Strategies for Success

1. Strategies for Success Children with Attention Deficit/Hyperactivity Disorder (ADHD) by Rodney Orders, LCSW-C FASAP Clinician 443-287-7000 rorders1@jhmi.edu

2. 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

3. The Story of Fidgety Philip Let me see if Philip canBe 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

4. 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.

5. 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)

6. 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

7. 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

8. 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.

9. 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)

10. How to identify if your child has ADHD? • Seek a Comprehensive Assessment • Behavioral • Educational • Medical Generally performed by • Developmental Pediatricians • Psychologists

11. 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

12. Treatment Options? • Behavioral • Time Management skills for parents/teachers • Positive reinforcements, time outs • Token Economy • Cognitive Behavioral Therapy

13. Treatment Options • Pharmacological Approaches • Psychostimulants • antidepressants, antianxiety, antipsychotics, and mood stabilizers are used primarily for those who don’t respond to psychostimulants

14. Treatment Options? • Multimodal Approaches • Medication/behavior treatment and medication only treatment works significantly better than behavioral therapy alone (NIMH, MTA study 1999)

15. Tips for Home • Make sure you maintain eye contact when speaking with your child • Use positive reinforcement more often than discipline • Make consequences as immediate as possible • Be proactive • Simplify directions

16. Tips for Home • Find your Child’s talents • Use token economies to help in enforcing rules • Create organizational systems to help your child • Create daily routines and stick to them as much as possible • Review your expectations for your child

17. 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

18. 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