The Curious Case of ADHD

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1 The Curious Case of ADHD Fintan J O Regan O MA fjmoregan@aol.com All Slides belong to Fin O Regan O 2008 and can only be used for presentation purposes with permission of the author but can be printed out onto a handout

2 Books etc. Cooper P and O Regan O 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

4 NICE Guidelines: Key points ADHD is a real and genuine condition A range of measures including educational and behavioural strategies can improve the outcomes of children with ADHD Medication can and should be used to improve the outcomes of individuals who suffer with ADHD symptoms Adult services should recognise the need to monitor and treat individuals with ADHD and continue to treat individuals previously under CAMHS when necessary Nice 2008

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

6 Core symptoms of ADHD Inattention Impulsivity Hyperactivity

7 Likely progression unless identified Age 7 Key Stage 2, low Self esteem Age 11 Key Stage 3, Disruptive Behavior, Learning Delay, Poor Social Skills Age 14 Key Stage 4, ODD, Challenging Behavior, Criminal Behavior, School Exclusion, Substance Abuse, Conduct Disorder, Lack of Motivation, Complex Learning Difficulties

8 Proportion of offenders with different risk factors during childhood Temperament Maltreatment Mother has low IQ Child has low IQ Parent convicted ADHD diagnosis Low Socio economic Status Youth Crime Action Plan June 2008

9 Nature vs. Nurture

10 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

11 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.

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 Diagnosis Pathways for referral should be made to secondary care professionals : Child psychiatrist Paediatrician Specialist ADHD child and adolescent mental health service (CAHMS) Adult psychiatrist

15 Assessment Medical evaluation (Parent interview) (Teacher interview) Patient interview Rating Scales Computerised testing Achievement testing Intellectual testing

16 Girls with ADHD 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

17 A learning and behaviour approach

18 What you are looking for in a school Full commitment to teach and manage children with ADHD from the SLT All Teaching and Support staff trained in recognition, teaching and management of these students Positive and realistic academic and socialisation expectations within policies outlined at the start with parents fully in the loop. In most cases a part individualised programme outlining key academic goals in core subjects, socialisation and behavioural targets.

19 Rules and Responsibilities *Students are expected to produce their best work of their ability *Physical/Verbal Aggression is not accepted in the school community *Timekeeping and main health and safety issues fully complied with Parents and students involved in rules and procedures, copy sent home and signed by students and parents

20 Application of R/R? Band 1 Band 2 Physical /Verbal abuse Distractibility Theft Disorganisation Timekeeping Calling out Attendance Fidgeting Dress Code Engaging others

22 Computers Children with ADHD respond well to an individualised or 1-11 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

23 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

24 Relationships Peer understanding about ADHD Bullying Developing friendships Making the class a team Trying to get other parents to understand the principles of Inclusion

25 Partnership with Parents Frequent telephone contact Frequent parent teacher conferences Daily report cards Children with ADHD 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 issues should be considered

26 Co morbidity ADHD CD Spld ODD ASD

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

28 Oppositional Defiant Disorder Argues with Adults Refuses and Defies Angry and Defensive Spiteful and Vindictive Possess a counter- will the more pressure we apply the greater the opposition

29 Riley s 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 I don t t know Logic revolves around denial or responsibility Douglas Riley the Defiant Child 1999

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

31 Family rules Think about the things that matter to you and the rest of the family Get the whole family together to discuss the rules Decide on 5 to 10 Make them clear and brief Make them positive Make them practical to enforce

32 Family rules Write them down and pin them up They key rules should apply to everyone

33 Routines and Rituals Areas that you should consider for routines and rituals are the following: Getting up and Going to bed Mealtimes Specific chores Homework Clearing up Self hygiene TV and Computer

34 Parenting Style Your style affects the climate in the home Your style models the behaviour that children copy The beliefs that you hold determine your style of approach

35 Parenting styles The Controllers The Friend The Benign Dictator Also The Grumblers, The Optimist, The Competitive one, The Pacifist, The Chatterbox, Dull as dishwater, The Explosive

36 Controllers Attitudes Children should be seen and not heard It s s my way or the highway Why did you substitute my child

37 Controllers Strategies Tell them what to do Threaten them with consequences Send them to your partner Outcomes Poor quality relationships High quality stress Learning will be impaired

38 The Friend Attitudes Children need nurturing like buds on a flower Being always nice will mean that children will like you Homes are a democracy where negotiation is the key

39 The friend Strategies Asking, Negotiating, Pleading followed by Why are you doing this to me (hurt) How many times have we been through this (frustration) Outcomes Uncertainty leads to insecurity Learning is significantly impaired

40 The benign dictator Attitude A parent s s job is to set boundaries A child s s job is to test them Children should be helped to experience achievement and mistakes will be part of the journey Caring means sometimes being prepared to make unpopular decisions The problem is the problem not the child Fairness is not giving everybody the same it is giving them what they need

41 The benign dictator Strategies Holds children accountable for their choices Creates a culture of praise that focuses on what children do well Redirects children towards success Applies consequences positive and negative with consistency Outcomes Children learn boundaries with dignity The parent is both leader and coach in the home Learning, risk taking and motivation are greatly enhanced

43 Communication 7% words 38% Tonality, Volume and Tempo 55% non verbal signals

44 Assertive Body language Eye contact Height/level positioning Relaxed Nodding Personal space balance Facial expressions Not fidgeting Focused, active listening Touch (if you are comfortable using it)

45 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

46 Reinforcing : Don ts 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 Other aggressive nvc arms flailing, aggressive facial expressions etc.

47 Active Listening To give your complete focus to what the other person is saying Let the other person finish before you start talking Maintain eye contact Keep your emotions in check Don t t interrupt or jump to conclusions Look for feelings or intent behind the words

48 Reinforcing : Do s Always focus on the incident not the child, don t personalise Try to provide a save face option in front of siblings by providing a choice of outcome Be prepared to go into the broken record mode at times i.e. don t t get into drawn into smokescreen behaviour

49 Getting back on track STUDENT PARENT It wasn t t me But they were doing the same thing I m m going to report and sue you I I hear what you are saying. I understand.... Be that as it may. I I was only.... Maybe you were. and yet.. You are not being fair It s s boring Sometimes I may appear that way.. You may think it is boring and yet You are a (name calling) I I am certainly not perfect however.

50 Rewards vs. Bribery A bribe is given in anticipation of a behaviour A reward is given as a result of a behaviour A bribe is given to entice someone to do something they would not normally do as it is not in their best interest A reward is given in recognition of a behaviour that is in the child s s best interest

51 Sanctions Sanctions will be something that children do not like but they should not be physically or psychologically harmful Sanctions are choice that children make Sanctions do not have to severe to be effective... it it s s not the severity it s s the certainty

53 The bullied can be someone.. Who is new in the school Who is fat, thin, short or tall Who is submissive Who is annoying Who is passive Who is poor or rich Who has a different accent, skin colour or culture Who has a particular interest, belief Who may appear to be sexually promiscuous or might be gay Who has acne, is deemed ugly, wears classes, wears braces etc.. Who has SEN (is 2 to 3 X more likely to be bullied) Is in the wrong place at the wrong time

54 Bullies: Characteristics Bullies appear to have many characteristics in common, some of which may be seen as the reason for their bullying. 1) They tend to react in an excessively aggressive manner; their behaviour is uninhibited. 2) They have a strong desire for power and dominance over others. 3) They are alienated from the world and regard people in a hostile way. 4) They cannot appreciate it is wrong to bully. 5) They cannot empathise with their victims. 6) They pass responsibility for their actions on to others, their victims deserve to be bullied. o A.Train The Bullying Problem 1995

55 Passive Victims 1. They have a high level of anxiety and insecurity. 2. They are cautious, sensitive and quiet. 3. They have low self-esteem. 4. They have few friends. 5. They have a negative attitude towards violence. A.Train The Bullying Problem 1995

56 Provocative Victims 1) When attacked by the bully they try to retaliate. 2) They may try to attack other children weaker that themselves. 3) They could be described as hyperactive as they are restless and unable to concentrate. 4) They may be clumsy and immature. 5) They may be disliked by others, including teachers, because they irritate and create tension. A.Train The Bullying Problem 1995

57 Cyber bullying: For Parents Know which websites your children visit and help them find the 'report abuse' or 'block sender' options so they can feel in control Tell your children not to reply to unpleasant messages Urge them to keep evidence not to delete bullying texts, s or posts on social networking sites Make sure they act thoughtfully in cyberspace comments and photos can stay online forever and texts can be forwarded widely Ensure they protect their password to keep their files and information safe Encourage them to take action and talk to you if they are cyber bullied GMTV website Nov 17 the 2009

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