By Dr. Josette Abdalla Part 1 An Overview of Observed behaviors at school Handout # 1: Teacher’s frequent comments when describing a child who may have ADHD What is ADHD? There are three types of ADHD o ADHD Predominantly Inattentive type (previously known as ADD) o ADHD Predominantly Hyperactive-Impulsive type o ADHD Combined type Handout # 2: Symptoms of ADHD based on the DSM-5 diagnostic criteria Impact of ADHD on the child, peers, and the learning process On the child: self-esteem, unhappiness, frustrations, sense of underachievement, difficulty making or maintaining friendships, possible problems with parents, etc. On peers: difficulty accepting the ADHD child in group activities, bullying, complaining about child to teachers or parents, etc. On the learning process: it is disrupted, and teacher and peers are often frustrated. Child gets punished, sent out of class, told to go to office, or suspended. Child therefore does not learn in a regular way, and has to make up for missed material through the help of parents, teachers and tutors. Causes of ADHD There is no conclusive evidence to date about what specifically causes ADHD. No single medical or psychological test can diagnose a child as having ADHD. ADHD probably results from a combination of factors. Among them are: Genetics: ADHD often runs in families; genes increase the possibility to develop this disorder (i.e. predispose) Environmental factors: pregnant woman’s smoking, alchohol/drug use, or high levels of lead Brain injuries: tumors, accidents, disorders, etc. Social/emotional factors: lack of discipline, disruptive families, chaotic family life, too much screen time, exposure to violence or traumatic events, too many changes, etc. Nutrition: e.g., sugars, glucose intolerance Comorbidity with other disorders: (to be discussed in detail later on) Part 2 Common problems often associated with Common problems often associated with ADHD 1. 2. 3. 4. 5. 6. Cognitive impairment and/or discrepancy between IQ indices Specific learning difficulties Sensory motor problems Speech and/or language difficulties Developmental, pervasisve, or psychiatric disorders Social/emotional/personality problems (including family dynamics) 7. Executive function deficits (handout # 3) Part 3 Handling school at Assessing ADHD The professional assessment of ADHD involves a multi-modal assessment approach. It includes, but does not rely exclusively on: • The results of questionnaires (e.g., Conners 3, BASC 3, CEFI) completed by parents and teachers (and child if above 12) • Behavior Observation of the child in different contexts • Clinical interview with the child and parents • Additional investigations to determine whether the ADHD is the core issue, or whether it is comorbid with, or secondary to, other disorders or causes. • The assessment CANNOT be done by a school teacher. However, the school SENCO can refer to relevant professionals, if ADHD is suspected. Steps for teachers of children with possible ADHD 1. Identify the problematic behavior in terms of description, intensity, frequency, duration and degree of disruptiveness to the child’s social and academic progress, as well as to the teaching process. 2. Consider other conditions that may or may not be involved, and decide on whether relevant specialized assessments are necessary. 3. If necessary, refer to specialized venues immediately to include or exclude possible coexisting or causal conditions, and have relevant recommendations. 4. It is necessary to fullly understand assessment findings as well as reasons for the recommendations suggested in the relevant reports. 5. On the basis of all of the above, consider accomodations that may be implemented in class. If ADHD is the primary diagnosis Recommendations suggested by the assessor/therapist are to be carefully read, discussed, and put in practice. Close collaboration and follow-up between the school, parents and assessor/therapist is necessary in order to implement the recommendations, modify them according to need, and monitor progress. Medication may or may not be considered, depending on the severity of the behaviors, and the improvement rate of the intervention plan. If the ADHD is comorbid or secondary to other problems • These should immediately be addressed • The recommendations for handling the ADHD behaviors should be determined,d in conjunction with the recommendations regarding the comorbid or primary cause. • Here again, close collaboration and follow up between the three parties is mandatory. General recommendtios for ADHD Predominantly Inattentive type • Seat the child close to the teacher in a place that is relatively free of distractions. • Ensure that the child’s attention is maintained as much as possible. This can be handled by having the teacher be as animated as possible (i.e., avoid a monotonous tone of voice, use varying pitches, and ensure that the body language when addressing the class is allso engaging). The teacher should calmly move around, and sometimes come close to where the child is seated while explaining something or during class assignments. • Keep the child alert by being unpredictable in asking questions, or enlist his/her help in doing/saying something, but ensure that the outcome (if not favorable) is not followed by negative comments. • Use a multisensory teaching approach as much as possible. • Seat the child next to clever and relatively engaging peers and encourage cooperation between them. • When there are certain tasks that are difficult or boring for the child, try to find alternative methods to keep him/her engaged. For example, allow the use of recording gadgets to self-dictate spelling words, or recite a passage,or type touch, etc. • Be quick and engaging • Use cue cards in agreement with the child to remind him/her to keep on track • Teach self-correction techniques when doing assignments or tests to ensure that no questions or parts of an assignment or quiz are missed. Have the child explain these techniques to other children in class • Break down tasks into smaller subtasks, and praise immediately when accomplished • Use visual as well as auditory reminders • Think of some kind of tracking system when doing certain activities so that the child can self-track progress or accomplishment • Think of natural consequences to use so as to decrease the need for repetition • Have the child repeat instructions in own words • Use organizers and colored folders and highlighters, etc. as ways of helping maintain attention General recommendations for ADHD Predominantly Hyperactive-Impulsive type • Anticipate beginning of restlessness and have a list of physical activities ready to unobtrusively ask the child to do • Give sensory breaks as much as possible • Assign the child tasks of a heavy physical nature, e.g., carrying books, giving out sheets, placing chairs back in place, etc. • Praise the child directly or vicariously for remaining in seat • Seat him so that the restlessness is not disruptive to the class, and ignore as much as possible • Use a behavior chart to control the impulsive amount of interruptions to teacher or talking to peers, etc. • Allow the child to engage in a particular non-disruptive activitiy, e.g., doodling • Be lavish with immediate praise, but not in an exaggerated manner, when the child is controlled • Have an extra form of reward if the child abstains from any impulsive reaction if provoked or aggressed by peers • Ensure that instructions to abstain from talking or hitting or making comments are clear. For example, instead of “Don’t be aggressive and hit peers” say “Don’t touch anyone in any way and for any reason” • Allow the child to fiddle with gadgets that are non disturbing to others and that release energy e.g., stress balls, elastic band • Assign some reponsibility to keep busy in class as well as maintain self-esteem in front of peers • Tie a rubber band between the two front legs of the chair and have the child place his/her legs behind it. Avoid • Openly criticizng the child • Punishing the child out of the classoom • Refrain from praising when any positive behvaior (or attempt) is done • Comparing with peers • Escalading confontations • Being slow in anticipating a problematic situation • Taking from your personal time to accommodate parents • Being overly uncooperative or critical with parents Role of teacher/school with parents • It is important to engage the parents’ cooperation in all cases,regardless of whether the child has possible ADHD or not. • Ensure that the SENCO is informed of everything that is going on, before addressing the parents. • Make sure, but in a highly diplomatic way, that the parent is aware of the relevant developmental milesones in terms of sleep, food, electronic time, physical outlets, sufficient time to do work and have fun at home and abstain from rushing the child from one training session/activity to another, etc.at the expense of sleep, energy and academics • If parents are cooperative, arrange for a proper time (that does not impinge on personal time) as well as an appropriate way, to communicate whatever is necessary. Agreement between teachers, SENCO and heads prior to the meeting is pivotal. • If parents are not cooperative, or are in denial, or accuse the teacher, school or system of shortcomings, make sure that all behaviours, and attempts to handle them at school are well documented, and call in the parents for a meeting, in the presence of all involved parties. • Have a gentle, understanding and firm tone of voice. • Do not offer a specific diagnosis and suggest more than one venue where the child can be assessed. • Project the feeling that everyone is participating to the child’s best interests. • Set firm parameters in as gently-stated as possible if parents remain uncooperative.
