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ADHD in the Classroom Can anyone survive?. Quote for the Day. I was trying to daydream, but my mind kept wandering. Steven Wright. Planning Outline for Presentation. By the end of today’s session, this may be how you will feel:. Information Overload.

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quote for the day
Quote for the Day

I was trying to daydream, but

my mind kept wandering.

Steven Wright

information overload
Information Overload
  • Google for ADHD = 15,700,000 sites
  • Amazon books listed on ADHD = 689 books
  • Local opinions = 1 (mine)

ADHD: Living Without Brakes

(book title by M. Kutscher)

I couldn’t repair your brakes, so I made your horn louder.

Steven Wright

let s get down to the issues
Let’s get down to the issues.

How would you describe the ADD/ADHD child in your classroom?

The better we can describe the behaviors, the better we can plan interventions.

  • How would you describe inattention?
  • Is being inattentive the same as being distractible?

Note: Inattention increases with difficulty of


  • As the child matures into adulthood, symptoms of inattention evolve into forgetfulness, losing things, and avoiding menial tasks.
  • How would you describe impulsivity?
  • What about excitability?
  • What about emotional regulation?
  • Common characteristics within ADHD include:
    • Low frustration tolerance
    • Quickness to anger
    • Impatience
    • Being easily excitable

These characteristics tend to persist into adulthood, even more so than hyperactivity.

impulsivity inattention
  • As the child matures into adulthood, impulsivity evolves into poor driving performance and self-medication.
  • What does hyperactivity look like?
  • Is being fidgety the same as being hyper?
  • What about sensory overload?
  • What about exciteability?
  • Compared to inattention and impulsivity, hyperactivity may be the least important symptom.
  • Also, hyperactivity tends to decrease as the child ages.
official diagnosis
Official Diagnosis
  • Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
  • Often has difficulty sustaining attention in tasks or play activities.
  • Often does not appear to listen when spoken to directly.
  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior of failure to understand instructions).
  • Often has difficulty organizing tasks and activities.
  • Often avoids, dislikes, or is reluctant to engage in tasks requiring sustained mental effort (such as schoolwork or homework).
  • Often loses things necessary for tasks or activities (for example,, toys, school assignments, pencils, books, or tools).
  • Is often easily distracted by extraneous stimuli.
  • Often forgetful in daily activities.
official diagnosis1
Official Diagnosis
  • Often fidgets with hands or feet or squirms in seat.
  • Often leaves seat in classroom or in other situations in which remaining seated is expected.
  • Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness).
  • Often has difficulty playing or engaging in leisure activities quietly.
  • Is often “on the go” or often acts as if “driven by a motor.”
  • Often talks excessively.
  • Often blurts out answers before questions have been completed.
  • Often has difficulty awaiting turn.
  • Often interrupts or intrudes on others (for example, butts into conversations or games).
  • DSM-IV differentiates between three different types of the disorder.
  • ADHD – predominately hyperactive/impulsive type (without inattention symptoms being significant).
  • ADHD – predominately inattentive type (without the hyperactive/impulsive symptoms being significant).
  • ADHD – combined type (the most common).
  • There is a problem for researchers and clinicians with the present diagnostic criteria for ADHD.
  • What if inattention is something entirely separate from impulsivity and hyperactivity?
why conduct a workshop on adhd
Why conduct a workshop on ADHD?
  • ADHD has long lasting and serious consequences for the child.
  • ADHD is the most common global disability experienced in the classroom.
  • There are still too many myths about ADHD.
  • ADHD in the classroom can be so frustrating.
long lasting serious consequences
Long lasting, serious consequences:
  • The national percentile score in reading achievement in early adolescence for children with ADHD is almost 30 points lower than for non-ADHD age- and gender-matched controls.
long lasting serious consequences1
Long lasting, serious consequences:
  • Youths with ADHD have higher rates of absentee days, especially after the 6th grade.
  • Students with ADHD are three times as likely to be retained in a grade by age 12.
  • The school drop-out rate is twice as high for boys with ADHD.
long lasting serious consequences2
Long lasting, serious consequences:
  • ADHD adolescent drivers have four times as many auto accidents and three times the number of speeding tickets as non ADHD adolescent drivers.
  • In adults, driving under the influence of ADHD produces similar driving errors as when under the influence of alcohol.
long lasting serious consequences3
Long lasting, serious consequences:
  • ADHD is associated with higher teen pregnancy rates
  • ADHD is associated with earlier experimentation with drugs and alcohol.
  • Girls with ADHD have a higher risk of pathological eating behavior and a desire for thinness.
  • ADHD increases the risk for certain psychiatric disorders.
long lasting serious consequences4
Long lasting, serious consequences:
  • Boys with ADHD are three times more likely to be arrested or incarcerated as adults (but there is more to this story).
  • In adults, ADHD produces diverse and serious impairments in functioning in education, occupation, social relationships, sexual activities, dating and marriage, parenting, financial management, and overall mental health.

ADHD is the most common global disability experienced in the classroom.

  • Nearly 7% of elementary–age children in the United States have been diagnosed with ADHD.
  • The number of boys diagnosed with ADHD outnumbers the girls almost 4 to 1.
myths about adhd
Myths about ADHD
  • Myth: Children grow out of it when the reach puberty or adulthood.
  • Fact: Only about a third lose their symptoms by adulthood. Inattention and emotional factors persist. Some symptoms change in nature.
myths about adhd1
Myths about ADHD
  • Myth: ADHD is not a real condition. It was created by the drug companies to sell medications.
  • Fact: ADHD is a well documented neurological disorder. (to be discussed further)
myths about adhd2
Myths about ADHD
  • Myth: ADHD is over diagnosed.
  • Fact: While some children may be misdiagnosed, many children with ADHD are never identified, especially girls.
myths about adhd3
Myths about ADHD
  • Myth: We never had ADHD when I was growing up!
  • Fact: Actually the symptoms were described in a medical document back in 1798. It has gone by many names since then.
myths about adhd4
Myths about ADHD
  • Myth: ADHD is caused by too much TV and too much junk food, especially sugar.
  • Fact: ADHD may be aggravated by these factors, but the causes are primarily genetic and trauma to the developing system.
myths about adhd5
Myths about ADHD
  • Myth: Children who take medication for ADHD will become addicted and will start using other drugs.
  • Fact: Medications used to treat ADHD do not increase the risk of future drug and alcohol abuse in early adulthood.
myths about adhd6
Myths about ADHD
  • Myth: All he needs is a good whooping.
  • Fact: Good discipline is essential, but spankings are usually short lived and not nearly as effective as structure and positive guidance.
a question to ponder
A Question to Ponder

Who has the hardest time in the classroom?

  • The ADHD child

B. The teacher

what is our attitude toward the adhd child
What is our attitude toward the ADHD child?

Just because you are in a wheelchair

doesn’t mean you can’t walk down the

steps like everyone else!


We struggle to understand:

    • What is really due to ADHD, and what is just being lazy, or not caring, or defiance, or …….?
    • What do we have a right to expect/demand?
what is adhd
What is ADHD?

It is a neurological disorder characterized by inattention, hyperactivity and impulsivity.

(see DSM-IV diagnostic criteria, Rief list 1-3)

  • Note the three types:
    • Predominantly hyperactive/impulsive type
    • Predominantly inattentive type
    • Combined type
the brain and adhd
The Brain and ADHD
  • The brains of children with ADHD were 3% to 4% smaller than the brains of children without ADHD.
the brain and adhd1
The Brain and ADHD
  • A recent study found a 3 year delay in brain maturation measured by cortical thickness.
  • (No wonder they can act so immature!)
  • These delays in maturation were most noticeable in brain regions related to executive control of attention, behavioral inhibition, working memory, evaluation of reward contingencies, coordination of higher order plans, and motor control.
what is adhd1
What is ADHD?

AHDH is now perceived by many as characterized by deficits in executive functioning, or the management of brain functions.

(see Rief list 1-2)

Here is where the disabilities show up.

the major concerns
The Major Concerns
  • Deficits in executive functions
  • Inattention
  • Deficits in inhibition
  • Deficits in working memory
  • Deficits in processing speed

associated characteristics
Associated Characteristics
  • Impatience
  • Demandingness
  • Low frustration tolerance
  • Poor listening skills
  • Avoidance of chores and academics
  • Poor task completion
associated characteristics1
Associated Characteristics

Positive Illusory Bias

classroom issues
Classroom Issues
  • Excessive movement about the room or at seat
  • Excessive talking
  • Failure to attend or keep up
  • Failure to start , complete, or turn in assignments
  • Conflict with peers
  • Restricted academic performance
  • Argumentative
writing issues
Writing Issues
  • Difficulty copying from board
  • Slow copying from book or paper
  • Poor legibility of handwriting
  • Resistance to writing at all
    • Fails to start
    • Rushes through, writing anything
    • Quits after brief start
reading issues
Reading Issues
  • Lose place (poor tracking)
  • Lose train of thought
  • Forget what just read, have to reread repeatedly (impedes comprehension)
  • Silent reading difficult (may subvocalize)
  • Lack of fluency
  • Learning deficits in reading (phonological, processing, language)
math issues
Math Issues
  • Remembering math facts
  • Following multiple steps
  • Recalling rules, procedures, directions, sequences
  • Poor attention to sign changes or operational changes
  • Poor self-correction
  • Poor alignment of numbers on page
  • Slow processing or writing speed
  • Difficulty with word problems
discipline issues
Discipline Issues
  • Needing constant redirection
  • Impulsiveness
  • Desire for attention
  • Feeling picked on
  • Anger
  • Few discipline options
what to do what to do
What to do?! – What to do?!

Be Patient

Be Structured

Be Interesting

the co conspirators
The Co-conspirators

(1/2 to 2/3 have comorbid behavior disorders)

  • ODD (Oppositional-Defiant Disorder)
  • CD (Conduct Disorder)
  • BPD (Bipolar Disorder)
  • ASD (Asperger’s Disorder)
  • TD (Tourette’s Disorder)
  • OCD (Obsessive-Compulsive Disorder)
  • Epilepsy
oppositional defiant disorder
Oppositional Defiant Disorder
  • Essential Feature: a recurrent pattern of negativistic, defiant, disobedient, or hostile behavior toward authority figures.
  • Characterized by:
    • Losing temper
    • Actively refusing to comply
    • Deliberately annoying others
    • Being touchy or easily annoyed
    • Being angry and resentful
    • Being spiteful or vindictive
conduct disorder
Conduct Disorder
  • Essential Feature: repetitive and persistent pattern of behavior in which the basic rights of others or major societal norms or rules are violated.
  • Characterized by:
    • Aggression to people and animals
    • Destruction of property
    • Deceitfulness or theft
    • Serious violation of rules
bipolar disorder
Bipolar Disorder
  • Essential feature: severe mood dysregulation
  • They may cycle through moods or present a chronic irritability
asperger s syndrome
Asperger’s Syndrome
  • Essential Features: severe and sustained impairment in social interaction and the development of restrictive, repetitive patterns of behaviors, interests, and activities.
difficult combinations
Difficult Combinations
  • ADHD, Tourette’s, OCD
  • ADHD, Asperger’s, OCD
  • ADHD, ODD, and or CD
  • ADHD and Epilepsy
adhd or cd
  • Within the ADHD adults with multiple repeat offenses and arrests, three behavior rating items in their childhood were predictive:
  • “often gets into fights with other children”
  • “lies to get out of trouble”
  • “takes things from other children”
more co conspirators
More Co-conspirators
  • Learning Disorders
  • Sensory Integration Disorders
  • Auditory Process Disorder (CAP-D)
  • Motor Deficits
  • Sleep Disorders
  • Bedwetting
parents as co conspirators
Parents as Co-conspirators?

ADHD children with ADHD parents:

  • Higher rates of ODD
  • Higher rates of mood or anxiety disorders
issues to confront
Issues to Confront
  • Organization
  • Time estimation
  • Volume estimation
  • Transitions
  • Motivation
  • Social interactions
  • Emotional adaptability/control
what not to do
What not to do.
  • Tie him up and put duck tape over his mouth.
  • Embarrass him.
  • Constantly call out his name.
  • Be overly critical.
  • Repeatedly tell him to stop rather than telling him what to do.
  • Run yelling and screaming out of the room.
what to do what to do1
What to do?! – What to do?!

Help the ADHD student organize. Develop a system and stick with it. (Use color coding and other organizational strategies.)

Question: Is it wrong to provide paper and pencils for the student?

what to do what to do2
What to do?! – What to do?!

Use Visual Prompts

  • About rules (color wheel, posters, lists)
  • About procedures/steps (printed instructions, reminders)
  • About content (key words, ideas)
  • About time (clocks, time remaining)
what to do what to do3
What to do?! What to do?!
  • Use the three “P’s”
  • Prepare
  • Pre-teach
  • Practice
what to do what to do4
What to do?! – What to do?!

Help Student Plan

  • What is my task?
  • What materials do I need?
  • How will I start?
  • What will I do next?
  • How long will this take?
  • When should I ask for help?
what to do what to do5
What to do?! – What to do?!

Monitor & Supervise

  • Redirect
  • Remind
  • Review
  • Reward
how do we motivate
How do we motivate?
  • Positive regard (forge a positive relationship)
  • Encouragement
  • Expectations
  • Guidance
  • Reward Systems
social interactions adaptability
Social Interactions & Adaptability
  • Help students learn how to shift from a change-oriented or problem solving strategy when a situation is controllable to a coping-oriented or emotion regulation strategy when a situation is less controllable.
other suggestions
Other Suggestions
  • Utilize deep breathing techniques.
  • Exercise
  • Try a mirror
  • Nature (get outside)
  • Use peers
how can we help children with adhd
How can we help children with ADHD?
  • Acknowledge and accept the reality of the disorder
  • Structure, structure, structure
  • Support, guide, assist
  • Use visual supports
  • Care and embrace with compassion




medications for adhd
Medications for ADHD
  • Originally – Dexedrine, Ritalin
  • Then – Adderall, Cylert
  • Then time released – Metadate, Concerta, Adderall XR
  • Something different – Strattera (norepinephrine reuptake inhibitor)
  • Most recent – Vyvanse, Guanfacine (Intuniv, Tenex)
  • Patch - Daytrana
additional medications
Additional Medications
  • Welbutrin (antidepressant)
  • Clonadine (blood pressure medication)
  • SRI’s (anti-depressants)
  • Risperdal, Seraquel, Abilify (anti-psychotics)
complications with medications
Complications with Medications
  • Rebounding
  • Disturbed sleep
  • Weight loss and delayed growth
  • Irritability, anger, psychotic thoughts
  • Heart rate increase
  • Anhedonia
  • Genetics
  • Environmental Risks
    • Prenatal alcohol/drug exposure
    • Oxygen deprivation
    • Brain trauma
    • Febrile seizures
    • Lead exposure
    • Maternal illness during pregnancy

What about sugar?

  • What about food dyes and preservatives?
  • What about exposure to TV and video games?
  • What about abuse?
don t forget
Don’t forget!