Attention Deficit
Hyperactivity Disorder (ADHD)
Prepared by:
Cicilia Evi GradDiplSc., M.Psi
Challenges
• The symptoms interfere daily life activities
• At risk for failing at school, being suspended,
abusing substances, dropping out of school,
having a very high rate of conflicts with their
families over doing chores and HW (Salend &
Rohena, 2003)
• Parents often express frustration and stress
(Barkley, 2005)
• Negatively influence their relationships with
others  rejected and disliked  lonely and
friendless
Challenges (2)
• For most individuals  symptoms continue
throughout their lives (Barkley 2005, 2006) 
affect adult life in many ways  35 lost days
of work in a year, totaling more than $19
billion in wasted human capital nationally
• Can have very successful lives  but require
accurate identification and effective services
(CHADD, 2007)
Definition
• DSM-IV-TR  breaks down ADHD into 3
subcategories: Predominantly Inattentive,
Predominantly Hyperactive-Impulsive, and
Combines  “is a persistent pattern of
inattention and/or hyperactivity-impulsivity that
is more frequent and severe than is typically
observed in individuals at a comparable level of
development” (APA, 2000, p. 85)  excessive
and cause significant impairment in social,
academic or occupational functioning (p. 93)
Definition (2)
• Before age 7, for at least 6 months, in more
than 1 setting
• Students must experience heightened
alertness to environmental stimuli (extraneous
classroom events  pencil tapping), which
results in limited alertness to their educational
environment (teacher’s instructions, lessons)”
Coexisting Disabilities
• In most cases, ADHD coexists with another
disability  comorbidity
– With LD
– With Emotional or Behavioral Disorders
With LD
• 1/3 of ADHD students
• Score higher on intelligence than other
students, incld those with LD and significant
reading problems (Kaplan et al., 2000)  but
score lower on standardized achievement
tests than their classmates without disabilities
(Barkley, 2006)
• Each requires an individualized educational
program to meet their specific need
With Emotional or Behavioral
Disorders
• Approximately 58% of students receiving special
education services under the emotional or
behavioral disorders category also had ADHD
(Schnoes et al., 2007)
• Boys  more into aggressive and antisocial
behavior  resulting in higher referral rates for
this category
• Girls  same level of impulsiveness but lower
level of hyperactivity, aggression, defiance and
conduct problems  not classified into EBD
(Barkley, 2006)
Characteristics
• They rely more on others (external factors) to
explain their accomplishments, and therefore
they are less persistent, expend less effort,
prefer easier work, and take less enjoyment in
learning
– Behavioral
– Academic
– Social
Behavioral Characteristics
• The root of many academic problems
experienced by ADHD students is at least one of
these 3:
– Inattention
– Hyperactivity
– Impulsivity
• Explain why students seem to daydream, miss the
little (but important) details about assignments,
and submit incomplete HW (Salend, Elhoweris &
van Garderen, 2003)
Inattention
• Commonly noticed by parents, teachers,
researchers
• They get distracted and don’t focus for the
seemingly short time span required to
complete their work  miss the details of the
problems
• Carelessness, distractibility, and forgetfulness
 associated with inattention
Hyperactivity
• Implying an excessive level of activity (Montague
& Dietz, 2006)  but the definition is hard to
agree, due to subjectivity of level of a specific
activity
• Diminish with age?
• Adolescents and adults  may still have trouble
with distractions due to daydreaming or ongoing
flows of thoughts and ideas in their mind when
concentration is needed for college course or
business meeting  internal restlessness
(Weyandt et al., 2003)
Impulsivity
• “an inability to control one’s response to the
environment “ (Montague & Dietz, 2006)  they
tend to blurt out a quick response before thinking
the question through
• They tend to redirect the topic of class discussion,
talk out of turn, or “butt into conversations”
(APA, 2003; Fowler, 2002, 2004)  gain fewer
positive response from their classmates and
decrease social acceptance (Merrell & Boelter,
2001)
Academic Performance
• Spend less time engaging in academic tasks than
their classmates without ADHD (Duhaney, 2003)
 trouble studying for long periods of time
• Disorganized and forgetful, messy handwriting,
sloppy and careless work, incomplete
assignments, their work is not logical and not
organized
• They need structure to support their learning and
social performance (Salend et al., 2003)
Contd.
• Teachers should make assignments
interesting, individualized when possible, and
relevant to their backgrounds and interests 
content enhancements and the use of
learning strategies are also of great benefit
Social Behavior
• ADHD characteristics  decrease positive social
interactions and increase antisocial behaviors (Merrell
& Boelter, 2001)
• They see themselves as having more internalizing
behaviors and are more introspective about their
problems (Volpe et al., 1999)  judge themselves as
social failures, engage in more solitary activities,
contributing to a cycle of increasing alienation and
withdrawal; sharpen pencil more often than their
classmates, looking out for something on the bookshelf
during quiet time or play with objects during lessons
(Duhaney, 2003)
Contd.
• Teachers can help:
– Providing explicit instructions on how to interact with
others and behave in a more socially appropriate
manner
– Using functional behavioral assessment data  to
reduce or eliminate inappropriate behaviors
– Teaching self-management strategies  including
rewards for conforming to classroom rules
• Positive characteristics of ADHD  intense
creativity, intuitiveness, emotional awareness,
exuberance (Honos-Webb, 2005)  think outside
the box, nonstandard problem solving
Prevalence
• The exact numbers are unavailable
• General consensus  3%-7% of schoolchildren
have ADHD (Barkley, 2006)
• Boys are generally identified at significantly
higher rates  girls are under-identified, possibly
due to a lack of awareness of how their
behavioral needs differ from those of boys
• Culture may be an important factor to consider
 understand and selecting the best intervention
Causes
• The exact cause is unknown  arises from many
different sources: brain injury (trauma or
infection), genetic contributions, and risk factors,
such as prenatal use of alcohol and tobacco ;
biological predisposition  inherent differences
in the way the brains of individuals with ADHD
function  ADHD has a neurological basis
• Executive functions  cognitive abilities that
enable us to plan, self-regulate, inhibit
appropriate behaviors and engage in goaldirected activities
Contd.
• Biology + environment = ADHD
• Genetics may contribute  same family
members
• A parent with ADHD may be less likely to
follow consistent routine and provide clear
and concise expectations or directions 
intensified their child’s ADHD characteristics
• P. 208
Overcoming Challenges
• Behavioral techniques, direct and systematic
instructions that is evaluated on a frequent basis
and a highly motivating instructional materials 
but, before that … medication
• Over 2 millions ADHD students consume Ritalin,
Concerta, Adderall, or Dexadrine  to control
their behavior (Austin, 2003)  increase the
arousal level of CNS, enhancing blood flow to the
frontal lobes or increasing electrical activity in the
brain and improving functions (working memory,
attention, planning and self regulations)
Contd.
• Stimulants  increase levels of certain
neurotransmitters that enhance brain functioning
(Ward & Guyer, 2002); help them to focus their
attention on assigned tasks, and medication is
effective for most (Forness & Kavale, 2001)
• Controversy  rapid increase of prescriptions,
side effects (reduction in appetite, problems
sleeping, jitteriness, dizziness)  need to
monitor their health and performance carefully
Contd.
• Educators need to work with family to:
– Medications not uniformly effective
– Take several adjustments  classroom obs
– Negative side effects  classroom obs
• Medications  not directly improve academic
functioning  more effective with behavioral
therapy
Assessment
• Early Intervention
– Less common than during school years  parents
might see the symptoms, but need professional
help to determined whether those are typical or
excessive for the child’s age (NIMH, 2006)
– Become noticeable when compared to their peers
– Pediatricians, child psychologist/psychiatrist
– Behavioral training for parents and social skills
training for the child
Assessment (2)
• Prereferral
– Purpose  to avoid unnecessary referrals to special
education by implementing research- validated
practices in the general education classroom
– Focus on preventing problem behaviors  physical
and instructional structure of the classroom must be
considered
– Well-planned behavior management system, rules,
procedures, and consistently delivered consequences
 maintenance of regular classroom routine!
Assessment (3)
• Identification
– Include multidimensional evaluations (Barkley &
Edwards, 2007; Weyandt, 2007)  include:
•
•
•
•
•
Diagnostic interview
Medical examinations
Behavior rating scale
Standardized tests
Observations
– Include medical profession  to gather the data
needed to understand each individual’s problems and
types of support/system needed  academic
performance, behavioral patterns, social interactions
and medical history
Assessment (4)
• Evaluation: Testing Accommodations
– Extending time  typically 8-12 minutes longer to
answer test items  surprisingly, giving longer
period does not significantly improve their scores
 but they feel more motivated, less frustrated,
and thought they performed better (Elliott &
Marquart, 2004)
– Testing in alternate setting  where distractions
may be limited
Early Intervention
• Preschoolers with ADHD  have poorer social
skills, more demanding and noisy during peer
interactions, display higher level of verbal and
physical aggression, and require more frequent
medical attention than non-ADHD peers (DuPaul
& Stoner, 2003)
• Parent behavior training  positive results 
reduction in parent-child conflicts
• Classroom-based behavioral interventions 
positive reinforcement, response cost, daily
rewards, and additional strategies
Contd.
• Community-based interventions  combined
with medical treatment, parent training, and
classroom-based behavioral interventions 
reduce negative characteristics of ADHD and
improve social skills and interactions, particularly
in classroom settings
• Results usually short-term and don’t produce
associated improvements in academic
performance (DuPaul & Stoner, 2003)  need
further research
Access to General Classroom
• Cumulative effects of unmet instructional and
behavioral needs  resulted in poor academic
achievements  because they miss blocks of
information and experience interruptions in
the learning process  access to general
classroom is inconsistent
• Selecting effective accommodations and
interventions  based on individual student’s
problems  the sooner the better
Instructional Accommodations
• Reducing distracting stimuli  avoid high-traffic
areas, pencil sharpener, hallway door, trash bin;
placing them near teacher and peer model to
influence positive behaviors
• Physical accommodations  pointers or
bookmarks to help students track words visually
during reading exercises, timers as reminders of
time left, visual cues (turn off the light to indicate
that the noise level is too high)
Contd.
• Accommodations  bring benefit for all
students! But mostly for ADHD students
• Instructions that are engaging, exciting and
culturally relevant to the students, pace of
presentation varies; teachers monitor the
understanding of key concepts and adjust the
lesson accordingly, directions are clear, concise
and thorough
• Feedback if students with ADHD able to delay
gratifications
Data-Based Practices
• If students engage in acting-out behaviors 
teachers need to check of the work is too difficult
for them
• Lack of motivation and persistence to make the
extra effort to learn when it is difficult for them
• Carefully planned educational procedures  let
them choose academic assignments from a group
of alternatives, shortening the task, giving clear
and precise instructions, reward for achievement
Self-Management Strategies
• Self-monitoring  learn to evaluate her own
behavior by determining whether it is on task or
off task
• Self-instruction or self-talk  use self-induced
statements to guide their actions
• Goal-setting  helpful to determine the level of
expected performance for a task
• Self-reinforcement  powerful self-regulation
strategy that allows students to earn rewards for
accomplishments
Technology
• Personal organizers  provide structures
necessary to reduce the number of
incomplete homework assignments or skipped
meetings with a tutor
• Software programs
• Web pages  provide interesting text and
stimulating pictures combined with movie or
audio clips  help them engage in prolonged
period of time and shift attention frequently
Transition
• Combination of medical interventions and
counseling  including individual,
family/marriage and/or vocational counseling
• Components needed in effective programs (p.
219)
• Information sharing (p. 220)
• Teachers can assist family (p. 221)