/or impulsivity.”
(Hallahan and Kauffman, 2003, p.513)
Prevalence of ADHD
• ADHD is the most common behavioral disorder in
children in America. (Kollins, Barkley, and
DuPaul, 2001)
• It exists in between 3 and 5 percent of school-aged
children.
• Boys are more often diagnosed with ADHD than
are girls, ranging somewhere between a 2.5 : 1 and
5 : 1 ratio.
• This may be because the behaviors associated with
ADHD are more characteristic and natural in boys
than they are in girls.
• Girls that do have ADHD most likely have
the inattentive type. (Boschett, 2002).
• Less than half of the children who have
ADHD use special education programs in
school.
Three Types of ADHD as defined under
Diagnostic and Statistical Manual of Mental
Disorders (DSM).
• -ADHD Predominately Inattentive Type
• -ADHD Predominately Hyperactive Impulsive
Type
• -ADHD Combined Type (Inattentive and
Hyperactive Impulsive)
Signs of Hyperactivity -Impulsivity
• Feeling restless, often fidgeting with hands or feet,
or squirming while seated
• Running, climbing, or leaving a seat in situations
where sitting or quiet behavior is expected
• Blurting out answers before hearing the whole
question
• Having difficulty waiting in lines or taking tours
Signs of Inattention
• Often becomes easily distracted by irrelevant
sights and sounds
• Often failing to pay attention to details and
making careless mistakes
• Rarely following instructions carefully and
completely losing or forgetting things like toys, or
pencils, books, and tools needed for a task
• Often skipping from one uncompleted activity to
another
The Symptoms
• Typically, AD/HD symptoms arise in early
childhood, unless associated with some type of
brain injury later in life.
• Some symptoms persist into adulthood and may
pose life-long challenges.
• Although the official diagnostic criteria state that
the onset of symptoms must occur before age
seven, leading researchers in the field of AD/HD
argue that criterion should be broadened to include
onset anytime during childhood.
Criteria for the three primary
subtypes are summarized as
follows:
AD/HD predominately inattentive type:
• Fails to give close attention to details or makes careless
mistakes.
• Has difficulty sustaining attention.
• Does not appear to listen.
• Struggles to follow through on instructions.
• Has difficulty with organization.
• Avoids or dislikes tasks requiring sustained mental
effort.
• Loses things.
• Is easily distracted.
• Is forgetful in daily activities.
AD/HD predominately hyperactiveimpulsive type:
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Fidgets with hands or feet or squirms in chair.
Has difficulty remaining seated.
Runs about or climbs excessively.
Difficulty engaging in activities quietly.
Acts as if driven by a motor.
Talks excessively.
Blurts out answers before questions have been
completed.
• Difficulty waiting or taking turns.
• Interrupts or intrudes upon others.
AD/HD combined type:
• Individual meets both sets of inattention and
hyperactive/impulsive criteria.
• Because everyone shows signs of these
behaviors at one time or another, the
guidelines for determining whether a person
has AD/HD are very specific.
• To be diagnosed with AD/HD, individuals
must exhibit six of the nine characteristics
in either or both DSM-IV categories listed
above.
• In children and teenagers, the symptoms must be
more frequent or severe than in other children the
same age.
• In adults, the symptoms must affect the ability to
function in daily life and persist from childhood.
In addition, the behaviors must create significant
difficulty in at least two areas of life, such as
home, school, social settings and work.
• Symptoms must be present for at least six months.
The Evaluation
• Determining if a child has AD/HD is a
multifaceted process.
• Many biological and psychological
problems can contribute to symptoms
similar to those exhibited by children with
AD/HD.
• For example, anxiety, depression and
certain types of learning disabilities may
cause similar symptoms.
• There is no single test to diagnose AD/HD.
• Consequently, a comprehensive evaluation
is necessary to establish a diagnosis, rule
out other causes and determine the presence
or absence of co-existing conditions.
• Such an evaluation should include a clinical
assessment of the individual’s academic,
social and emotional functioning and
developmental level.
• A careful history should be taken from the
parents, teachers and when appropriate, the
child.
• Checklists for rating AD/HD symptoms and
ruling out other disabilities are often used
by clinicians.
• There are several types of professionals
who can diagnose AD/HD, including school
psychologists, private psychologists, social
workers, nurse practitioners, neurologists,
psychiatrists and other medical doctors.
• Regardless of who does the evaluation, the
use of the Diagnostic and Statistical
Manual IV (DSM-IV) criteria is necessary.
• A medical exam by a physician is important
and should include a thorough physical
examination, including hearing and vision
tests, to rule out other medical problems
that may be causing symptoms similar to
AD/HD.
• Only medical doctors can prescribe
medication if it is needed.
• According to a June 1997 AMA study,
“AD/HD is one of the best researched
disorders in medicine, and the overall data
on its validity are far more compelling than
that for most mental disorders and even for
many medical conditions.”
• Goldman, L.S., Genel, M., Bezman, R, et.al. (1998) Diagnosis and treatment of attentiondeficit/hyperactivity disorder in children and adolescents. Journal of the American
Medical Association.
• The exact causes of AD/HD remain illusive.
• Currently, most research suggests a
neurobiological basis.
• Since AD/HD runs in families, inheritance
appears to be an important factor.
•
U. S. Department of Health and Human Services. (1999). Mental Health: A Report of the Surgeon
General (Children and Mental Health).
• Even though a diagnostic test for AD/HD
does not exist, the 1998 National Institute of
Health Consensus Statement concludes,
“there is evidence supporting the validity of
the disorder.”
•
National Institute of Health. (1998). Diagnosis and treatment of attention deficit hyperactivity disorder.
Washington, D.C.: NIH Consensus Statement.
Multimodal Treatment
• There may be serious consequences for
persons with AD/HD who do not receive
treatment or receive inadequate treatment.
• These consequences may include low selfesteem, social and academic failure, career
underachievement and a possible increase in
the risk of later antisocial and criminal
behavior.
• Treatment plans should be tailored to meet
the specific needs of each individual and
family.
• So treating AD/HD in children often
requires medical, educational, behavioral,
and psychological intervention.
This comprehensive approach to
treatment is called “multimodal” and
often includes:
• Parent training
• Behavioral intervention strategies
• An appropriate educational program
• Education regarding AD/HD
• Individual and family counseling
• Medication, when required
• Research from the landmark NIMH
Multimodal Treatment Study of AD/HD is
very encouraging.
• Children who received medication, alone or
in combination with behavioral treatment
showed significant improvement in their
behavior and academic work plus better
relationships with their classmates and
family.
• Psychostimulants are the most widely used
class of medication for the management of
AD/HD related symptoms.
• Approximately 70 to 80 percent of children
with AD/HD respond positively to
psychostimulant medications.
• Significant academic improvement is shown
by students who take these medications:
increased attention and concentration,
compliance and effort on tasks, amount and
accuracy of schoolwork produced and
decreased activity levels, impulsivity,
negative behaviors in social interactions and
physical and verbal hostility
• Other medications that may decrease
impulsivity, hyperactivity and aggression
include some antidepressants and
antihypertensives.
• However, each family must weigh the pros
and cons of taking medication.
• Behavioral interventions are also a major
component of treatment for children who
have AD/HD.
• Important strategies include being
consistent and using positive reinforcement,
and teaching problem-solving,
communication, and self-advocacy skills.
• Children, especially teenagers, should be
actively involved as respected members of
the school planning and treatment teams.
• School success may require a variety of classroom
accommodations and behavioral interventions.
• Most children with AD/HD can be taught in the
regular classroom with minor adjustments to the
environment.
• Some children may require special education
services if an educational need is indicated.
• These services may be provided within the regular
education classroom or may require a special
placement outside of the regular classroom that
meets the child’s unique learning needs.
• Behavioral treatments for AD/HD should be
started as soon as the child receives a diagnosis.
• There are behavioral interventions that work well
for preschoolers, elementary-age students, and
teenagers with AD/HD, and there is consensus that
starting early is better than starting later.
• Parents, schools, and practitioners should not put
off beginning effective behavioral treatments for
children with AD/HD
What is behavior modification?
• With behavior modification, parents, teachers and
children learn specific techniques and skills from a
therapist, or an educator experienced in the
approach, that will help improve children’s
behavior.
• Parents and teachers then use the skills in their
daily interactions with their children with AD/HD,
resulting in improvement in the children’s
functioning in the key areas noted above.
• In addition, the children with AD/HD use the
skills they learn in their interactions with other
children.
• Behavior modification is often put in terms
of ABCs: Antecedents (things that set off or
happen before behaviors), Behaviors (things
the child does that parents and teachers
want to change), and Consequences (things
that happen after behaviors).
• In behavioral programs, adults learn to
change antecedents (for example, how they
give commands to children) and
consequences (for example, how they react
when a child obeys or disobeys a command)
in order to change the child’s behavior (that
is, the child’s response to the command).
• By consistently changing the ways that they
respond to children’s behaviors, adults teach
the children new ways of behaving.
• Parent, teacher and child interventions should
be carried out at the same time to get the best
results.
• The following four points should be
incorporated into all three components of
behavior modification:
– Start with goals that the child can achieve in small
steps.
– Be consistent — across different times of the day,
different settings, and different people.
– Implement behavioral interventions over the long
haul — not just for a few months.
– Teaching and learning new skills take time, and
children’s improvement will be gradual.
• Parents who want to try a behavioral
approach with their children should learn
what distinguishes behavior modification
from other approaches so they can
recognize effective behavioral treatment and
be confident that what the therapist is
offering will improve their child’s
functioning.
How does a behavior modification program
begin?
• The first step is identifying a mental health
professional who can provide behavioral
therapy.
• Finding the right professional may be
difficult for some families, especially for
those that are economically disadvantaged
or socially or geographically isolated.
• The mental health professional begins with
a complete evaluation of the child's
problems in daily life, including home,
school (both behavioral and academic), and
social settings.
• Most of this information comes from
parents and teachers. The therapist also
meets with the child to get a sense of what
the child is like.
• The evaluation should result in a list of
target areas for treatment. Target areas —
often called target behaviors — are
behaviors in which change is desired, and if
changed, will help improve the child’s
functioning/impairment and long-term
outcome.
• Target behaviors can be either negative
behaviors that need to stop or new skills
that need to be developed.
• That means that the areas targeted for
treatment will typically not be the
symptoms of AD/HD — overactivity,
inattention and impulsivity — but rather the
specific problems that those symptoms may
cause in daily life.
• Common classroom target behaviors
include “completes assigned work with 80
percent accuracy” and “follows classroom
rules.”
• At home, “plays well with siblings (that is,
no fights)” and “obeys parent requests or
commands” are common target behaviors.
• After target behaviors are identified, similar
behavioral interventions are implemented at home
and at school.
• Parents and teachers learn and establish programs
in which the environmental antecedents (the A’s)
and consequences (the C’s) are modified to change
the child’s target behaviors (the B’s).
• Treatment response is constantly monitored,
through observation and measurement, and the
interventions are modified when they fail to be
helpful or are no longer needed.
Parent Training
• Behavioral parent training programs have been
used for many years and have been found to be
very effective.
• Although many of the ideas and techniques taught
in behavioral parent training are common sense
parenting techniques, most parents need careful
teaching and support to learn parenting skills and
use them consistently.
• It is very difficult for parents to buy a book,
learn behavior modification, and implement
an effective program on their own.
• Help from a professional is often necessary.
• However, with early identification and
treatment, children and adults can be
successful.
• Studies show that children who receive
adequate treatment for AD/HD have fewer
problems with school, peers and substance
abuse, and show improved overall
functioning, compared to those who do not
receive treatment.
• The topics covered in a typical series of parent training
sessions include the following:
– Establishing house rules and structure
– Learning to praise appropriate behaviors (praising good behavior at
least five times as often as bad behavior is criticized) and ignoring
mild inappropriate behaviors (choosing your battles)
– Using appropriate commands
– Using “when…then” contingencies (withdrawing rewards or
privileges in response to inappropriate behavior)
– Planning ahead and working with children in public places
– Time out from positive reinforcement (using time outs as a
consequence for inappropriate behavior)
– Daily charts and point/token systems with rewards and
consequences
– School-home note system for rewarding behavior at school and
tracking homework
The Prognosis
• Children with AD/HD are “at-risk” for
potentially serious problems: academic
underachievement, school failure, difficulty
getting along with peers, and problems
dealing with authority.
• Furthermore, up to 67 percent of children
will continue to experience symptoms of
AD/HD in adulthood.
Contact Today’s Presenter at:
Renee B. Leach
Technology/Curriculum Consultant
Upper Cumberland Special Education Cooperative
116 North 4th Street
Williamsburg, KY
Phone: 606-539-0510
Email: [email protected]
Additional resources:
• www.chadd.org
• http://www.help4adhd.org/index.cfm
• http://www.chadd.org/fs/fs2.htm
• http://www.familyeducation.com/article/1,1
120,23-16631,00.html
• www.add.org
For your attention!!!!
Characteristics of
Attention Deficit
Hyperactivity
Disorder
(AD/HD)
Renee B. Leach,
Consultant
Upper Cumberland Special
Education Cooperative