Chapter 3: Attention Deficit / Hyperactive Disorder (ADHD)

Chapter 3: Attention Deficit / Hyperactive Disorder (ADHD) Upon completion of this chapter, you should be able to: Explain what is ADHD Identify the signs and symptoms of ADHD Identify the possible causes of ADHD Discuss the steps educators can take to help learners with ADHD 3.1 Preamble 3.2 What is ADHD? 3.3 Myths about ADHD 3.4 Signs and symptoms of ADHD 3.5 Positive effects of ADHD 3.6 Causes of ADHD 3.7 Treating ADHD 3.8 Teaching students with ADHD Summary References Chapter 1: Introduction to Special Education Chapter 2: Dyslexia Chapter 3: ADHD Chapter 4: Autism Chapter 5: Learning Disabilities Chapter 6: Auditory & Visual Chapter 7: Emotional & Behavioural Disorders Chapter 8: Giftedness 1

3.1 Preamble This chapter examines another disorder that may be found among preschool children, namely Attention Deficit / Hyperactive Disorder (ADHD). Emphasis is on the signs and symptoms of ADHD and various myths about the disorder. Also examined are the possible explanations for the cause of ADHD and the steps that teachers can take to help children with the disorder. 3.2 What is ADHD? It s normal for children to occasionally forget their homework, daydream during class, act without thinking, or get fidgety at the dinner table. But inattention, impulsivity, and hyperactivity are also signs of attention deficit disorder (ADD/ADHD), which can affect a child s ability to learn and get along with others. We all know kids who can t sit still, who never seem to listen, who don t follow instructions no matter how clearly you present them, or who blurt out inappropriate comments at inappropriate times. Sometimes these children are labelled as troublemakers, or criticized for being lazy and undisciplined. However, they may have ADD/ADHD. Attention deficit hyperactivity disorder (ADHD) is a disorder that appears in early childhood. You may know it by the name attention deficit disorder, or ADD. ADD/ADHD makes it difficult for people to inhibit their spontaneous responses responses that can involve everything from movement to speech to attentiveness. Is it normal kid behaviour or is it ADHD? The signs and symptoms of ADD/ADHD typically appear before the age of seven. However, it can be difficult to distinguish between attention deficit disorder and normal kid behaviour. If you spot just a few signs, or the symptoms appear only in some situations, it s probably not ADD/ADHD. On the other hand, if your child shows a number of ADD/ADHD signs and symptoms that are present across all situations at home, at school, and at play it s time to take a closer look. Once you understand the issues your child is struggling with, such as forgetfulness or difficulty paying attention in school, you can work together to find creative solutions and capitalize on strengths. 2

3.3 Myths of Attention Deficit Hyperactivity Disorder Myth #1: All kids with ADD/ADHD are hyperactive. Fact: Some children with ADD/ADHD are hyperactive, but many others with attention problems are not. Children with ADD/ADHD who are inattentive, but not overly active, may appear to be spacey and unmotivated. Myth #2: Kids with ADD/ADHD can never pay attention. Fact: Children with ADD/ADHD are often able to concentrate on activities they enjoy. But no matter how hard they try, they have trouble maintaining focus when the task at hand is boring or repetitive. Myth #3: Kids with ADD/ADHD could behave better if they wanted to. Fact: Children with ADD/ADHD may do their best to be good, but still be unable to sit still, stay quiet, or pay attention. They may appear disobedient, but that doesn t mean they re acting out on purpose. Myth #4: Kids will eventually grow out of ADD/ADHD. Fact: ADD/ADHD often continues into adulthood, so don t wait for your child to outgrow the problem. Treatment can help your child learn to manage and minimize the symptoms. Myth #5: Medication is the best treatment option for ADD/ADHD. Fact: Medication is often prescribed for attention deficit disorder, but it might not be the best option for your child. Effective treatment for ADD/ADHD also includes education, behaviour therapy, support at home and school, exercise, and proper nutrition. a) What is ADHD? b) List some of the myths and facts about ADHD 3

3.4 Signs & Symptoms of Attention Deficit Hyperactivity Disorder Which one of these children may have ADD/ADHD? A. The hyperactive boy who talks nonstop and can t sit still. B. The quiet dreamer who sits at her desk and stares off into space. C. Both A and B The correct answer is C. When many people think of attention deficit disorder, they picture an out-of-control kid in constant motion, bouncing off the walls and disrupting everyone around. But this is not the only possible picture. Some children with ADD/ADHD are hyperactive, while others sit quietly with their attention miles away. Some put too much focus on a task and have trouble shifting it to something else. Others are only mildly inattentive, but overly impulsive. Is it really ADD / ADHD? Just because a child has symptoms of inattention, impulsivity, or hyperactivity does not mean that he or she has ADD or ADHD. Certain medical conditions, psychological disorders, and stressful life events can cause symptoms that look like ADD / ADHD. Before an accurate diagnosis of ADD / ADHD can be made, it is important that you see a mental health professional to explore and rule out the following possibilities: Learning disabilities or problems with reading, writing, motor skills, or language. Major life events or traumatic experiences (e.g. a recent move, death of a loved one, bullying, divorce). Psychological disorders including anxiety, depression, and bipolar disorder. Behavioural disorders such as conduct disorder and oppositional defiant disorder. Medical conditions, including thyroid problems, neurological conditions, epilepsy, and sleep disorders. It isn t that children with ADD/ADHD can t pay attention: when they re doing things they enjoy or hearing about topics in which they re interested, they have no trouble focusing and staying on task. But when the task is repetitive or boring, they quickly tune out. Staying on track is another common problem. Children with ADD/ADHD often bounce from task to task without completing any of them, or skip necessary steps in procedures. Organising their schoolwork and their time is harder for them than it is for most children. Children with ADD/ADHD also have trouble concentrating if there are things going on around them; they usually need a calm, quiet environment in order to stay focused. 4

Symptoms of INATTENTION in children: Doesn t pay attention to details Makes careless mistakes Has trouble staying focused; is easily distracted Appears not to listen when spoken to Has difficulty remembering things and following instructions Has trouble staying organized, planning ahead, and finishing projects Gets bored with a task before it s completed Frequently loses or misplaces homework, books, toys, or other items HYPERACTIVITY signs and symptoms of ADD/ADHD The most obvious sign of ADD/ADHD is hyperactivity. While many children are naturally quite active, kids with hyperactive symptoms of attention deficit disorder are always moving. They may try to do several things at once, bouncing around from one activity to the next. Even when forced to sit still which can be very difficult for them their foot is tapping, their leg is shaking, or their fingers are drumming. Symptoms of HYPERACTIVITY in children: Constantly fidgets and squirms Often leaves his or her seat in situations where sitting quietly is expected Moves around constantly, often runs or climbs inappropriately Talks excessively Has difficulty playing quietly or relaxing Is always on the go, as if driven by a motor May have a quick temper or a short fuse 5

Impulsive signs and symptoms of ADD/ADHD The impulsivity of children with ADD/ADHD can cause problems with self-control. Because they censor themselves less than other kids do, they ll interrupt conversations, invade other people s space, ask irrelevant questions in class, make tactless observations, and ask overly personal questions. Instructions like Be patient and Just wait a little while are twice as hard for children with ADD/ADHD to follow as they are for other youngsters. Children with impulsive signs and symptoms of ADD/ADHD also tend to be moody and to overreact emotionally. As a result, others may start to view the child as disrespectful, weird, or needy. Symptoms of IMPULSIVITY in children: Acts without thinking Blurts out answers in class without waiting to be called on or hear the whole question Can t wait for his or her turn in line or in games Says the wrong thing at the wrong time Often interrupts others Intrudes on other people s conversations or games Inability to keep powerful emotions in check, resulting in angry outbursts or temper tantrums Guesses, rather than taking time to solve a problem Hence, the three primary characteristics of ADD/ADHD are inattention, hyperactivity, and impulsivity. The signs and symptoms a child with attention deficit disorder has depends on which characteristics predominate. Children with ADD/ADHD may be: Inattentive, but not hyperactive or impulsive. Hyperactive and impulsive, but able to pay attention. Inattentive, hyperactive, and impulsive (the most common form of ADD/ADHD). Children who only have inattentive symptoms of ADD/ADHD are often overlooked, since they re not disruptive. However, the symptoms of inattention have consequences: getting in hot water with parents and teachers for not following directions; underperforming in school; or clashing with other kids over not playing by the rules. A learning disability may be mistaken for ADHD Think your child has attention deficit disorder? Sometimes, kids who are having trouble in school are incorrectly diagnosed with ADD/ADHD, when what they really have is a learning disability. Furthermore, many kids struggle with both ADD/ADHD and a learning disability [Learning Disabilities will be discussed in Chapter 5]. 6

a) What are the symptoms of hyperactivity in children? b) List the symptoms of impulsivity in children? c) What are the symptoms of inattention in children? d) How would you determine if a child has ADHD? 3.5 Positive Effects of ADHD Having ADHD doesn t mean you have a handicap. As somebody once noted, ADHD often endows children and adults with gifts such as creativity, intuition, imagination, and a sense of adventure. In In addition to the challenges, there are also positive traits associated with people who have attention deficit disorder: Creativity Children who have ADD/ADHD can be marvellously creative and imaginative. The child who daydreams and has ten different thoughts at once can become a master problem-solver, a fountain of ideas, or an inventive artist. Children with ADD/ADHD may be easily distracted, but sometimes they notice what others don t see. Flexibility Because children with ADD/ADHD consider a lot of options at once, they don t become set on one alternative early on and are more open to different ideas. Enthusiasm and spontaneity Children with ADD/ADHD are rarely boring! They re interested in a lot of different things and have lively personalities. In short, if they re not exasperating you (and sometimes even when they are), they re a lot of fun to be with. Energy and drive When kids with ADD/ADHD are motivated, they work or play hard and strive to succeed. It actually may be difficult to distract them from a task that interests them, especially if the activity is interactive or hands-on. Keep in mind, too, that ADD/ADHD has nothing to do with intelligence or talent. Many children with ADD/ADHD are intellectually or artistically gifted. What are some of the positive effects of ADHD? 7

3.6 Causes of Attention Deficit Hyperactivity Disorder ADHD is not caused by poor parenting, too much sugar, or vaccines. ADHD has biological origins that aren't yet clearly understood. No single cause has been identified, but researchers are exploring a number of possible genetic and environmental links. Studies have shown that many kids with ADHD have a close relative who also has the disorder. Although experts are unsure whether this is a cause of the disorder, they have found that certain areas of the brain are about 5% to 10% smaller in size and activity in kids with ADHD. Chemical changes in the brain also have been found. Research also links smoking during pregnancy to later ADHD in a child. Other risk factors may include premature delivery, very low birth weight, and injuries to the brain at birth. Some studies have even suggested a link between excessive early television watching and future attention problems. However, the evidence is inconclusive and it is generally believed that children under 2 years should have controlled and limited screen time" (TV, DVDs or videotapes, computers, or video games). The American Academy of Paediatrics suggest limiting children under 2 years of age to about 1-2 hours per day of screen time. [source: WebMD. Attention Deficit /Hyperactivity Disorder: Causes of ADHA. 2012] 3.7 Treating Attention Deficit Hyperactivity Disorder ADHD can't be cured, but it can be successfully managed. The goal is to help a child learn to control his or her own behaviour and to help families create an atmosphere in which this is most likely to happen. In most cases, ADHD is best treated with a combination of medication and behaviour therapy. Any good treatment plan will require close follow-up and monitoring, and doctors may make adjustments along the way. Because it's important for parents to actively participate in their child's treatment plan, parent education is also considered an important part of ADHD management. Sometimes the symptoms of ADHD become less severe as a person grows older. Hyperactivity tends to get less as people grow up, although the problems with organisation and attention often remain. More than half of kids who have ADHD will continue to have symptoms as young adults. 8

Medications Several different types of medications may be used to treat ADHD: Stimulants are the best-known treatments they've been used for more than 50 years in the treatment of ADHD. Some require several doses per day, each lasting about 4 hours; some last up to 12 hours. Possible side effects include decreased appetite, stomachache, irritability, and insomnia. There's currently no evidence of long-term side effects. Antidepressants are sometimes a treatment option; however, in 2004 the U.S. Food and Drug Administration (FDA) issued a warning that these drugs may lead to a rare increased risk of suicide in children and teens. Medications can affect kids differently, and a child may respond well to one but not another. When determining the correct treatment, the doctor might try various medications in various doses, especially if a child is being treated for ADHD along with another disorder. Behavioural Therapy Research has shown that medications used to help curb impulsive behaviour and attention difficulties are more effective when combined with behavioural therapy. Behavioural therapy attempts to change behaviour patterns by: reorganising a child's home and school environment giving clear directions and commands setting up a system of consistent rewards for appropriate behaviours and negative consequences for inappropriate ones The following are examples of behavioural strategies that may help a child with ADHD: Create a routine. Try to follow the same schedule every day, from wake-up time to bedtime. Post the schedule in a prominent place, so your child can see what's expected throughout the day and when it's time for homework, play, and chores. Get organised. Put schoolbags, clothing, and toys in the same place every day so your child will be less likely to lose them. Avoid distractions. Turn off the TV, radio, and computer games, especially when the child is doing homework. Limit choices. Offer a choice between two things (outfit, meal, toy, etc.) so that the child isn't overwhelmed and overstimulated. Change adult interactions with child. Instead of long-winded explanations and cajoling, use clear, brief directions to remind the child of his or her responsibilities. Use goals and rewards. Use a chart to list goals and track positive behaviours, then reward the child's efforts. Be sure the goals are realistic (think baby steps rather than overnight success). 9

Discipline effectively. Instead of yelling or spanking, use timeouts or removal of privileges as consequences for inappropriate behaviour. Younger kids may simply need to be distracted or ignored until they display better behaviour. Help the child discover a talent. All kids need to experience success to feel good about themselves. Finding out what the child does well whether it's sports, art, or music can boost social skills and self-esteem. a) What are the possible causes of ADHD? b) List the types of behavioural strategies that may help a child with ADHD? 3.8 Teaching Students with ADHD Students who exhibit ADD/ADHD s hallmark symptoms of inattention, hyperactivity, and impulsivity can be frustrating. You know the brainpower is there, but they just can t seem to focus on the material you re working hard to deliver. Plus, their behaviours take time away from instruction and disrupt the whole class. Challenges of ADHD in the classroom Think of what the school setting requires children to do: Sit still. Listen quietly. Pay attention. Follow instructions. Concentrate. These are the very things kids with ADD/ADHD have a hard time doing not because they aren t willing, but because their brains won t let them. That doesn t make teaching them any easier, of course. Students with ADD/ADHD present the following challenges for teachers: They demand attention by talking out of turn or moving around the room. They have trouble following instructions, especially when they re presented in a list. They often forget to write down homework assignments, do them, or bring completed work to school. They often lack fine motor control, which makes note-taking difficult and handwriting a trial to read. 10

They often have trouble with operations that require ordered steps, such as long division or solving equations. They usually have problems with long-term projects where there is no direct supervision. They don t pull their weight during group work and may even keep a group from accomplishing its task. Students with ADD/ADHD pay the price for their problems in low grades, scolding and punishment, teasing from peers, and low self-esteem. Meanwhile, you, the teacher, wind up taking complaints from parents who feel their kids are being cheated of your instruction and feeling guilty because you can t reach the child with ADD/ADHD. What teachers can do to help? So how do you teach a kid who won t settle down and listen? The answer: with a lot of patience, creativity, and consistency. As a teacher, your role is to evaluate each child s individual needs and strengths. Then you can develop strategies that will help students with ADD/ADHD focus, stay on task, and learn to their full capabilities. Successful programs for children with ADHD integrate the following three components: Accommodations: what you can do to make learning easier for students with ADD/ADHD. Instruction: the methods you use in teaching. Intervention: How you head off behaviours that disrupt concentration or distract other students. Your most effective tool, however, in helping a student with ADD/ADHD is a positive attitude. Make the student your partner by saying, Let s figure out ways together to help you get your work done. Assure the student that you ll be looking for good behaviour and quality work, and when you see it, reinforce it with immediate and sincere praise. Finally, look for ways to motivate a student with ADD/ADHD by offering rewards on a point or token system. Dealing with Disruptive Classroom Behaviour To head off behaviour that takes time from other students, work out a couple of warning signals with the student who has ADD/ADHD. This can be a hand signal, an unobtrusive shoulder squeeze, or a sticky note on the student s desk. If you have to discuss the student s behaviour, do so in private. And try to ignore mildly inappropriate behaviour if it s unintentional and isn t distracting other students or disrupting the lesson. Classroom arrangements for students with ADHD As a teacher, you can make changes in the classroom to help minimize the distractions and disruptions of ADHD. Seating Seat the student with ADD/ADHD away from windows and away from the door. Put the student with ADD/ADHD right in front of your desk unless that would be a distraction for the student. 11

Seats in rows, with focus on the teacher, usually work better than having students seated around tables or facing one another in other arrangements. Information Delivery Give instructions one at a time and repeat as necessary. If possible, work on the most difficult material early in the day. Use visuals: charts, pictures, colour coding. Create outlines for note-taking that organize the information as you deliver it. Student work Create a quiet area free of distractions for test-taking and quiet study. Create worksheets and tests with fewer items; give frequent short quizzes rather than long tests. Reduce the number of timed tests. Test the student with ADD/ADHD in the way he or she does best, such as orally or filling in blanks. Show the student how to use a pointer or bookmark to track written words on a page. Divide long-term projects into segments and assign a completion goal for each Segment. Let the student do as much work as possible on computer. Accept late work and give partial credit for partial work. Organisation Have the student keep a master notebook, a three-ring binder with a separate section for each subject, and make sure everything that goes into the notebook has holes punched and is put on the rings in the correct section. Provide a three-pocket notebook insert for homework assignments, completed homework, and mail to parents (permission slips, PTA flyers). Colour-code materials for each subject. Allow time for student to organize materials and assignments for home. Post steps for getting ready to go home. Make sure the student with ADD/ADHD has a system for writing down assignments and important dates and uses it. Teaching techniques for students with ADD/ADHD Teaching techniques that help students with ADD/ADHD focus and maintain their concentration on your lesson and their work can be beneficial to the entire class. Starting a lesson Signal the start of a lesson with an aural cue, such as an egg timer, a cowbell or a horn. (You can use subsequent cues to show much time remains in a lesson.) List the activities of the lesson on the board. In opening the lesson, tell students what they re going to learn and what your expectations are. Tell students exactly what materials they ll need. 12

Establish eye contact with any student who has ADD/ADHD. Conducting the lesson Keep instructions simple and structured. Vary the pace and include different kinds of activities. Many students with ADHD do well with competitive games or other activities that are rapid and intense. Use props, charts, and other visual aids. Have an unobtrusive cue set up with the student who has ADHD, such as a touch on the shoulder or placing a sticky note on the student s desk, to remind the student to stay on task. Allow a student with ADHD frequent breaks. Try not to ask a student with ADHD perform a task or answer a question publicly that might be too difficult. Ending the lesson Summarise key points. If you give an assignment, have three different students repeat it, then have the class say it in unison, and put it on the board. Be specific about what to take home. a) What are the challenges presented by children with ADHD? b) How should a teacher conduct his or lesson with ADHD children? c) How should the classroom be organised with ADHD kids? 13

SUMMARY Attention deficit hyperactivity disorder (ADHD) is a disorder that appears in early childhood. The signs and symptoms of ADD/ADHD typically appear before the age of seven. It can be difficult to distinguish between attention deficit disorder and normal kid behaviour. Some children with ADD/ADHD are hyperactive, but many others with attention problems are not. Children with ADD/ADHD are often able to concentrate on activities they enjoy. Medication is often prescribed for attention deficit disorder, but it might not be the best option for your child. When many people think of attention deficit disorder, they picture an out-of-control kid in constant motion, bouncing off the walls and disrupting everyone around. Children who only have inattentive symptoms of ADD/ADHD are often overlooked, since they re not disruptive. The most obvious sign of ADD/ADHD is hyperactivity. While many children are naturally quite active, kids with hyperactive symptoms of attention deficit disorder are always moving. Your most effective tool, however, in helping a student with ADD/ADHD is a positive attitude. Research has shown that medications used to help curb impulsive behaviour and attention difficulties are more effective when combined with behavioural therapy. Students with ADD/ADHD pay the price for their problems in low grades, scolding and punishment, teasing from peers, and low self-esteem. 14

REFERENCES Richard S. Kingsley, MD. 2012. http://kidshealth.org/parent/medical/learning/adhd.html# WebMD. Attention Deficit /Hyperactivity Disorder: Causes of ADHA. 2012 15