The curious case of ADHD/ASD

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1 The curious case of ADHD/ASD Fintan J O Regan MA fjmoregan@aol.com

2 Publications Cooper P and O Regan F (2001) EDUCATING children with ADHD: Routledge Falmer Press O Regan F (2002) How to teach and manage children with ADHD: LDA a division of McGraw- Hill O Regan F (2005) ADHD : Continuum International O Regan F (2005) Surviving and Succeeding in SEN Continuum International O Regan F (2006) Challenging Behaviours Teachers Pocketbooks O Regan F (2006) Troubleshooting Challenging Behaviours Continuum International O Regan F (2008) The Small Change 2 BIG DIFFERENCE series Hyperactive, Inattentive and Disorganised, Special Direct fjmoregan@aol.com

3 Behaviour Behaviour is learned Behaviour is purposeful in a social setting Behaviour is chosen Behaviour communicates information about needs Behaviour can be the result of BDS Behaviour can be changed Behaviour can be taught Rogers 1997

4 What is ADHD? Three types of ADHD Predominantly Inattentive Predominantly Hyperactive/Impulsive Combined type

5 The school day..through a child s eyes Everything distracts you at school. If someone drops a pen on the floor you know about it if someone drops a pen in a different school, you d probably know about it. If teachers know you are ADHD as soon as someone does something they will blame you instantly. We do things we don t mean to do, like fiddling around and fidgeting and it makes you stick out. I quite often go into daydreams because of my ADHD. I might drift off for a few minutes and then when I come back round I realise everyone else is two pages ahead of me.

6 Nature vs. Nurture

7 ADHD ADHD is a real condition and not the result of poor parenting, food allergies or excess sugar ADHD is considered the most commonly diagnosed psychiatric disorder in children and adolescents The cause is unknown but scientists classify it as a neurological disorder

8 What we know Genetic influences are very strong Several changes in the DNA of chromosomes are now known to be associated with ADHD, these changes are in the genes that control specific neurotransmitters especially dopamine.

9 Triad of Social Impairment: ASD Social Communication Social Imagination Social interaction..also Sensory sensitivity and processing

10 Neurochemicals which are crucial to both neurodevelopment and function. Serotonin (5-HT). Glutamate + GABA.

11 Some common issues Receptive Language and processing difficulties Social language problems Problems handling transitions and change Weaknesses in attention, time management skills Working in Group situations Obsessive interests The need for structure and routines Whirling minds Difficulties with dealing with frustration

12 Social clumsiness / Response Inhibition Got to say it Got to say it now..

13 Are individuals with ADHD always Inattentive and Hyperactive? Their behaviour will vary according to the degree to which rules are managed, the amount of structure and support for compliance and the degree to which the child is interested in the activity Mike Gordon 1992

14 Assessment Medical evaluation Parent interview Teacher interview Patient interview Rating Scales Computerised testing Achievement testing Intellectual testing

15 ODD A pattern of negativistic, hostile and defiant behaviour lasting at least 6 months, during which four or more of the following are present: often loses temper often argues with adults often actively defies or refuses to comply with adults requests or rules often deliberately annoys people Source: Attention/deficit/Hyperactivity Disorder. In: Diagnostic and Statistical Manual of Mental Disorders: DSM IV 4th ed. Washington, DC.: American Psychiatric Press; 1194:

16 ODD often blames others for his or her mistakes or behaviour is often touchy or easily annoyed by others is often angry or resentful is often spiteful and vindictive Source: Attention/deficit/Hyperactivity Disorder. In: Diagnostic and Statistical Manual of Mental Disorders: DSM IV 4th ed. Washington, DC.: American Psychiatric Press; 1194:

17 Riley s Rules regarding ODD They live in fantasy land where they can defeat all authority figures They are optimistic and fail to learn from experience You must be fair to me no matter how I treat you Seek revenge when angered Need to feel tough Feel you will run out of moves eventually Feel equal to their parents Emulate the behaviour of their least successful peers Answer most questions with I don t know Douglas Riley the Defiant Child 1999

18 The Explosive Child Inflexibility + Inflexibility = Meltdown Ross Greene 2004

19 Girls with ADHD/ASD Their problems are frequently underappreciated May be inattentive only By adolescence may appear depressed, to have low self esteem and to be learning disabled If hyperactive, may present differently

20 Is there a formula for Management? SF3R Fintan O Regan 2004

21 Structure Behaviour expectations and consistent application of rules and rituals for learning and behaviour Staff trained in identification of and management of Non traditional learning children Partnership with Parents

22 Flexibility Adapting the environment and curriculum to the child rather than the child to the curriculum Problem solving specific situations Considering alternative options for management

23 The 3 Rs Rapport with children with learning and socialisation issues Successful programmes to foster positive Relationships between children with learning and socialisation issues with peers Positive Role Models for all children

24 A learning and behaviour approach

25 Rules, Routines and Rituals will Reduce anxiety Enhance motivation, confidence and self esteem Enhance concentration and reduce distractions Facilitate independence

26 Rules and Responsibilities * Rules, Rights and Responsibilities posted clearly in classes *Graduated Positive and Logical consequences reinforcement charts explained on a regular basis *Set up escape hatch for certain students to sound off/diffuse can t do it in public

27 Classroom layout Identify a safe haven / quiet area Sit away from door, window, corridor Sit away from resources not in use Sit away from resources needed by other students Sit near teacher Sit near student with good study and attention skills If available use work stations Use horseshoe layout for discussion

28 Giving instructions to children Maintain eye contact (or not) with students during verbal instruction. Simplify complex directions. Avoid multiple commands. Make sure the student comprehends before beginning the task. Use Visual aids ( ie PECS) to supplement instructions and to transmit important points

29 Poor attention skills Try and work out what are the main distracters (auditory, visual, kinaesthetic, internal) Reduce expectations of seat work and use alternative ways of task completion Only one or two activities per page Avoid unnecessary pictures or visual stimuli Ensure white space on each page Provide alternative environments for some tasks and activities

30 Excessive motor activity Allow student to fiddle with an agreed object e.g. stress ball, concentrators, bar magnets etc Give short breaks between assignments Plan ahead for transition times Use alternative technology e.g. computer, music Set variety of tasks and activities, where possible include hands on activity Give whole class stretching exercises midway through

32 Organisation Clearly identify certain places in the room, trays, shelves, boxes where students know where to put assignments Have a daily assignment schedule booklet/sheet Colour Code books folders, materials Clipboard for papers on desk Use post it notes for recording information, ideas, thoughts 2nd set of key text books at home Get them to use a timer/watch with alarms and set it to vibrate or beep at certain intervals during the day

33 Computers Children with ADHD/ASD respond well to an individualised or 1-1 setting Attention is focused on the screen Multi-sensory experience Non-threatening: can retry problems, constant feedback and reinforcement Impersonal: computer doesn't yell or have favourites Variety of presentation; attend to novel stimuli Student can control pace, flexible: programmed to do things Rapid assessment Game like approach: challenge

34 Groups Group leader : facilitates progress Note taker : records ideas Time keeper: monitors task completion Summariser : checks agreement Spokesperson : provides feedback Resource finder : whatever group needs they grab it

35 Social skills How to open a conversation with someone new Understanding the differences between teasing and taunting How to share and take turns Reading body language and facial expressions Understanding tone of voice To work on what is OK to say and not to say

36 Let student use parent secretary Homework Ensure homework diary being used efficiently Reduce homework to only that which is essential Shorten assignments (bonus points for doing more) Find ways to reduce writing requirements i.e. dictate into tape recorder /allow computer use Use chart instead of written report, mind mapping etc Give choices/let students design their own homework Earn free homework passes Have student stay at school to finish homework Allow partnering /Build in social component

37 Language Probably better not to ask Why? ask What? e.g. What should you be doing now? Use a 3 word instruction that includes name, task, please. e.g. David, sit down, please Use, Stop, Wait instead of No. Say I need you to instead of can you or will you Use either/or and when/then.. e.g..lewis either put the phone in your bag or on my table. when you have put the chair back under the table then you can go

38 Rapport Instead of saying Be quiet! Can t you see I m talking? Maybe try saying Please don t interrupt How many times do I have to tell you? Please listen carefully You re always getting into trouble Do you need me to help you with this? David get back in your seat I m warning you! (Angrily) Stop it David you should be sitting down Please listen to me. I need you to get back on task/line/learning

39 Summary of Assertive Sentence starters Let s.. I need you to In five minutes you will have. When I return I will see.. Today we are going to.. You will be.. I expect you to.. I know that you will Thank you for

40 Value of praise Praise can improve self-esteem, self-reliance, autonomy, achievement and motivation Praise will have different effects according to the gender, home background, abilities and personality of pupils Praise should be seen as encouragement and as part of a continuing process

41 Types of praise Wallpaper praise.. great, lovely Personnel Praise.. you are brilliant Directed praise well done for following the rule Reflective praise.you should feel good about this work Contextual praise.this assignment is so good that I need to show it to the Head so that we can display it on the wall or enter it for an award etc..

42 Working with LSAs Keep in mind They come from a variety of backgrounds and will have a number of skills They need to be seen as working in partnership with the teacher not just with a specific student but with all the children in the class

43 ODD : options Try to read the mood of the student before choosing the strategy Focus on the incident not the student, don t personalise Try to let this student save face in front of peers by providing a choice of option Use the broken record technique, don t get into the smokescreen/secondary behaviour Be calm and assertive when facing confrontations..do not appear too passive match the mood.

44 ODD ctd Give clear messages about negative behaviours and costs Refer to rights and responsibilities and regret the sanction if non compliance occurs However : You can t talk to a drunk when he s drinking Avoid spraying matches with skunks

45 Inflaming Shouting Not listening to their views Bringing up past unrelated misdemeanours Standing toe to toe/face to face Raising our voices in response to theirs Allowing conflict in a public forum Other aggressive non verbal communication-use arms flailing, aggressive facial expressions.

Fires Need Oxygen: this is the mood or atmosphere in which emotions are occurring Need a Fuel : this is the mind reacting to the mood causing thoughts/feelings such as

46 Fires Need Oxygen: this is the mood or atmosphere in which emotions are occurring Need a Fuel : this is the mind reacting to the mood causing thoughts/feelings such as fear or threat Need a Spark : this is the response to the mood which is affected by a specific person or situation. Fires : are the body responding physically and verbally

47 Medication Options When? Only after comprehensive evaluation When a child is significant risk of harming himself or others When earnest attempts at non-medical interventions have proved insufficient When the child is at risk of emotional and/or academic failure

48 Medications - stimulants Short acting Ritalin, Equasym Dexamphetamine Long Acting Concerta Ritalin SR Equasym XL

49 Documented benefits of Medication Cognitive Improves attention, short term memory, increase amount and accuracy of work completed Motor Reduce activity level, improve handwriting, decrease talkativeness, noisiness, disruptiveness Social Improve cooperation, reduce anger, improve parent child interactions, reduce non compliance

50 Impact of Medication Medication initially treats the core symptoms of ADHD Flow on effect to improved self esteem and social skills Parents begin to show warmth to their children Improvements allow other strategies to be more effective i.e. behavioural management, educational strategies etc

51 Partnership with Parents Frequent telephone contact Frequent parent teacher conferences Daily report cards Children with ADHD/ASD can place a great deal of pressure on family relationships Behavioural modification strategies are important - to be followed through at home Parents must try and look after themselves In persistently difficult situations the possibility of unrecognised parental ADHD/ASD issues should be considered

52 Avoids ridicule and criticism and can find a SoH in trying circumstances The Ideal Teacher Thoroughly knowledgeable about ADHD/ASD and accepts legitimacy of the disorder Tough as nails about rules but always calm and positive and runs an absolutely predictable and organised classroom Deals with homework in a pragmatic way Provides immediate and consistent feedback regarding behaviour Willing to work with outside agencies

ADHD and Challenging Behaviour

ADHD and Challenging Behaviour 10 th of November 2017 Fintan O Regan 07734 715 378 www.fintanoregan.com Fjmoregan@aol.com Publications Cooper P and O Regan F (2001) EDUCATING children with ADHD: Routledge