Attention Deficit Hyperactivity Disorder. Faculty Meeting Presentation By: Tonya LaPlante 3/18/2014

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1 Attention Deficit Hyperactivity Disorder Faculty Meeting Presentation By: Tonya LaPlante 3/18/2014

2 What is ADHD? A neurobehavioral disorder that affects children, adolescents, and adults, and is characterized by a persistent pattern of inattention and/or hyperactivity and impulsivity. It is the most commonly diagnosed neurobehavioral disorder in children. It is more commonly diagnosed in boys than girls. There are three core symptoms of ADHD. Inattention, Hyperactivity, and Impulsivity.

4 Inattention Failure to pay close attention to details or makes careless mistakes in schoolwork, work, or other activities Difficulty sustaining attention in tasks or play activities Does not seem to listen when spoken to directly Does not follow through on instructions and fails to finish schoolwork, chores, or work duties (not due to oppositional behavior or failure to understand) Difficulty organizing tasks and activities Avoids, dislikes, or is reluctant to engage in tasks requiring mental effort (e.g., schoolwork, homework) Loses things necessary for tasks or activities (e.g., written instructions, school assignments, textbooks, pencils, tools, toys) Is easily distracted by extraneous stimuli Is forgetful in daily activities

5 Hyperactivity Fidgets with hands or feet and squirms in seat Leaves seat in classroom or other situations where remaining seated is expected Runs about or climbs excessively in situations where these activities are considered inappropriate; in adolescents or adults, this feature may be limited to subjective feelings of restlessness Has difficulty in playing or engaging in leisure activities quietly Is on the go or acts as if driven by a motor Talks excessively

6 Impulsivity Blurts out answers before questions are completed Has difficulty awaiting turn (impatient) Interrupts or intrudes on others (e.g., butts in on conversations, games)

7 Symptoms in Teens ADHD Symptoms Inattention Hyperactivity Impulsivity Teens with ADHD May lose things such as homework and schoolwork, make careless mistakes, be disorganized, and fail to complete tasks. May fidget with hands and feet, have feelings of restlessness, and have difficulty engaging in quiet activities. May talk excessively, be impatient, and frequently interrupt or intrude on others to the point of causing difficulties in social and academic settings.

8 Typical Teen Behavior Versus ADHD Symptoms Teen Without ADHD May forget to finish school assignments once or twice a month May change his/her mind several times about going on a family outing Puts off taking out the garbage Loses his/her watch Teens With ADHD May forget to do school assignments several times a week, or even every day May change his/her mind on many things, often every day Rarely takes out the garbage, even when reminded to many times Loses his/her watch, in the same week as losing his/her cell phone, bag, keys, and other items

9 Impact in Different Life Settings ADHD symptoms can impact teens at home, at school, and in social situations. Some examples of how ADHD symptoms may affect teens at school: Skipping items on tests, not checking assignments before handing them in Forgetting to write down assignments Disrupting the classroom and/or straying off task Feeling restless during class Blurting out answers before questions are completed

10 The Brain We do not know exactly why people develop ADHD. It may be related to problems with a part of the brain called the prefrontal cortex. Certain regions of the prefrontal cortex may not function properly in people with ADHD.

12 ADHD and Brain Function Affected area: Frontal lobes of brain Executive Functions Time Management Regulation of Emotions Planning Forethought Learning from Consequences Organization These difficulties are present even in individuals with high Intelligence Quotient (IQ) Stephanie Moulton Sarkis PhD, 2011

13 A Look into Executive Functioning Think about people you know who have ADHD. They re the ones who have trouble listening to or following instructions, who begin tasks and then are easily sidetracked, or who struggle to wait their turn. They sometimes blurt things out when they know better, touch things when asked not to, or don t delay reacting to something long enough to recall that they ve been in similar situations before and are about to make a silly statement and embarrass themselves or others. What s going on inside their brains when these things happen? Answer: a breakdown in executive functioning.

14 Executive Function- What is it? Specific sets of mental (thinking) skills that are coordinated with the way the brain works. Executive functions involve: organizing and planning, shifting attention, regulating emotions, self-monitoring, and holding information in mind for easy recall. Executive functions are essential in virtually every aspect of our lives.

16 Executive Function

18 Treatment Components Education for the student regarding ADHD Along with school staff Medical Psychosocial (behavioral) Academic Supports/Accommodations

19 Behavioral Treatment and Management Increased frequency and amount of feedback and reinforcement Behavior modification techniques Individualized interventions (e.g., daily report cards, contracts, self-monitoring and selfregulation strategies) Sandra Rief, 2008

20 Educational Implications Attention Deficit Hyperactivity Disorder (ADHD) is a diagnosis with significant educational implications. Children with ADHD struggle because of: Low engagement rates Inconsistent work productivity Approximately 20-30% are classified as learning disabled because of deficits in the acquisition of specific academic skills. DuPaul & Stoner, 2003

21 A student with ADHD may have these academic experiences

22 Strategies for Students Please note that study- can be replaced with learn-

23 School Accommodations Teens with ADHD may qualify for extra support in school to help with issues such as poor organizational skills, incomplete work, or a failure to turn in work. Teens may be eligible for accommodations through the 504 Rehabilitation Act or special education through an Individualized Education Program (IEP) as part of the Individuals with Disabilities Education Act (IDEA).

24 Classroom Supports Preferred classroom seating (not necessarily the front of the room) Modifications for homework Alternate locations for taking tests Extended time for projects, quizzes, tests (standardized testing as well) Chunking of long term assignments Breaks as needed Frequent check-ins to check for initiation, understanding, and assistance Access to teacher notes Visual and auditory access to expectations/assignments and instruction Organizational support

25 ADHD and school: Tips for teachers Make assignments and expectations clear Provide several opportunities for success Create a system for frequent communications Ongoing collaboration with parents and additional school staff (school counselor, school psychologist, special education teacher) Give positive reinforcement Be sensitive to self-esteem issues Utilize the student s strengths Involve the school counselor or psychologist to collaborate or provide support

26 ADHD and school: Tips for teachers (continued) Give frequent reminders Incorporate a prompting/cueing system to engage (or re-engage students) Vary teaching modalities to reach all types of learners Opportunity to begin homework in class (even 5 minutes) is helpful to make sure that the student knows what they need to do and materials to complete the work Be sure to incorporate legally mandated accommodations and/or modifications as part of a 504 plan or IEP

27 Great Links to Explore on ADHD This is a great video with two pediatric neuropsychologists. This is a great video that incorporates classroom management strategies and supports. Website with a plethora of information on ADHD. Website with tons of information about ADHD. I have an account that you may access if interested. Phenomenal website with articles and current research/information by Dr. Thomas Brown, leader in the field of ADHD. <-- New communication tool to use with parents. Great resource for academic interventions. This website has a lot of great information on ADHDmany webinars available to watch also. Again, a lot of great information on ADHD. Worth exploring!

28 Oppositional Defiant Disorder (ODD) Ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that seriously interferes with the individual s day to day functioning. One to sixteen percent of all school-age children and adolescents have ODD. Symptoms may be more noticeable at home or at school.

29 Symptoms of ODD Frequent temper tantrums Excessive arguing with adults Often questioning rules Active defiance and refusal to comply with adult requests and rules Deliberate attempts to annoy or upset people Blaming others for his or her mistakes or misbehavior Often being touchy or easily annoyed by others Frequent anger and resentment Mean and hateful talking when upset Spiteful attitude and revenge seeking

30 Strategies to use when working with individuals with ODD Always build on the positives, give the individual praise and positive reinforcement when they show flexibility or cooperation. Allow a time-out or cool-down break to eliminate the possibility of making a conflict worse. Pick your battles. Since the individual has trouble avoiding power struggles, prioritize the things you want the individual to do. Set up reasonable, age appropriate limits with consequences that can be enforced consistently. Be sure the rules are clear and referenced regularly.

31 Strategies to use when working with individuals with ODD (continued) Ask open-ended questions to collect more information before having the student respond. Assign a reflective processing essay after misbehaviorsubmit brief process plan outlining how the individual will improve their behavior. Do not get entangled in arguments- avoid being dragged into arguments or unnecessary discussion when disciplining students. Emphasize the positive in teacher requests- using a positive spin it is less likely to trigger a power struggle and more likely to gain student compliance. Categorize misbehaviors into three group levels and assign problem behaviors and consequences appropriately.

32 Strategies to use when working with individuals with ODD (continued) Listen actively- demonstrate a sincere desire to understand the individual s concerns/point of view. Validate the student s emotion by acknowledging it- don t be dismissive. Keep responses calm, brief, and businesslike- teacher sarcasm or lengthy negative reprimands can trigger defiant student behavior. Project calmness when approaching an escalating student and relax before responding- keeps the situation more in control. State teacher directives as two-part choice statements- teacher can structure verbal requests to both acknowledge the student s freedom to choose whether to comply and present the logical consequences for non-compliance when a student is being confrontational (need for control). Use a buddy teacher for brief student breaks- turn and talk to help reinforce teaching and also give the student/teacher a break, when needed.

33 Great Links to Explore on ODD or_families/facts_for_families_pages/children_with_opp ositional_defiant_disorder_72.aspx <-- Lots of information available on this website on ODD for families. <-- Lots of information on ODD, covers basic information. sparkpolicy.com/buildingbridges/.../trainingoddpresentati on.pdf Great powerpoint on ODD. <-- Website with interventions for ODD.

Island Coast Pediatrics

Island Coast Pediatrics ADHD Assessment Form is composed of 2 parts. The first part is the parent s questionnaire and the second part is the teacher s questionnaire. Both parts would need to be completed.