Strategies for Success

Children with Attention Deficit/Hyperactivity Disorder (ADHD)byRodney Orders, LCSW-CFASAP Clinician443-287-7000rorders1@jhmi.edu

Origins of the Disorder

First described by Dr. Heinrich Hoffman in 1845 The Story of Fidgety Philip 1902 Sir George F. Still Royal College of Physicians

in England 1940s Brain Damage Behavior Disorder 1950s Minimal Brain Dysfunction (MBD) 1968 DSM-II Hyperkinetic Reaction of Childhood 1970s ADD with/without hyperactivity

The Story of Fidgety Philip Let me see if Philip can

Be a little gentleman;Let me see, if he is ableTo sit still for once at the table:Thus Papa bade Philip behave;And Mamma look'd very grave.But fidgety Phil,Won't sit still;He wrigglesand giggles,And then, I declare,Swings backwards and forwardsAnd tilts up his chair,Just Like any rocking horse; --"Philip! I am getting cross!" See the naughty restless childGrowing still more rude and wild,Till his chair falls over quite.Philip screams with all his might.Catches at the cloth, but thenThat makes matters worse again.Down upon the ground they fall.Glasses, plates, knives, forks and all.How Mamma did fret and frown.When she saw them tumbling down!And Papa made such a face!Philip is in sad disgrace. Where is Philip, where is he?Fairly cover'd up you see!Cloth and all are lying on him;He has pull'd down all upon him.What a terrible to-do!Dishes, glasses, snapt in two!Here a knife, and there a fork!Philip, this is cruel work.Table all so bare, and ah!Poor Papa, and poor MammaLook quite cross, and wonder howThey shall make their dinner now.

Book Images and poem are from http://www.adhdcanada.com

Definition for ADHD

According to the U.S. Office of Special Education Programs ADHD is a neurological condition that involves problems with inattention and hyperactivity-impulsivity that are developmentally inconsistent with the age of the child.

Prevalence

It is estimated that 1.46 million to 2.46 million children 3 to 5 percent of the student population have ADHD (American Psychiatric Association, 1994)

Boys are four to nine times more likely to be diagnosed and found in all cultures, although prevalence rates differ (Ross and Ross, 1982)

Inattention

DSM-IV TR identifies these signs of Inattention Often becoming easily distracted by irrelevant

sights and sounds Often failing to pay attention to details and making

careless mistakes Often loses things necessary for tasks or activities

(i.e. toys, pencils, assignments) Often skipping from one uncompleted activity to

another

Hyperactivity-Impulsivity

DSM-IV TR identifies the following as signs of Hyperactivity Often fidgets with hands or feet or squirms in seat Running, climbing, or leaving a seat in situations

where sitting or quiet behavior is expected Often talks excessively Impulsivity Often blurts out answers before question can be

completed Having difficulty waiting in line or taking turns

Comorbidity

Almost 1/3 of children with ADHD have learning disabilities (NIMH)

Current literature indicates that 40-60% of children with ADHD have a least one coexisting disability. Certain disabilities appear to be more common

than others including conduct disorders, mood disorders, anxiety disorders, tics and Tourette’s syndrome.

Causes of ADHD

It is a Genetic Neurobiologic condition Underutilization of Glucose in the attending

areas of the brain by a PET scanning technique (1990 NIH Study)

There seems to be a genetic overlap between ADD, Autism, Tourette’s syndrome and alcoholism (1991 Journal of the American Medical

Association)

How to identify if your child has ADHD? Seek a Comprehensive Assessment

Behavioral Educational Medical

Generally performed by Developmental Pediatricians Psychologists

How to Choose a Quality Behavioral Health Provider?Ask questions about the organization

What is the organization’s service philosophy? Are well-qualified staff available? Individualized treatment plans? Does the organization have a procedure for

resolving/receiving client disputes? Are the buildings/ground suitable for treatment? How does the organization ensure that care, treatment, and

services are delivered safely? Is it accredited by Joint Commission on the Accreditation of

Health Care Organizations (JCAHO)

Seek the Advice of FASAP

Treatment Options?

Behavioral Time Management skills for parents/teachers Positive reinforcements, time outs Token Economy Cognitive Behavioral Therapy

Treatment Options

Pharmacological Approaches Psychostimulants antidepressants, antianxiety, antipsychotics, and

mood stabilizers are used primarily for those who don’t respond to psychostimulants

Treatment Options?

Multimodal Approaches Medication/behavior treatment and medication

only treatment works significantly better than behavioral therapy alone (NIMH, MTA study 1999)

Tips for Home

1. Make sure you maintain eye contact when speaking with your child

2. Use positive reinforcement more often than discipline

3. Make consequences as immediate as possible

4. Be proactive

5. Simplify directions

Tips for Home

8. Find your Child’s talents

9. Use token economies to help in enforcing rules

10. Create organizational systems to help your child

11. Create daily routines and stick to them as much as possible

12. Review your expectations for your child

Tips for School

The following are tips for teachers Work on the most difficult concepts early in the day Give directions to one assignment at a time instead

of directions to multiple tasks all at once Vary the pace and type of activity to maximize the

student’s attention Structure the student’s environment to

accommodate his or special needs

Questions?

For more information about this or other topics please contact us:

Faculty and Staff Assistance Program

550 N. Broadway/Suite 507 (Medical Campus)

or

1101 East 33rd St, Suite C-100 (Eastern H.S.)

(443) 997-7000 or 7-7000 on campus