Attention Deficit Hyperactivity Disorder (ADHD). Implications for Teachers Ulidia Resource Centre October 2002 Roz Lacey & Gayle Nixon (Educational Psychologists). Aims. To increase understanding of Attention Deficit Hyperactivity Disorder (ADHD) and its implications
Attention Deficit Hyperactivity Disorder (ADHD) Implications for Teachers Ulidia Resource Centre October 2002 Roz Lacey & Gayle Nixon (Educational Psychologists)
Aims • To increase understanding of Attention Deficit Hyperactivity Disorder (ADHD) and its implications • To provide practical strategies for the management of ADHD in the classroom
Programme • What is ADHD? • Causes, prevalence and co-morbidity • Coffee • Assessment & diagnosis • Treatment • Medication • Lunch • Strategies for school
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Activity - ADHD in class • Describe the types of behaviour that would lead you to believe a child had ADHD. • What difficulties do these behaviours pose in school for: • The teacher? • The child? • His / her classmates? • What strategies are typically employed by your school to deal with these behaviours? • Are these effective?
Activity How much do you know about ADHD?
Current Diagnostic Criteria • Diagnostic & Statistical Manual of Mental Disorders – 4th Edition, American Psychiatric Association, 1994 (DSM-IV) • Entirely behavioural in nature • 2 clusters of symptoms (Inattention & Hyperactivity / Impulsivity) • Each cluster consists of 9 behavioural descriptions • Behaviours must also: • Be developmentally inappropriate; • Be present for at least 6 months; • Be present before age 7; • Cause impairment in at least 2 settings; • Result in clinically significant impairment in social or academic functioning.
Current Diagnostic Criteria - DSM-IV • DSM-IV outlines 3 subtypes of ADHD: • ADHD(I) Predominantly Inattentive Type • ADHD(HI) Predominantly Hyperactive-Impulsive Type • ADHD(C) Combined Type
ADHD(I) - Inattentive Type Inattention Distractibility
ADHD(I) - Inattentive Type • Look out for the child who… • Is often off-task • Doesn’t finish their work • Makes careless mistakes • Appears lazy / disinterested • Daydreams / Appears not to listen • Misses instructions / asks for things to be repeated • Can’t seem to focus • Is unable to maintain effort over time • Is forgetful / disorganised
ADHD(HI) - Hyperactive Impulsive Type Impulsivity Problems with activity level
ADHD (HI) – Hyperactive Impulsive Type • Look out for the child who… • Talks excessively • Shouts / blurts out • Interrupts / intrudes • Can’t wait her turn • Doesn’t wait to hear instructions • Is restless / fidgety / out of seat • Is always “on the go”
ADHD(C) - Combined Type Inattention Distractibility Problems with activity level Impulsivity
E n v i r o n m e n t a l Biological Level Cognitive Level Behavioural Level
What causes ADHD? • Research suggests that ADHD is genetic • Symptoms are a result of neurotransmitter dysfunction • Recent research suggests dopamine is not being recycled properly • MRI scans show differences in brain activity between ADHD children and controls
How many children have ADHD? • 3% - i.e. one in every class of 30 • 1% ADHD (I) • 2% ADHD (HI) • Boys more frequently diagnosed than girls • Ratio of ~4:1 • Girls more likely to be diagnosed with ADHD(I) • Frequency of ADHD diagnoses tend to increase dramatically from the pre-school to the primary school years.
What about your school?
Is ADHD a unitary condition? • Difficulties of differential diagnosis • Co-morbidities • Emotional disorder • Antisocial behaviour disorder • Tic disorder • Pervasive developmental disorder • Learning difficulty • Motor planning problem • Self-esteem problem • Gt. Ormond St. Study • DAMP
Assessment and diagnosis Recognition of indicators (home or school) Referral to G.P. or E.P. Referral to Paediatrician / Child Psychiatry Assessment across contexts (DSM-IV) Diagnosis or not
In your experience…?
E n v i r o n m e n t a l Biological Level Cognitive Level Behavioural Level
Medication • Psychostimulants - most common • Ritalin (methylphenidate) • Dexedrine (dextroamphetamine) • Considered to be very safe • Immediate, observable effects (1/2 hr) • Wears off in 3-4 hours (not addictive) • Monitoring should be by consultant • Personality should not seem dulled • Some side effects possible • NOT SUFFICIENT BY ITSELF!!!
The MTA Study • Biggest study ever completed on ADHD treatment • 4 groups • 1) Medication management • 2) Behaviour treatment • 3) Combined treatment • 4) Community care
The MTA Study (Cont.) • Findings – • Medication alone better than behaviour alone on core symptoms • Combination not substantially better than medication • Carefully managed medication had fewer side effects (no additional medication needed) • Combined treatment group needed lower doses of medication
Help for parents • Increased understanding and insight • Support groups • Good quality liaison with school • Programmes such as ‘1,2,3 magic’ by Thomas Wheelan • Excellent Booklet “All about ADHD”, Tel: 020 7535 7400
Activity How much have you learned?
Practical Strategies for Schools • Aim: To maximise the potential for all children in the classroom by reducing the time the teacher has to spend responding to the child’s behaviour. • Aim: To reduce teacher stress!!!
Favourites • Headphones / screen • Traffic lights • Behaviour programmes • Visual timetable / chunking • Attention training • Brain gym • Stress toy • ICT • Circle time • Coffee jar challenge
Knowledge of ADHD & Strategies Chosen • Knowledge level influences choice of behaviour management strategy • Higher knowledge = whole class strategies chosen • Different strategies affect behaviour in different ways… • Individual strategies = increased attention and concentration • Whole-class strategies = reduced hyperactivity
Strategies for Particular Diffficulties: Sustaining effort • Reduce task length (differentiation) • Break long assignments into chunks & reward completion promptly • Follow difficult task with preferred task • Short breaks between tasks • Use timer • Quality rather than quantity • Alternative methods of recording
Strategies for Particular Diffficulties: Easily distracted • Seat at front away from distractions • Use earphones • Utilise study carrels / flexible seating • Use physical proximity • Ensure eye contact when giving instructions • Cue pupil to stay on task • Attention training
Strategies for Particular Diffficulties: Talking out of turn • Ignore inappropriate comments & questions • Traffic light system • Positive reinforcement for listening
Strategies for Particular Diffficulties: Poor Recall • Multi-sensory approach • Seeing, saying, writing, doing • Role-playing activities • Computer assisted instruction • Memory techniques Mnemonics Visualisation Sub-vocalisation Verbal mediation
Strategies for Particular Diffficulties: Untidy/Disorganised • Assist pupil with personal organisation • Arrange for peer support • Reward tidiness • Be willing to repeat expectations • Keep worksheet format simple • Keep materials needed to hand • Develop a clear system for keeping track of completed and uncompleted work
Strategies for Particular Diffficulties: Transition Time • Use individual / group work schedules (in picture or written format) • Define requirements carefully • Aim for consistency across tasks/classes • Always give a 5 minute warning before ending an activity
Arrange joint activities in class with likely friends Use co-operative learning activities Reward appropriate social behaviour (involve parents and lunchtime supervisors) Assign pupil responsibility in the presence of his/her peer group Utilise Circle Time /P.S.E /Drama to teach concepts of communication, participation and co-operation Strategies for Particular Diffficulties: Peer Problems
Strategies for Particular Diffficulties: Fidgets / Squirms • Break tasks into small steps • Allow alternative seating • Allow alternative movement where possible • Stress toy • Consider ‘Brain Gym’
Whole-class strategies: Behaviour Management • Provide frequent, immediate and consistent feedback about acceptable and unacceptable behaviour • Praise specific behaviour • Be sure to criticise the behaviour, not the child
Whole-class strategies: Rules & Routines • Keep classroom rules clear and simple • Display them [positively] • Ensure that pupils know what happens if these rules are kept or broken • Strive for consistency of expectation, action, reward and punishment • Establish a daily classroom routine and schedule
Whole-class strategies: Giving Instructions • Get quiet attention first • Be clear and concise • Give instructions in the order you want them to be carried out • Follow up oral instructions with written reminders • Keep checking that pupils know what to do
Whole-class strategies: Marking work • Use self-correcting materials • Pair pupils to check work • Encourage pupils to check over their work • If possible, correct work in presence of pupil • Write useful, specific comments
Whole-class strategies: Lesson Structure & Presentation • Review previous lessons on the topic • Set learning and behavioural expectations at outset • Actively involve pupils in presentation • Keep lessons short & interesting • Include a variety of activities • Vary the pace • Use multi-sensory approach or IT • Allow adequate time for lesson review / recap
Behaviour Programmes • Why? • Help the child to focus on specific targets • Shift the emphasis from bad to good behaviour • Should positively impact on behaviour in class, self-esteem & peer relations
Behaviour Programmes • How? • 3 simple targets • 1 achieves already • 2 sometimes manages • 3 more difficult but not impossible • Keep it visual (e.g. chart / diary) • Involve parents • Only comment on positive behaviour • Build in rewards • Reward effort, not just achievement • Don’t shift the goal posts too soon!
Behaviour Programmes using response cost • Children with ADHD have difficulty visualizing the potential reward • Give rewards at the start of time period with potential to lose • Build in an early warning system • Keep it tangible & visual • Reward approximate behaviour
9.45-10.30 Group 2 Response Cost System 10.30-11.15 11.15-12 12-12.45 9-9.45 John Peter Group 1
Encouragement • You’re on 2! • Keep it up!