ADD/ADHD
Chapter 5 Objectives
At the end of this presentation you should be able to:
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Describe the characteristics of attention deficit/hyperactivity disorder.
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Understand the different terminology and probable causes of ADHD.
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Understand the characteristics of ADHD and it’s educational implications.
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Describe the educational strategies that are commonly used with this population.
Chapter Objectives
Definition
• Neurological condition
– Failure of brain circuitry that monitors inhibition and selfcontrol
– Impairs ability to defer immediate rewards for later gain
• Inattention
• Hyperactivity/impulsivity
• Excessive motor activity which may be seen as non-compliance
• Developmentally inconsistent with age of child
• Runs in families
Case Study
• Attention video
• http://www.pbs.org/wgbh/misunderstoodminds/at
tention.html
• Nate’s story
• http://www.pbs.org/wgbh/misunderstoodminds/m
eetnathanS.html
Subtypes
• ADHD (with hyperactivity)
– easier to diagnose
– move continuously
– trouble sitting still
– poor impulse control
– temper outbursts
• ADHD without hyperactivity (impulsive and inattentive form)
– withdrawn or "spaced-out"
– poor academic achievers
– occur concurrently with Learning Disabilities
– excessive anxiety or shyness
DSM-IV
• Three sub-types
– Predominantly inattentive
– Predominantly hyperactive-impulsive
– Combined types
DSM-IV
• Must exhibit several characteristics
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Severity
Early onset
Duration
Impact
Settings
• At least 6 symptoms of one or both of the following:
– Inattention
– Hyperactivity
Symptoms
• Inattention
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Lacks of attention to detail, careless
Has difficulty sustaining attention
Does not appear to be listening when spoken to directly
Is not able to follow through on instructions
Difficulty organizing
Avoids tasks requiring mental effort
Often loses things
Easily distracted
Forgetful
Symptoms
• Hyperactivity
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Fidgets/squirms
Difficulty remaining seated
Runs or climbs excessively
Difficulty playing quietly
“On the go”
Talks excessively
Blurts out answers
Difficulty awaiting turn
Interrupts or intrudes on others
Causes
• Inability of brain to filter competing sensory inputs
• Inability to inhibit impulsive motor responses to sensory inputs
• Possible genetic and/or biological
– Certain portion of brain (basal ganglia) is smaller in some children
– Area which regulates impulses
• Non-genetic factors
– Prematurity
– Maternal chemical use
– Exposure to lead
– Prenatal neurological damage
– Influence of environment
Incidence
• Symptoms apparent before 7 years of age
• Symptoms present in two or more settings
• Significant impairment in social, academic, or
occupational functioning
• Symptoms not occurring exclusively during a
course of a mental health condition
Incidence
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1.5-2.5 million in U.S.
Boys - 4-9 times more likely to be diagnosed
Found in all cultures
1/3 identified with LD
40-60% co-exist with other conditions
Historical Account
• ADHD has been known by many names over the last
century:
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Hyperactive Impulse Disorder
Hyperactive Child Syndrome
Developmental Hyperactivity
Hyper-kinetic Syndrome
Minimal Brain Dysfunction
Minimal Brain Damage Syndrome
Moral Control Deficit
Organic Drivenness (1930)
Historical Account
• 2500 years ago, the great physician-scientist, Hippocrates
described a condition that seems to be compatible with what we
now know as ADHD.
• He described patients who had.... "quickened responses to
sensory experience, but also less tenaciousness because the
soul moves on quickly to the next impression".
• Hippocrates attributed this condition to an "overbalance of fire
over water". His remedy for this "overbalance" was "barley rather
than wheat bread, fish rather than meat, water drinks, and many
natural and diverse physical activities".
From Hippocrates: Aphorisms. In The Genuine Works of Hippocrates (Translated from greek by Fancis Adams).
Diagnosis
• mental health professionals
– parents and teachers observations of
child
– rate behavior using specific
questionnaires
Evaluation
• Behavioral
– Questionnaires and rating scales
• Educational
– Impact on educational progress
– Classroom observation
– Measurement of productivity
• Medical
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Medical exam
Questionnaires
DSM-IV criteria
Assessment of co-existing conditions
Legal/Educational Requirements
• Free and Appropriate Public Education (FAPE)
– IDEA
– Section 504 of Rehabilitation Act of 1973
• Categorical placement
– “other health impaired”
– Limits strength, vitality, or alertness (response to
environmental stimuli)
– Significant impact on educational performance
Treatment Options
• Behavioral approach
– Modify physical and social environment to alter behavior
– Behavioral training
• Pharmacological approach
– Most common and controversial
– Prescribing is responsibility of qualified health care provider
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Psychostimulants
Antidepressants
Anti-anxiety medications
Antipsychotics
Mood stabilizers
Treatment Options
• Multimodal approach
– Combination of approaches
• Educational approach
• http://www.pbs.org/wgbh/misunderstoodminds/attention
strats.html#suggestions
– Mental energy
– Processing
– Production
Discussion
• Parent perspective
• http://www.pbs.org/wgbh/misunderstoodminds/attention
basics.html
• Does AD/HD exist?
• http://www.pbs.org/wgbh/misunderstoodminds/attention
diffs.html
• Medication debate
• http://www.pbs.org/wgbh/misunderstoodminds/attention
strats.html
Educational Implications
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Consistent failure to understand or follow school rules
Frequent classroom interruptions
Poor academic performance
Lower daily grades
Failed courses
Expulsions
Increased dropout rates
Low rate of college-bound students
Inattention
• Missing important details
• Daydreaming
• Difficulty organizing materials/assignments
Hyperactivity
• Verbal or physical disruptions
• Constant movement
• Blurting/interrupting
Impulsivity
• Careless errors
• Giving answers before thinking
• Attending only to entertaining or novel activities
Approach to AD/HD in the classroom
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Collaborate between home and school
Develop a behavior plan
Feedback on response to medications
Positive behavioral intervention plan
Student input
Work on most difficult concepts early in the day
One assignment at a time
Vary pace and types of activities
Structure student environment
Approach to ADHD at home
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Discreet rewards and consequences
Daily routine
Time-out from reinforcing behaviors
Use tangible reminders
Be consistent when responding to inappropriate
behaviors
• Avoid surprise consequences
Activity
• http://www.pbs.org/wgbh/misunderstoodminds/at
tention.html