ADD and ADHD

By Clare Paronich, Allison Pfeiffer, Ashleigh Carlucci and Samantha Esposito

Attention Deficit Disorder:◦ Is a syndrome usually diagnosed in childhood,

characterized by a persistent pattern of impulsiveness, a short attention span and interfering especially with academic, occupational and social performance.

Attention Deficit Hyperactivity Disorder:◦ Is attention deficit disorder in which hyperactive

behavior is present.

Definitions

The American Psychiatric Association states in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR) that 2%-7% of school-aged children have ADHD.

As of 2007, parents have reported that approximately 9.5% of children ages 4-17 have been diagnosed with ADHD.      

   Rates of ADHD diagnosis have increased an average of

5.5% per year from 2003 to 2007.        

ADHD affects up to 1 in 20 children in the USA, which has led to the impression that ADHD is largely an American disorder and is much less prevalent in other countries.

Prevalence

http://youtu.be/Rcy2jF1EXjk

Video

Inattentive vs. hyperactiveInattention symptoms of ADHD include: Not paying attention to detail Making careless mistakes Failing to pay attention and keep on task Not listening Being unable to follow or understand

instructions Avoiding tasks that involve effort Being distracted or forgetful Losing things that are needed to complete tasks

Inattentive vs. HyperactiveHyperactivity-impulsivity symptoms of ADHD

include: Fidgeting Squirming Getting up often when seated Running or climbing at inappropriate times Having trouble playing quietly Talking excessively or out of turn Interrupting

Combinations of inattentive and hyperactive1. ADHD, Combined Type: Both inattention

and hyperactivity-impulsivity symptoms2.ADHD, Predominantly Inattentive Type:

Inattention, but not enough (at least 6 out of 9) hyperactivity-impulsivity symptoms

3. ADHD, Predominantly Hyperactive-Impulsive Type: Hyperactivity-impulsivity, but not enough (at least 6 out of 9) inattention symptoms

◦ Hyperactivity, fidgetiness and/or squirming.

◦ Impulsivity (difficulty staying focused on an immediate task because other thoughts often intrude and race through the mind.

◦ Inattention for “boring” or “unexciting” mental activity (school work or formal learning experiences)

◦ Walking slowly or being disorganized and/or grumpy in the morning unless anticipating high excitement activity.

Characteristics of ADD and ADHD

Difficulty remaining seated when required to do so

Difficulty waiting for a turn in tasks, games, or group situations

Blurting out answers before questions have been completed

Shifting from one unfinished activity to another Loosing things necessary for tasks/activties Difficulty delaying gratification

Characteristics (cont.)

◦ Falling asleep slowly and with great difficulty at night.

◦ Episodic explosiveness (also referred to as emotional outburst or temper tantrums) manifest as verbal violence and/or hitting, biting, kicking etc.

◦ Unexplained and unreasonable emotional negativity.

◦ Spatial dyslexia Writing mirror imagine reversals of letters, difficulty with

left-right discrimination, and difficulty properly sequencing letters, words or numbers.

Characteristics (cont.)

Only kids who are hyper have ADHD/ADD. ________ Bad parenting does not cause ADHD. _________  ADD/ADHD affects a person’s intelligence. _________ ADHD/ ADD can be found in adults and teenagers, as well as children.

______  Children can outgo ADHD/ADD. _________  Children on ADHD or ADD medicine are more likely to take drugs when

they get older. _________  Children with ADHD/ADD have trouble sleeping at night. _________  Children with ADHD/ADD are just poorly disciplined. ________  Ritalin can temporarily effect a child’s height. _________  Children with ADD/ADHD will never amount to anything. _________ 

Myths vs. Facts Activity

There is no single medical or physical test for diagnosing ADD/ADHD.

A doctor or health professional will have to get involved in order to diagnosis a child.

A checklist of symptoms Answer to questions about past or present problems. Medical exam to rule out other causes for symptoms

Learning disabilities and emotional issues have similar symptoms as ADD/ADHD

Assessment

Important factors to consider when diagnosis or evaluating for ADD/ADHD

◦ How severe are the symptoms?◦ When did the symptoms start?◦ How long have the symptoms been bothering you

or your child?◦ When and where do the symptoms appear?

Assessment

Exact cause is unknown. Experts know that there is a strong genetic

component. ◦ Although in some cases there is no genetic link.◦ High frequency of ADD/ADHD occur when one

or more family members has ADHD. ◦ At least 1/3 of all fathers or mothers who had

ADHD in their youth, have children with ADHD. Some brain changes can cause ADHD.

◦ Children or adults who have abnormal functioning, or deregulation, of neurotransmitters.

◦ There also tends to be abnormal functioning in the nerve pathways that regulate behavior.

Etiology

According to the Individuals with Disabilities Education Act, ADD and ADHD does not fall under the thirteen qualifying categories of learning disabilities.

◦Therefore this means the child is not granted automatic entry into special education.

Placement

If a parent feels that their child’s ability to learn is being adversely affected, they can ask the school for a student study team meeting. If the SST team believes that the child could have a

specific learning disability, they may recommend a formal special education evaluation. If the IEP/SST team feels that modifications are

appropriate for the child to be successful they can be implemented through a 504 plan.

If the parents still feels the child’s disorder is severe enough to warrant a placement in special education, they can request a special education evaluation. But a general education class with a 504 plan would be first step.

PlacementSteps to take as a parent:

On an IEP, ADD/ADHD is classified as an Other Health Impairment, and in order to classify for special education services in public schools under the category of OHI, the health impairment must affect the child’s educational performance ◦ Decisions about the need for special/related

services for students with ADD/ADHD are made on an individual basis depending on the level of severity

Related Services

A student whose disability is categorized as ADD/ADHD or OHI on their IEP has no mandated services according to state laws

If they are categorized for another disability in addition to ADD/ADHD, such as a Learning Disability, they may qualify for:◦ Occupational Therapy◦ Physical Therapy◦ Speech/Language Therapy◦ Reading Specialist◦ Counseling

Related Services (cont)

Prepare the students for the days lesson- briefly explain what you will be doing ◦ review, new info, activities

Review previous lessons ◦ remind children what you did yesterday & practice before moving on

Set learning expectations ◦ what are students expected to learn?

Set behavioral expectations ◦ can they talk to their neighbor, is it independent, where they should be

sitting State all materials that will be needed Explain additional resources

◦ Where can students look for help?

Academic Instruction

Be predictable ◦ structure and consistency is best minimal rules and

choices are most effective Support student participation in class

◦ silent cues/warnings, avoid sarcasm and criticism Use lots of visuals Assess student performance throughout the lesson Help students correct their own mistakes

◦ do not do it for them! Provide written and oral follow-up directions

◦ page numbers on board, repeat directions Provide advance warnings

Academic Instruction (cont.)

Silent Reading Partner reading (pair child with stronger

reader Storytelling Role-play Board games Recorded books

ELA & Reading ComprehensionInstructional Strategies

Mnemonics ◦ “when two vowels go walking, the first does the talking”

Word familiesBoard gamesPicture-letter charts

Instructional Strategies for Handwriting:Quiet places with little distraction

◦ classroom officeSpacing between wordsLined paperShoe line, writing line, belt line, hat line

Instructional Strategies for Phonics

Establish standards for acceptable written work Storyboard

◦ describe different parts of the story you are writing Classroom post office

◦ encourage students to write letters to one another and teacher

Instructional Strategies for Spelling Use everyday examples for hard to spell words- if a student is

having a sandwich for lunch, practice spelling it Spelling words- frequent words Keep a dictionary of frequently misspelled words Partner spelling- quiz Movement activities- jump rope and spell, dances, songs

Instructional Strategies for Writing

Teach students to recognize patterns (hundreds chart)

Mnemonics (PEMDAS Use real life examples and students names! Color code symbols (+,-,x,÷) Board games Highlight key words in word problems Number lines, manipulatives, graph paper,

Instructional Strategies for Math:

Children and youth with ADD and ADHD often have serious problems in school. Inattention, impulsiveness, hyperactivity, disorganization, and other difficulties can lead to unfinished assignments, careless errors, and behavior which is disruptive to one's self and others. Through the implementation of relatively simple and straightforward accommodations to the classroom environment or teaching style, teachers can adapt to the strengths and weaknesses of students with ADD. Small changes in how a teacher approaches the student with ADD or in what the teacher expects can turn a losing year into a winning one for the child.

Accommodations

require fewer correct responses for grade

reduce amount of homework

instruct student in self-monitoring using cueing

seat student in quiet area seat

student near good role model seat student near "study buddy"

increase distance between desks

allow extra time to complete assigned work

shorten assignments or work periods to coincide with span of attention;

use timer break long assignments into smaller parts so student can see end to work

Accommodations for Inattention

provide reassurance and encouragement

frequently compliment positive behavior and work product

speak softly in non-threatening manner if student shows nervousness

review instructions when giving new assignments to make sure student comprehends directions

look for opportunities for student to display leadership role in class

conference frequently with parents to learn about student's interests and achievements outside of school

send positive notes home

Accommodations for Mood

if reading is weak: provide additional reading time; use "previewing" strategies; select text with less on a page; shorten amount of required reading; avoid oral reading

if oral expression is weak: accept all oral responses; substitute display for oral report; encourage student to tell about new ideas or experiences; pick topics easy for student to talk about

if written language is weak: accept non-written forms for reports (i.e. displays, oral, projects); accept use of typewriter, word processor, tape recorder; do not assign large quantity of written work; test with multiple choice or fill-in questions

if math is weak: allow use of calculator; use graph paper to space numbers; provide additional math time; provide immediate correctness feedback and instruction via modeling of the correct computational procedure

Accommodations

ignore minor, inappropriate behavior increase immediacy of rewards and consequences

use time-out procedure for misbehavior

supervise closely during transition times

use "prudent" reprimands for misbehavior (i.e. avoid lecturing or criticism)

attend to positive behavior with compliments etc..

acknowledge positive behavior of nearby students

seat student near role model or near teacher

Accommodations for Impulsiveness

ask for parental help in encouraging organization,

provide organization rules

encourage student to have notebook with dividers and folders for work

provide student with homework assignment book

supervise writing down of homework assignments

send daily/weekly progress reports home

regularly check desk and notebook for neatness, encourage neatness rather than penalize sloppiness

Organization Planning

remind student to check over work product if performance is rushed and careless

give extra time to complete tasks

allow student to stand at times while working

provide opportunity for "seat breaks" i.e.run errands, etc.

provide short break between assignments

supervise closely during transition times

Accommodations for Motor Activity

praise compliant behavior

provide immediate feedback

ignore minor misbehavior

use teacher attention to reinforce positive behavior

seat student near teacher

set up behavior contract

implement classroom behavior management system

Accommodations for Compliance

praise appropriate behavior

monitor social interactions

set up social behavior goals with student and implement a reward program.

prompt appropriate social behavior either verbally or with private signal

Encourage cooperative learning tasks with other students

provide small group social skills training

Accommodations for Socialization

http://youtu.be/xfo1tZ95Ypk

ADD/ADHD Simulator Activity

Materials/Equipment Assistive Technology is defined as "Any

item, piece of equipment, or product system, whether acquired commercially or whether off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of people with disabilities" (Technology-Related Assistance for Individuals with Disabilities Act of 1988).◦ help to improve certain skills and deficits and

increase self reliance◦ ranges from low-tech, to high tech, to  no tech.

Low-Tech Assistive Technology Highlighter:

- draw out the main ideas from a reading passage- receive a copy of notes and highlight

important/emphasized sections so the student can stay at the same pace as the rest of the class without losing content and information due to slow writing or processing skills.

Pointers: - visually track written words on a page

(bookmarks)

Low-tech (continued) Porcupine pens:

◦  decorated with fabric: students who need tactile feeling. 

◦ students stay focused instead of tapping pencils or tearing paper

Stress ball: (binder clips)◦ Students who need tactile items

Low-tech (continued) Graphic Organizers:

◦ Can be used in all subject areas and grade levels◦ make material less intimidating ◦ help provide direction◦ help students to organize content and pick out

the essential information Timers:

◦ Help track student progress during lesson◦ No surprises when you say to clean up if they are

not yet finished

High-tech assistive technology Livescribe Pen:

◦ WIFI smart pen◦ Records audio that you can (tap on notes and plays back)◦ Transferred wirelessly to computer◦ http://www.livescribe.com/en-us/smartpen/wifi-smartpen/

WordQ:◦ Reads aloud any text you can highlight ◦ Helps with comprehension and proofreading◦ http://www.goqsoftware.com/products/

Strategies in the classroomBehavior Management Strategies 

Give your attention to appropriate behaviors. Provide opportunities for physical movement Use progress charts and other visual records of

behavior to encourage more appropriate behavior.  Assign a capable "study buddy" who can remind

and assist the active or disorganized student. Assign duties that require self-control (e.g., line

leader, materials distributor).  Teach self management of behavior

 

Strategies in the classroomModifications To The Classroom Environment Assign the student to a seat that best allows him/her to

observe you while avoiding distractions (e.g., away from doors, windows, pencil sharpeners).

Eliminate excessive noise. Eliminate excessive visual stimuli and clutter that might

distract the youngster. Employ study carrels or seat the student in the area of

the classroom with the least distractions, and/or face the desk toward the wall. 

Keep directions and commentary short and to the point.  Avoid "overloading" the student with too much verbiage.

Strategies in the classroomStarting Your Lesson  Provide "do now" activities for other students tob focus the

ADD/ADHD student. Be sure you have the pupil's attention before you start. Use alert cues to get the student's attention before giving

directions. Use more than one modality when giving directions. 

Supplement verbal instructions with visual ones. Repeat and simplify the directions. Place instructions on an audio tape that can be replayed by

the student as needed. To ensure understanding, have the student repeat the

directions in his/her own words. Have the student underline or highlight directions. 

Strategies in the classroomMaking Lessons More Interesting  Give a general overview first.  Let the student(s) know

what will be learned and why it is important in life. Devise interesting activities. Use examples that capitalize on the student's interests. Ensure that your style of presentation is enthusiastic

and interesting. Use game formats to teach and/or reinforce concepts

and material. Use concrete objects to assist in keeping the student's

attention. Incorporate movement into lessons. 

Strategies in the classroomTransitions Set up routines that prepare the youngster

for upcoming transitions. Set expectations for behavior BEFORE an

activity or event. Provide checklist of things one may need to

transition to next class on desk so they can refer to it.

Keep unstructured time to a minimum. Seat student next to appropriate models.

Strategies in the classroomTesting Accommodations  Use oral testing if that format will keep the student's

attention and better assess his/her knowledge. Use performance testing.  Have the student do something

or make something. Provide extended time to finish. Assign the test grade based on performance on different

aspects of the assessment (i.e., organization, writing mechanics, subject knowledge displayed).

To increase reflection and concentration, have the student identify the correct answer AND cross out incorrect answers on multiple choice tests.  Inform the student that there may be more than one correct answer. 

Metacognition in the classroom Ask metacognitive questions throughout the

day.◦ What strategies will you use to study for the test?◦ What strategies worked best for you?◦ What will you do differently?

Use models to have students evaluate their work.

Have students repeat directions in their own words.

Metacognition in the classroom Give assignments that require evaluative

skills.◦ Asking students what grade they deserve on

assignment. Demonstrate thinking aloud during lessons.

◦ Students will use your thought process as a model when completing assignments

Praise students that use metacognitive skills.

More and more high school students with disabilities are planning to continue their education in postsecondary schools, including vocational and career schools, two- and four- year colleges, and universities.

Students with ADD/ADHD have unlimited options. It is really the individual’s choice whether he or she would like to continue schooling after high school.

Many students with ADD/ADHD choose to go to two year schools, four year colleges or universities, or trade schools.

Post-Secondary Vocational Schools

Children with ADD/ADHD often have energy to burn. Organized sports and other physical activities can help them get their energy out in healthy ways and focus their attention on specific movements and skills

Teachers should encourage parents to involve their child in sports!

Recreational Programs

The benefits of physical activity are endless: it improves concentration, decreases depression and anxiety, and promotes brain growth. Most importantly for children with attention deficits, however, is the fact that exercise leads to better sleep, which in turn can also reduce the symptoms of ADD/ADHD.

Children with ADD/ADHD may also benefit from martial arts training, tae kwon do, or yoga, which enhance mental control as they work out the body.

Continued..

CHADD is a membership organization, produces the bi-monthly Attention magazine (for members), and sponsors an annual conference. The National Resource Center is the CDC-funded national clearinghouse for evidence-based information about ADHD.◦ CHADD was founded in 1987 in response to the

frustration and sense of isolation experienced by parents and their children with ADHD.

◦ The  website provides information on symptoms, diagnosis treatment, educational issues and living with ADHD for individuals and families affected by the disorder.

Organizations and Agencies

Attention Deficit Disorder Association (ADDA)

◦ The National Attention Deficit Disorder Association (ADDA) is a non-profit organization dedicated to working with adults with Attention Deficit Hyperactivity Disorder (ADD/ADHD) and their families, and parents of children with ADD/ADHD. The association, which comprise of ADD/ADHD support group leaders, parents of ADD/ADHD children, and adults with ADD/ADHD, has for the last five years been involved with Attention Deficit Disorder and its related disorders. ADDA lends its experience to providing educational tools and resources, and advocating on behalf of those afflicted by ADD/ADHD and their families.

Continued..

Activity Works integrates 12-minute exercise bursts with core curriculum for elementary classrooms. Scientifically developed, this plug-and-play program is used to maximize academic performance, combat obesity and meet state mandates for physical education◦ Students start by 1. Walking in place2. Moving arms3. Running in place

Activity- Activity Works

http://activityworks.com/inside_activity_works/

Activity Works Website

Medication for ADD/ADHD Stimulants: help focus thoughts and ignore

distractions.◦ Adderall and Adderall XR◦ Concerta◦ Ritalin, Ritalin SR, Ritalin LA◦ Dexedrine◦ Focalin and Focalin XR◦ Metadate CD and Metadate ER◦ Methylin and Methylin ER◦ Vyvanse◦ Daytrana◦ Quillivant XR

Medications for ADD/ADHD Nonstimulant medications: can improve

concentration and impulse control (without side effects of stimulant drugs)◦ Straterra◦ Intuniv

Side effects to medication Decreased appetite/weight loss Sleep problems/fatigue Headaches Jitteriness Irritability/mood swings Headaches Depression Dizziness

Why medication may be controversial

Effect on the developing brain — The long-term impact of ADD/ADHD medication on the youthful, developing brain is not yet known. Some researchers are concerned that the use of drugs such as Ritalin in children and teens might interfere with normal brain development.

Heart-related problems — ADD/ADHD stimulant medications have been found to cause sudden death in children and adults with heart conditions. The American Heart Association recommends that all individuals, including children, have a cardiac evaluation prior to starting a stimulant. An electrocardiogram is recommended if the person has a history of heart problems

Psychiatric problems — Stimulants for ADD/ADHD can trigger or exacerbate symptoms of hostility, aggression, anxiety, depression, and paranoia. People with a personal or family history of suicide, depression, or bipolar disorder are at a particularly high risk, and should be carefully monitored when taking stimulants.

Potential for abuse — Stimulant abuse is a growing problem, particularly among teens and young adults. College students take them for a boost when cramming for exams or pulling all-nighters. Others abuse stimulant meds for their weight-loss properties. If your child is taking stimulants, make sure he or she isn’t sharing the pills or selling them.

Medication alone is not enough Exercise regularly  Eat a healthy diet Get plenty of sleep Try therapy Maintain a positive attitude

Medication for ADD/ADHD Stimulants: help focus thoughts and ignore

distractions.◦ Adderall and Adderall XR◦ Concerta◦ Ritalin, Ritalin SR, Ritalin LA◦ Dexedrine◦ Focalin and Focalin XR◦ Metadate CD and Metadate ER◦ Methylin and Methylin ER◦ Vyvanse◦ Daytrana◦ Quillivant XR

Medications for ADD/ADHD Nonstimulant medications: can improve

concentration and impulse control (without side effects of stimulant drugs)◦ Straterra◦ Intuniv

Side effects to medication Decreased appetite/weight loss Sleep problems/fatigue Headaches Jitteriness Irritability/mood swings Headaches Depression Dizziness

Why medication may be controversial

Effect on the developing brain — The long-term impact of ADD/ADHD medication on the youthful, developing brain is not yet known. Some researchers are concerned that the use of drugs such as Ritalin in children and teens might interfere with normal brain development.

Heart-related problems — ADD/ADHD stimulant medications have been found to cause sudden death in children and adults with heart conditions. The American Heart Association recommends that all individuals, including children, have a cardiac evaluation prior to starting a stimulant. An electrocardiogram is recommended if the person has a history of heart problems

Psychiatric problems — Stimulants for ADD/ADHD can trigger or exacerbate symptoms of hostility, aggression, anxiety, depression, and paranoia. People with a personal or family history of suicide, depression, or bipolar disorder are at a particularly high risk, and should be carefully monitored when taking stimulants.

Potential for abuse — Stimulant abuse is a growing problem, particularly among teens and young adults. College students take them for a boost when cramming for exams or pulling all-nighters. Others abuse stimulant meds for their weight-loss properties. If your child is taking stimulants, make sure he or she isn’t sharing the pills or selling them.

Medication alone is not enough Exercise regularly  Eat a healthy diet Get plenty of sleep Try therapy Maintain a positive attitude

Exit Slip:◦ Please fill out the exit slip and be sure to include:

3 things you learned 2 questions that you have 1 thing you are still confused about

Closing Activity

Why Can’t Jimmy Sit Still By Sandra L. Tunis Cory Stories By Jeanne Kraus Sometimes I Drive My Mom Crazy, But I Know

She’s Crazy About Me by Lawrence E. Shapiro Howard B. Wigglebottom By Howard Binkow It’s Hard to be a Verb By Julia Cook A Walk in the Rain with a Brain By Edward

Hallowell Joey Pigza Looses Control By Jack Gantos Shelley, The Hyperactive Turtle By Deborah

Moss

Bibliography of Children’s Books

http://www.addmtc.com/clinical◦ The ADD Medical Treatment Center of Santa Clara

Valley ◦ http://www.helpguide.org/mental/adhd_add_diagn

osis.htm A trusted Non profit-resource.

http://www.understandingspecialeducation.com/ADHD-in-children.htmlUnderstandingSpecialeducation

Resources

http://www.addmtc.com/clinical◦ The ADD Medical Treatment Center of Santa Clara

Valley ◦ http://www.helpguide.org/mental/adhd_add_diagn

osis.htm A trusted Non profit-resource.

http://www.understandingspecialeducation.com/ADHD-in-children.htmlUnderstanding Specialeducation

Webliography

http://www2.ed.gov/rschstat/research/pubs/adhd/adhd-teaching-2006.pdf

http://www.livescribe.com/en-us/smartpen/wifi-smartpen/

http://www.goqsoftware.com/products/ http://sogpubs.unc.edu//electronicversions/s

lb/slbsum02/article2.pdf?

http://www.pbs.org/wgbh/pages/frontline/shows/medicating/schools/feds.html

Continued..

http://addwarehouse.com/shopsite_sc/store/html/article4.htm accommodations

http://kc.vanderbilt.edu/kennedy_files/PostSecondary-Tips-Resources-June2011.pdf vocational opportunities

http://www.helpguide.org/mental/adhd_add_parenting_strategies.htm recreational programs