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Attention Deficit Hyperactivity

Disorder:
What Educators Need To Know

By: Annie Schave


Michigan State University
CEP 841

Have You Ever. . .


Thought a child was lazy because they seemed to never start
an assignment?
Gotten mad at the child who kept getting out of their seat?
Become so frustrated with the child in the back of the room
banging his pencil on his desk over and over and over again?
Reminded a child to bring home their book at least five times
and then they still forget it?
Been in the middle of a lesson when a child blurts out some random
information irrelevant to the lesson?
Had a child listen to you talk and then not know what you just said?

If You Answered Yes. . .

You are not alone!


Today, in every
classroom across the
country there are
several students who
are diagnosed with
ADHD.
It is vital for teachers
to understand ADHD
so you dont feel
frustrated, upset, or
defeated.

What You Will Get From This


Presentation

What are the statistics and myths of ADHD?


What is ADHD?
How is it diagnosed and what is the teachers role?
What causes ADHD?
What are Executive Functions?
What deficits do children with ADHD have?
What can a teacher do to help children with these
deficits?
What medication should teachers know about?
Where can help be found about ADHD?

Statistics

The Diagnostic and Statistical Manual of Mental Disorders Fourth


Edition (American Psychiatric Association, 1994; DSM-IV) shows
that ADHD affects 3 to 5% of school aged children.
This adds up to 1.46 to 2.46 million children in schools today (U.S.
Department of Education, 2004).
ADHD is the most commonly diagnosed childhood psychiatric
disorder (Miernicki & Hukriede, 2004)
4 to 13% of the United States Population is affected by ADHD
(Meaux, 1999)
Boys are 4 to 9 times more likely to be diagnosed than girls (U.S.
Department of Education, 2004).
to 1/3 of ADHD students also have learning disabilities (U.S.
Department of Education, 2004)
Symptoms in a child may change as that child grows older but that
does not mean that the child will grow out of their ADHD diagnosis
(U.S. Department of Education, 2004).
ADHD children are at higher risk for unintentional injuries,
delinquency, and anti-social behavior (Meaux, 1999).

ADHD Myths Busted

As published on ADDitude Magazines


website, these are the most common ADHD
myths:

#7: People with ADHD are stupid and lazy.


#6: ADHD children on medication will abuse
drugs as teenagers.
#5: ADHD is the result of bad parenting.
#4: ADHD affects only boys.
#3: Children with ADHD often outgrow the
condition.
#2: Children given ADHD accommodations are
given an unfair advantage.
#1: ADHD is not a real medical disorder.

From: www.additudemag.com

What is ADHD?
The American Psychiatric Association in the DSM-IV (1994) defines
three main types of Attention Deficit Hyperactivity Disorder.
Individuals can have predominately inattentive ADHD,
predominately hyperactive-impulsive ADHD, or combined type
depending on the presenting symptoms (p. 83-85).
Inattention
Fails

to give close attention to details


Difficulty sustaining attention in tasks
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
Often has difficulty organizing tasks and
activities
Often loses things necessary for tasks or
activities
Is often easily distracted
Often forgetful in daily activities

Hyperactivity-Impulsivity
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
-often has difficulty playing or engaging in
leisure activities
-often is on the go or as if driven by a motor
-talks excessively
Impulsivity
-often blurts out answers before questions are
completed
-has difficulty awaiting turn
-interrupts or intrudes on others

Diagnostic Criteria

A: Six or more of the previously noted symptoms


persisting for 6 months or longer qualifies for a diagnosis
of ADHD in either the inattentive category or
hyperactivity-impulsive category. If both inattentive and
hyperactive-impulsive symptoms are present then a
combined type diagnosis is given. Please see chart on
previous screen.
B: One of the symptoms needs to have been present
before the age of 7.
C: Some impairment from the symptoms is present in
two or more settings, such as school or home.
D: There must be clear and significant evidence of a
social, academic, or occupational impairment.
E: The symptoms are not better accounted for by
another mental disorder.

Note: Taken from American Psychiatric Association DSM-IV (1994,


p. 83-85)

Reasons ADHD Students Misbehave


1.

2.
3.
4.

5.
6.
7.
8.
9.
10.

Frustration because they have a different perception


of the situation.
Lack of structure.
They act the role of being bad.
They dont know how to ask to get what they need so
they act out.
The classroom is full of distractions.
The child feels misunderstood.
Hunger.
They feel overwhelmed with tasks assigned.
They feel criticized.
They are stuck in the victim cycle.

Note: From Appelbaum Training Institutes How to Handle the


Hard-to-Handle Student Resource Handbook, (2005).

What Educators Need to


Remember:

According to Schuck & Crinella (2005), the


most worrisome deficits of children with
ADHD are not the product of low IQ, but
rather of instability of control processes
that govern everyday applications to the
environment (p. 275).
The ADHD student is not dumb, lazy, or out
of control. They are smart kids who need
our help to gain the proper strategies to be
successful!

What Can An Educator Do If Some


Symptoms Appear To Be Present?
Maintain behavior logs citing observations of behaviors and
situations. Remember to include inventions used and their
efficiency.
2.
Inform parents of behavioral concerns and discuss
behaviors at home.
3.
Request child study or equivalent meeting with parents,
special education teachers, school psychologist, etc. to
discuss classroom behaviors. This can lead to diagnosis
from a doctor and then an IEP for the student.
4.
If needed, rating scales may be given to teachers and
parents.
Remember: Diagnosis and identification of ADHD needs to
come by a medical evaluation from a family doctor,
psychologist, or psychiatrist outside of the school system!
Your job is to observe the child and find interventions that
work to make that child successful!
1.

Note: From Vaughn, Bos, & Schumm (2006).

What Rating Scales Are Used Most?

The most common rating scale used is


Conners Teachers Rating Scale which will
ask you to rate the behaviors and form
statements about the behavior (Vaughn,
Bos, & Schumm, 2006).
Similar forms may include the ADHD Rating
Scale or the Behavior Rating Form based on
DSM IV symptoms (Vaughn, Bos, &
Schumm, 2006).
It is important to know how often the
behavior occurs when completing these
forms!

What Causes ADHD?

According to Barkleys website (

http://www.russellbarkley.org/adhd-facts.htm), there
is significant evidence that ADHD occurrences are due to
biological factors.
Other factors, as stated on the previous website, may
include: difficulties during pregnancy, prenatal exposure
to alcohol or tobacco, low birth weight, high lead levels,
and prenatal injury to the prefrontal lobe of the brain.
A recent study published in Pediatrics by scientists at
Texas Tech. University shows that there is no link
between ADHD and television. This is however still
heavily controversial (www.additudemag.com).

Causes continued. . .

New research suggests that ADHD is present with


dysfunctions in the prefrontal lobes of the brain.
Prefrontal lobes control executive functions which
children with ADHD are lacking (Dawson & Guare,
2004). These dysfunctions being studied include size
differences in prefrontal regions, basal ganglia, and
cerebellum. This can lead to abnormal activation
patterns in the brain (Barkley, 2003).
Other research still not concluded at this time states that
ADHD children have abnormal dopamine and
norepinephrine levels in the brain (Barkley, 2003).
Another neurological cause is related to lower glucose
levels affecting neurotransmitter activity in parts of the
brain (ADDA, http://www.add.org/articles/index.html ).

What Are Executive Functions?

An executive function is a
neuropsychological concept referring
to the cognitive processes required to
plan and direct activities, including
task initiation and follow through,
working memory, sustained attention,
performance monitoring, inhibition of
impulses, and goal-directed
persistence. (Dawson & Guare,
2004, p. vii)

Why Are Executive Functions


Important?

These skills allow us to organize our


behavior over time and override immediate
demands in favor of longer-term goals
(Dawson & Guare, 2004, p. 1).
They also allow for the management of
emotions and effective thought monitoring.
Children with problems in a particular
executive function area have a deficit in
that skill area.

Deficit: Response Inhibition

This is the capacity to think before


you act (Dawson & Guare, p. 47).
Children with this deficit tend to be
impulsive. They will say things
without thinking about what it is that
they are saying.

Deficit: Working Memory

This is the ability to hold information


mind while performing complex
tasks (Dawson & Guare, p. 49).
Students with this deficit tend to
forget easily. They may forget their
homework or books at school on a
regular basis.

Deficit: Self-Regulation Of Affect

This is the ability to manage


emotions in order to achieve goals,
accomplish tasks, or control and direct
behavior (Dawson & Guare, p. 50).
These students tend to become upset
quickly with situations, unable to
control their emotions. These
students tend to have outbursts that
disrupt daily functioning.

Deficit: Sustained Attention

This is the capacity to maintain attention to


a situation or task in spite of distractibility,
fatigue, or boredom (Dawson & Guare, p.
52).
Students with this deficit tend to have a hard
time getting started on a task. These
students will get up often when a task is
given. They talk to other students when they
shouldnt. Their attention is on everything in
the room other than their work.

Deficit: Task Initiation

This is the ability to begin a task


without undue procrastination, in a
timely fashion (Dawson & Guare, p.
54).
These students tend to put off doing
work that they need to complete.
They lack the processes to start the
task.

Deficit: Planning

This is the ability to create a roadmap to


reach a goal or to complete a task. It also
involves being able to make decisions about
whats important to focus on and whats not
important (Dawson & Guare, p. 55).
These students tend to wait till the last
minute to complete tasks and then not
know what to do when they go to complete
them.

Deficit: Organization

This is the ability to arrange or place


things according to a system
(Dawson & Guare, p. 58).
These students tend to have messy
desks or cubbies. They lose papers
often and frequently shove papers
instead of placing them in appropriate
spots.

Deficit: Time Management

This is the capacity to estimate,


allocate, and execute within time
constraints (Dawson & Guare, p.
60).
These children get work done at the
last minute and frequently ask for
assignment extensions. Also, they
often use excuses for not having
work.

Deficits: Goal-Directed Persistence

This is the capacity to have a goal, follow


through to the completion of the goal, and
not be put off by or distracted by
competing interests (Dawson & Guare, p.
62).
These students are able to create goals for
themselves but are not able to achieve
them. They are not able to understand the
necessary steps to reach a goal and often
become distracted with outside stimuli
negatively impacting their task completion.

Deficit: Flexibility

This is the ability to revise plans in the


face of obstacles, setbacks, new
information, or mistakes (Dawson &
Guare, p. 63).
These students have difficulty in transitions
and new situations. These students
struggle longer than others at the
beginning of each year. They also are
thrown off by changes in daily schedules.
These students have limited problem
solving strategies.

Deficit: Metacognition

This is the ability to stand back and take a birdseye view of oneself in a situation. It is an ability to
observe how you problem solve. It also includes
self-monitoring and self-evaluative skills (Dawson &
Guare, p. 65).
These students make careless mistakes frequently.
They also will complete one step then stop instead of
finishing the series of steps. For example, these
students may add instead of subtract over and over
again while failing to review their work and realizing
their mistake. Also, these students will do one step
of long division and then stop, not reflecting on the
whole process needed to complete the task.

What Are The Intervention Areas?

Educational Accommodations

Executive Functioning Deficits


Classroom Interventions

Promoting Appropriate Behavior


Medication Options

Stimulant Medication
Medication and Side Effects

Response Inhibition

Reduce situations where the child can get


into trouble
Proximity Control: Increase supervision of
the child
Control impulses by modeling appropriate
behavior
To teach the skill:

Explain the skill and behaviors


Model behaviors
Discussion situations to use the skill
Reinforce the skill
Ignore inappropriate behavior

Note: From Dawson & Guare, (2004).

Working Memory

Enforce use of assignment books


consistently
Utilize checklists and to-do lists
Use cue devices such as verbal reminders,
alarm clocks, and Post-Its
To teach the skill:

Explain the skill


Give options to the child for cues and checklists
to use
Create a monitoring system for the child to
monitor their own skill usage

Note: From Dawson & Guare, (2004).

Self-Regulation Of Affect

Prepare child for problem situations


Give child scripts for problem situations and practice
regularly
Structure environment to avoid situations that can lead to
problems
Break tasks down into small steps
Give breaks to child during tasks as needed
Teach child I-statements
Use social stories that teach emotional control
To teach this skill:

Explain the skill


Provide coping strategies
Practice with the child
Reinforce child when strategies are used
Discuss real life situations of using the strategy

Note: From Dawson & Guare, (2004).

Sustained Attention

Write start and stop times on assignments


Use incentive systems
Break down tasks into steps
Make tasks interesting for students
Give child something fun to do when task is completed
Provide attention and praise when student is remaining
on task
To teach the skill:

Discuss attention time with the student


Teach them to break down tasks on their own
Help them make work plans for completing tasks
Reinforce them when they use the plan

Note: From Dawson & Guare, (2004).

Task Initiation

Use verbal cues to get child started


Create a visual cue to prompt child to get started, such
as a note on their desk
Walk through the first part of the task to help child get
started
Have child tell you when they will begin the task and cue
them when the time arrives
To teach the skill:

Teach the child to create a written plan for starting the


task including time and type of task
Teach child to break down the task if needed
Teach child to use cue such as alarm clock to start task
Reinforce child when no additional cues are needed
Fade supervision

Note: From Dawson & Guare, (2004).

Planning

Plan a schedule for the child


Use rubrics
Break long assignments into smaller pieces with
deadlines for each piece
Create planning sheets with due dates
Use assignment planners
To teach the skill:

Walk through the planning process with the child

Have child model the planning process

Tell student to create roadmaps for tasks

Ask questions such as What do you have to do


first?

Note: From Dawson & Guare, (2004).

Organization

Maintain an organized classroom


Create schemes for organizing backpacks
and folders
Color-code folders, notebooks, and papers
for classes
To teach the skill:

Teach child to separate papers and categorize


them
Have them create their own organization plan

Get the plan in writing

Have them implement the plan

Note: From Dawson & Guare, (2004).

Time Management

Give child a schedule to follow


Prompt student with each step of a task
Impose time limits for assignments
Provide frequent reminders for remaining time to
complete task
Use cueing devices such as alarm clocks
To teach the skill:

Help child understand what the task involves


Have child think of distractions that may be present
when completing task
Create an estimated time for completion; compare
estimated time to actual time
Find strategies to decrease distractions

Note: From Dawson & Guare, (2004).

Goal-Directed Persistence

Give students goals and have them keep track of their


progress
Goals need to have motivational interest to the
student
Include students in establishing goals
Create reasonable goals
To teach the skill:

Follow a coaching process:

Hold a goal setting session where a goal is set,


obstacles are discussed and a plan is written
Hold daily coaching sessions where goal is re-discussed
and progress is assessed by asking questions

Note: From Dawson & Guare, (2004).

Flexibility

Give advance warning for new schedules or activities


Allow student to practice new schedules or activities
Provide rubrics to follow
Read social stories to teach coping strategies in
problem situations
Offer positive reinforcement and step by step
assistance with difficult problems
To teach the skill:

Teach students what inflexibility is and how to


recognize it

Teach and model coping strategies with plans and


cues

Create strategies to fall back on

Teach relaxation strategies

Note: From Dawson & Guare, (2004).

Metacognition

Ask child to explain how they solved the problem or if


they can think of another way to solve the problem.
Create buddy systems for students to check work.
Give assignments where students can evaluate their
work ethic and give a grade.
Use rubrics.
To teach the skill:

Define the skill and what is needed to use the skill


appropriately

Practice the skill

Create error-monitoring checklists

Teach children to ask themselves self-monitoring


questions while tasks are being completed

Note: From Dawson & Guare, (2004).

Classroom Setup To Accommodate


ADHD

Seat ADHD student away from distractions, preferably


front and center (www.addinschools.com).
Seat student near a good role model
(www.addinschools.com).
Increase distance between desks to decrease
distractions (www.addinschools.com).
Create a cool-down area (National Education
Association, 2005).
Play quiet music (Appelbaum Training Institutes How
to Handle the Hard-to-Handle Student Resource
Handbook, (2005).
Create a stage for announcements in the classroom
(Appelbaum Training Institutes How to Handle the
Hard-to-Handle Student Resource Handbook, (2005).

Other Solutions To Helping The


ADHD Child

Make lessons very clear


Use lots of visuals
Pair students together to complete assignments
Provide hand signals
Play beat the clock
Use behavioral contracts
Use sticker charts
Provide study carrels or private offices
Allow students to move around
Allow more time for tests
Put luggage tags on book bag to remind students of what to bring home
Put sponges or mouse pads on desks for students who like to tap
Have special highlighters for students to use
Use picture mats or file folders cut into thirds to chunk assignments
Provide headphones for students to use
Use manipulatives such as Koosh balls or hand exercisers for students

Note: From Appelbaum Training Institutes How to Handle the Hard-to-Handle


Student Resource Handbook, (2005).

How To Promote Appropriate


Behavior In The Classroom

Use positive reinforcement regularly.


Implement Class-wide problem solving
strategies such as FAST or SLAM.
Practice Positive Behavioral Support by
conducting functional behavior assessments
to create individualized interventions.
Hold class meetings that teach and
reinforce proper social skills, acceptance of
others and conflict resolution.

From: Vaughn, Bos, & Schumm, (2006).

Medicinal Treatments

Miernicki & Hukriede (2004) found that most


elementary school teachers and middle school
teachers feel that stimulant medications along with
interventions work best to help children with ADHD.
Stimulant medication is used to alter perceptions and
feelings making the student more successful by
targeting the areas of the brain that effect executive
functioning (Miernicki & Hukriede, 2004; Schuck &
Crinella, 2005).
70 to 80% of children on psychostimulant medications
respond positively to them because they help
communication between nerve networks in the brain
(www.help4adhd.org).

Commonly Used Medications

Stimulants

Ritalin, Concerta, Metadate, Focalin, Adderall,


Dexadrine

Given in short-acting (4-6 hours) or long-acting (612 hours) doses

Side Effects: difficulty sleeping, lack of appetite,


fatigue, headache, stomach-ache, possible
occurances of motor tics
Nonstimulants

Strattera, antidepressants such as Zoloft or Celexa

Affect dopamine and norepinephrine levels in the


brain

Side Effects: difficulty sleeping, lack of appetite,


fatigue, headache, stomach-ache

From: http://www.help4adhd.org/treatment/medical/WWK3

Conclusion

Given the amount of


children with ADHD
today, we are bound to
encounter an ADHD
student in our
classroom. Hopefully,
the information in this
presentation will
increase your
knowledge of ADHD
and also help you
effectively teach these
students. Thank you!

Where to Find Help?

www.addinschools.com
http://www.nimh.nih.gov/publicat/ad
hd.cfm
www.additudemag.com
www.add.org/
www.adhdinfo.com
www.russellbarkley.org

References
Additude Magazine. (2004). http://www.additudemag.com Viewed July 13, 2006
ADHD in School. (2006) www.addinschool.com Viewed July 13, 2006
American Psychiatric Association (1994). Diagnostic and statistical manual of mental
disorders (4th ed.). Washington, DC: Author.
Applebaum Training Institute. (2005). How to Handle the Hard-to-Handle Student Resource
Handbook.
Attention Deficit Disorder Associaton (ADDA). (2006).
http://www.add.org/articles/index.html Viewed July 13, 2006
Barkley, R. Attention-Deficit/Hyperactivity Disorder. Child Psychopathology, Second Edition.
The Guilford Press. New York. 2003.
Dawson, P, & Guare, R. (2004). Executive Skills in Children and Adolescents: A Practical
Guide to Assessment and Intervention. The Guilford Press. New York.
Meaux, J, (2000). Stop, Look, and Listen: The Challenge for Children with ADHD. Issues in
Comprehensive Pediatric Nursing. 23, 1-13. Viewed using ERIC Database on July 11,
2006.

References continued. . .
Miernicki, S. & Hukriede, J. (2004). Intervention Types and the Perceptions of Academic
Success of Students with Attention Deficit Hyperactivity Disorder. Viewed Using ERIC
Database on July 11, 2006.
National Education Association. The D Word. NEAToday. September 2005, p.29.
National Resource Center on ADHD. (2006). http://www.help4adhd.org/ Viewed July 11,
2006
Russell A. Barkley, Ph.D. The Official Site. (2005). www.russellbarkley.org/adhd-facts.htm
Viewed July 13, 2006
Schuck, S, and Crinella, F. (2005) Why Children With ADHD Do Not Have Low IQs. Journal
of Learning Disabilities. May/June 2005. 262-280. Viewed using ERIC Database on
July 11, 2006.
U.S. Department of Education. (2004). Teaching Children with Attention Deficit Hyperactivity
Disorder: Instructional Strategies and Practices. 2004. Viewed using ERIC Database
on July 11, 2006.
Vaughn, S, Bos, C, & Schumm, J (2006). Teaching Exceptional, Diverse, and At-Risk
Students in the General Education Classroom. Allyn and Bacon. Boston, MA.