Attention Deficit Disorder

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Revision as of 20:59, 20 March 2006

Definition

A syndrome, usually diagnosed in childhood, characterized by a persistent pattern of impulsiveness, a short attention span, and often hyperactivity, and interfering especially with academic, occupational, and social performance (American Heritage Dictionary)

Also commonly referred to as ADD or ADHD

School districts almost solely use the ADHD diagnosis when developing an IEP for a student whether or not hyperactivity is a side effect of the issue.

Symptoms

1. Inattention or distractability

2. Impulsivity

3. Difficulty delaying gratification

4. Hyperactivity

5. Emotional overarousal

6. Non-compliance

7. Social problems

8. Disorganization

(Phelan, 1993)

It is important to note that symptoms are relative to the age of the student. Younger students will naturally have a smaller attention span than older students. The smaller attention span of the young student is not necessarily an indication of ADD/ADHD. (Reid 1999)

Causes

There is no evidence to support the presence of a single cause. However, there are a few theories that attempt to explain the cause.

Theory 1: Biochemical imbalances of neurotransmitters

Neurotransmitters communicate with each other in order to send messages across the brain. The theory explains that there is a lack of a certain type of neurotransmitter which results in the brain’s activity being understimulated resulting in deficiencies in regulating activities such as attention.

Theory 2: Lowered glucose metabolism

Research conducted on adults who has been hyperactive since childhood found that they had significantly lower levels in the metabolic activity which affected two areas that are known to be associated with paying attention and regulating motor activity.

Theory 3: Hereditary

It was found that a child is three times more likely to have ADD if the parent also has it. In addition, having a sibling with ADD increases your chances 25-30%.

(Phelan, 1993)

Common Myths about the Causes

Contrary to once popular belief, none of the following play a role in the cause of ADD/ADHD

Bad parenting

Physical brain damage

Nutrition

Allergies

(Phelan, 1993)

The Diagnostic Process

Interview parents

Interview child

Obtain rating scales from questionnaires such as Barkley’s Home and School Situations Questionnaire and Connors Scale

Collect grades, achievement test scores, and current placement

Psychological testing for IQ and learning disabilities

Contributions of physical and neurological exams

(Phelan, 1993)

Be aware that there are many "look alike" symptoms that are often thought to be ADD and may be indications of other issues. Included are:

• Depression
• Bi-Polar Disorder
• Asperger's Syndrome
• Chronic ear infections
• Seasonal Affective Disorder
• Poor diet, food allergies, food sensitivities

(Bluestein 63).

• Immaturity may be a "look alike" syndrome as well

Making a diagnosis

Match presenting problems with symptoms

Match developmental history with typical course of untreated ADD/ADHD

Check family history

Is self-report consistent with symptoms?

Are testing results consistent with age-level?

Does Barkley’s questionnaire indicate more than 50% of situations as problems?

Does school testing information indicate child is not working to capacity?

Do the parents feel their child has an attention deficit?

(Phelan, 1993)

Effects in the classroom

Inability to sit still in class

Unable to concentrate

Misbehaves frequently

Lack of friends

Failure to give attention to detail

Difficulty following instructions

Forgetful in daily activities

(Phelan, 1993) The first 3 effects may be seen more commonly in students with ADHD. The others may occur in students who present either ADD or ADHD.

Statistics

Approximately 4-6% of the population suffers from ADD/ADHD

30-40% of all ADD/ADHD children also have a learning disability

(http://www.add.org) (http://www.chadd.org)

According to a study by Safer et al (1995) the use of methylphenidate has more than doubled between 1990 and 1995 in the U.S. About 2.8% of children between the ages of 5 and 18 are taking methylphenidate for AD/HD. AD/HD is diagnosed more frequently in the U.S. than in most other countries. Most researchers believe that this is due to an increased awareness of AD/HD, not an actual increase in the number of individuals affected.

Safer, et al, Increased Methylphenidate Usage for Attention Deficit Disorder in the 1990s. Pediatrics, Dec. 1996.

Treatment

Education

Make the child and parents understand that it is no one’s fault

Develop a symptom rating scale and determine severity of each symptom

Work on increasing self-esteem

Counseling

Individual counseling

Self-control training

Social skills training

Counseling for the parents

Medication

Stimulants: Ritalin, Dexedrine, Cylert

These drugs work to stimulate the unaroused areas of the brain which have a lack in production of some neurotransmitters. The result allows a child to be more focused and organized.

Possible Good Effects:

Increase in concentration

Less impulsivity

Improved grades

Less aggressiveness

Less noisiness

More cooperation with requests

Less disruptive in class

Less hyperactivity and restlessness

Possible Side Effects:

Appetite suppression

Insomnia

Headache

Stomachache

Irritability

Drowsiness

Increased hyperactivity

Depression

Anxiety

Blood glucose changes

Increased blood pressure

Psychosis or paranoia (rare - may occur from overdose)

Antidepressants: Tofranil, Norpramin

These drugs are used in certain situations when a stimulant fails to work or produces unwanted side effects. Antidepressants are sometimes used primarily if a child is also experiencing anxiety or depression. In some cases, antidepressants are used in conjunction with stimulants to produce a longer duration of action in the medicines. Side effects are similar to those produced by stimulants.

Antihypertensive: Clonidine

This drug is commonly used in children who also show signs of conduct disorder, extreme aggression, and oppositional behavior. It helps reduce hyperactivity and overarousal although stimulants are better at helping selective attention and distractability.

Some other infrequently used drugs include anticonvulsants, lithium, and tranquilizers.

(Phelan, 1993)

Another drug currently being used to treat ADHD is Strattera. "Strattera is the first and only non-stimulant medication approved by the US Food and Drug Administration (FDA) for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children, adolescents, and adults. Strattera is a norepinephrine reuptake inhibitor."

Benefits of Strattera

• Proven Safe and Effective
• All-day ADHD Symptom Relief
• Not a Stimulant
• Low risk of Appetite Suppression and Insomnia in Children and Adolescents
• No Abuse Potential

What Can Teachers Do?

In addition to becoming aware of this syndrome and its components, there are many other specific strategies teachers can use to help ADD students adapt to the classroom environment. Choosing an appropriate behavior management technique and being consistent in its application is necessary for ADD children to learn what behaviors will be tolerated. The “1-2-3�? method is used for giving students two verbal warnings and then giving a brief time-out for a third disruption. Other strategies that can help prevent problems before they occur include placing the desk of an ADD child close to the front of the room, having overall consistent structure in the classroom, and allowing the child brief periods of movement such as taking a bathroom break, getting up to sharpen a pencil, and stretching. Finally, maintaining a close relationship with the parents is important to discuss some of the problems a student may be facing and ways that they can work cooperatively to assist him/her.

Additional methods for helping students with ADD/ADHD

Classroom environment

Eliminate distractions Do not have students with ADD/ADHD sit near a window, open doorway, or other distracting area. It is best to have their desk near the teeacher's desk or the blackboard.

Desk arrangement - Arrange desks in rows, not in groups. Sitting with a group of students opens the door for many more distractions and temptatiions to get of task.

Class size - Smaller class sizes, while beneficial for all students, are particularly beneficial for students with ADD/ADHD. There will be less distraction and more student-teacher interaction.

Behavioral intervention

Class rules - Have a clearlyworded rules that are posted in view of the students.

Reinforcers - Reinforcment has been show to be effective in helping students with ADD/ADHD. Examples of reinforcment techniques includes response-cost, time-outs. token economy, and notes home (positive notes home as well, not just negative.)

Metacognition

Students with ADD/ADHD have a decreased ability to self-regulate. Teaching students self-regulation, self-monitoring, and self-management helps students become more aware of their own behavior. A greater awareness of appropriate/innapropriate behvior gives the student a greater ability to control their behavior.

Organization and Study Skills

Students with ADHD struggle with organizational and study skills Strategies/methods to help:

-assign a peer “study buddy�?

-teacher should write all assignments on board (i.e. not just orally assigned)

-'to do' lists (in addition to general assignment sheets)

-Break down large projects into smaller units

-Scaffold the process of working on larger projects

Famous People who have ADD/ADHD

Albert Einstein

Leonardo DaVinci

Robin Williams

Ben Franklin

John F Kennedy

Abraham Lincoln

Isaac Newton

Pablo Picasso

Steven Hawking

Walt Disney

Thomas Edison

John Lennon

What is the evidence that these historic people have ADD/ADHD?

Personal Testimonies

I believe to many of our children in schools are labeled as ADD or ADHD and are presribed medication for too long of a time. I think it has become too much of a 'easy solution' for parents and schools. I don't think there is a problem with the children who are overactive, I think most of the problem is with the way we have quickly prescibed medicine for children who may not even need it.- Brandon

Having taught briefly a student with ADHD, I have found that the stigmas attached to it are consistently more negative than the actual situation. My particular student simply needed accomodations and adaptations, much like all students most likely will at one point or another and it was simply a matter of finding "what worked" for him. Our solution to his major problem of sitting still was just to allow him to read or do his work in the bean bag chair in the back of the room. He was able to move around without being disruptive, and he was able to get his work done. -E.Walsh

After spending some time learning about ADHD in my Special Education class, I find it easy to judge someone as ADHD. I do not want to undermine the importance of helping those that have severe ADHD, I just wonder if ADHD is over diagnosed. I feel like every person can become bored and fidgety. I'm afraid people are too anxious to medicate for ADHD. Also, I wonder if changes in the way lessons are done in the classroom could positively affect students with ADHD. If more inquiry-based learning is used, students may be more focused during classtime. Finally, I wonder if the changes towards a fast-paced, technology-driven society has led to kids being different than "what they used to be." -L. Weinstein

I, myself, have ADHD. For most of my high school career, it wasn't a problem, since the structure of high school and my parents kept me very on track. When I hit college, however, my problems multiplied. Without the rigid structure imposed on me as i was used to, I was near hopeless when it came to concentrating and stayin on task. I am a constant fidgeter as well, I can't be content sitting in one place for very long. Knowing my problems I can compensate for them; setting aside more time for myself or doing work with someone else to help me stay on task. At one point I tried medication, but the way it changed me just felt unnatrual and very "out of body." Matt Munley

My Son-in-law has ADD,but he has learned to accommodate for the disability in his life. First, he realized early on that he was not going to be able to sit at a desk and work in an office. He works outside putting up cellular antennae for different cell phone companies. He has to travel a lot, but it works out for him. He also realized that when he has to do a job that requires attention, then he psychs himself up to do just that. I am sure everyone who has ADD has to learn what works for them. Sharon Morrisette

Ralph Alexander- I felt I had to add a story here. When I was attending Illinios State University I sat next to a student in class who had ADD and he drove me completely bonkers. He could not shut up and he was always asking me questions and I would tell him to shut up and he would for about two seconds. It drove the Professor bonkers also, but he realized the situation and for the most part ignored it. However, I can see how it would be distracting not only for teachers, but for classmates of an ADD student as well.

N. Frick - I have worked with several ADD and ADHD students in the past two years. I have found in my experience that these students flourish in an environment where there is structure and routine. Most of the students have been medicated, but one is not. She came to my classroom in the middle of the year this year. I have seen much improvement in these few short months. It seems that the predictability makes it easier for her to work and concentrate at a higher level.

Connie Early – I have worked with several ADD and ADHD students. It can be a frustrating situation; the children are often noisy and demand much of your time. It is important for a teacher to become educated about the disorder to help in dealing with the child on a day-to-day basis. I’m not a big believer in medicating a child, but I have seen it work nothing short of a miracle. Patience and thoroughness in diagnosis is a must. In addition to the websites given, I would also recommend: Behavior Management Advice Site

I teach in a junior high school and many of the students are diagnosed as having ADD. Majority of these students are boys. Sometimes I wonder if it is the age of the students( hormones, maturity) that enforces this labeling. Many of these students are medicated for ADD/ADHD and they have an IEP. The teachers try to work with the students to control their actions and teach them alternative ways to keep the classroom managable for the students and the teacher. Nichole Jessup

As a teacher, I have mixed feelings about the ADD diagnosis. I realize that there are children who are Attention Deficit, but I wonder if it is too overly diagnosed. I believe the percent stated above is lower than the percent I see in my classes that are ADD diagnosed. I have seen too many kids use their ADD as an excuse to behave or perform poorly. Students will tell me that they did poorly on a test due to their ADD or excuse their behavior by saying that they did not take their medicine that day. This makes me wonder how much the student needs to know about their diagnosis. They shouldn't feel the need to use it as an excuse, but should do their best to overcome it. C. Snodgrass

I additionally worry about the over diagnosis of ADD or ADHD in elementary school settings, particularly of students of color. Although I know that some of these students actually have ADD/ADHD, the overwhelming numbers reported seem simply astounding, and are simply statistically impossible! Even within my own family, some of the children have been diagnosed with ADD in public schools, but when they were moved to private schools or changed instructors (different situations) the parents were told that the child did not have any problems... I think this situation should be HEAVILY monitored, to ensure that ADD or ADHD is not used as an excuse to attach even more labels of deficit to our children. Jasmine Johnson

I have similar feelings about the over diagnosis of ADHD. There are several assessment tools such as Corner's Rating Scales used for the evaluation. Teachers and parents are required to report information regarding home and school activities in order to evaluate a child's tendency of ADHD. By looking at the items in the rating scale, teachers and parents are able to know how a child perform compared to nationalwide children in order to say a child has ADHD. However, some of the items in the rating scale is pretty subjective. For instance, one item is to rate how well a child is able to stay on a chair. Different people will rate differently based on varied observations. I would say when a teacher finds his or her student cannot focus, he or she should evaluate if the activities interest the particular student. --Ting 11:42, 11 Dec 2004 (CST)

Something interesting that I recently read is that students with ADHD or ADD did much better in school when they spent some time each day in a park or in the woods. It wasn't having them outside that made the difference, it was having them in a space with trees. I wish that I remembered where I read that because that has all kinds of implications. What if trees, not medicine, was what was really needed?

My cousin has adhd and my aunt swears that when she changes his diet, his behavior is drasticly changed. I thoguth this was interesting since there is no proven research stating her theory is true.

As a child, a close friend of mine was diagnosed with ADD. I saw her take numerous visits to the "doctor" and a frustrated mom, not knowing how to handle the arising issues. My friend had a great amount of difficulty in the classroom and in relating with her teacher. After some time, this child switched schools because the first school did not provide adequate support. From a parents perspective, switching schools may be a necessary measure for dealing with a child with ADD. From a teachers perspective, we should have the skills and resources to provide the necessary support for children with ADD. - Marie Daniel

I have had several students with ADHD. I have also found that structure and routine is very helpful for these students. I have found that giving students some cue that prompts them to get back on task or refocus is also beneficial. For example, I might tap the top of their desk or snap my fingers. Also, sometimes a behavior chart works really well to help students monitor their behavior and remind them of expectations. - E. Elrick elementary/preschool teacher for 7 years.

Teachers have to be creative with teaching methods for students with attention deficit disorder. As a music teacher I find that the students with disabilities are usually very good musicians. For instance, many percussionists shows symptoms of ADD and ADHD and become wonderful musicians. I believe that role of the teacher is to be extremely adaptive to all students, including those with attention deficit disorder. --Chris Royer--

I know several people with ADD and ADHD. My Godmother, her sons and her daugher have been diagnosed with some form of it and the symptoms really noticeable. My Godmother hardly sleeps because she is always active, she is very unorganized, hardly gets anything done, and she talks really fast. She is very spastic. The same traits behold her sons but her daughter is not very hyper. She just is very unorganized and with the attention level of a flea. Dealing with these types of disorders can be difficult if one does not have any patience but in my case, since I am psychology major, I am better able to deal with them because of the research i have done on the disorder.It is a task but it can be done. Ty Martin.

I currently am a special education teacher and work with students who have ADD and ADHD. This disorder seems to be one that is overly diagnosed. Many parents notice that their children seem to have a lack of attention or lack of interest in school and take them to a doctor and get them tested. The doctor will make an evaluation on the student saying they need to be placed in special education so their students can get accommodations such as extended time. This is very beneficial for the students because many times it entitles them to accommodations such as extended time on quizzes, tests, projects, and most importantly the ACT/SAT. When the student is placed into Special Education they are labeled as having a primary disability of OHI (Other Health Impairment).

When working with students in the classroom that truly have this disorder I find that teaching using a Kinestetic approach helps them out because they are moving around and more active in the classroom. This allows them to have a hands on approach instead of the old school method of taking notes, reading, and taking quizzes and tests. Brian Bucciarelli (January 30, 2006)

Over the past ten years ADD and ADHD has become the main "Buzz Word” for many troubled children around the Junior High where I teach. I have been in-serviced numerous times on ADD and ADHD and I was not sure if I was buying into this disorder. I was starting to wonder if it was just a "Scape Goat” for a struggling student. This was until my daughter started having some trouble. She was always having difficulty sitting still to study and could hardly finish reading a page in her book without having to re read the page. It was a fight every night just to get her homework done. The older she got the worse the problem became. We had her go through testing and we were told she was ADD. She was put on Concerta and man did it make a difference. She can now stay on task and it is no problem to get her homework done. She has learned to enjoy reading and her grades have soared!! My only question is if this is disorder hereditary? The symptoms she had are exactly what I experienced when I was an adolescent. Dale Donner (Jan. 30, 2006)

I feel that ADD can be an overprescribed disorder. I have seen with my own students that they sometimes just need to train their brains to stay focused on a task. So many children are over stimulated from fast changing scenes on television, video games, and computer games, that they have not sufficiently trained certain parts of their brain to be able to concentrate for long durations on high level thinking tasks. I have noticed some children who are identified as having ADD do not have an attention problem when it comes to watching television. However, watching television usually does not involve large amounts of brain activity unlike tasks teachers ask students to complete in school. This situation has led me to question whether ADD is being used as an excuse diagnosis for students who do poorly in school.

On the other hand, I do believe it is a legitimate diagnosis for some people. I have seen inattentiveness in some students diagnosed with ADD in a variety of settings other than just the classroom. These cases have shown me the child truly has attention problems. For these students, I believe medication can possibly be used to help the child achieve a normal range of attentiveness. However, if medication is not used for some reason, I feel the child, parents, physicians, and teacher need to work together to teach the child appropriate coping mechanisms that will help the child be successful in a variety of environments. -Tricia Pearl

In third grade my son was evaluated by the school district for ADHD. The classroom teacher had a conference with us to tell us about the decision to evaluate him and at the same time shared other concerns she had regarding my son. One of those concerns was the way he was finding the answers to his math assignments - he was using tables and diagrams rather than the method taught in class. When asked by the teacher how he arrived at the correct answer he would share his thought process - but as she explained to me - she was not able to follow it and thus he needed to stop doing this and use the method taught. This coupled with the fact that he did not pay attention in class was what brought her to decide he needed to be tested for ADHD. I was baffled! My son did exhibit many of the symptoms of ADHD such as disorganization, restlessness and impulsiveness but if he was interested in a topic it was very difficult to get his attention which always led me to believe he was bright and not ADHD. The school district determined the he was not ADHD but still recommended that we see our physician. We did and we did try for a very short time some of the medicines and the results were that there was no change. My concern here is that bright students who may be bored in class are being label ADHD as opposed to being given an IEP to address what they really need - more challenging instruction. In the fourth grade my son's teacher allowed him great freedom to explore as long as his class work was complete. As a result of this freedom, he did technology demonstrations to the class as well as science demos and had a terrific year. ~Becky Small

I will be honest, I originally thought that students diagnosed with ADD or ADHD just used the diagnosis as a copout. Kids with short attention spans seemed to run straight to their doctor for a ADD label then they had a built-in excuse for not doing well and not paying attention. But now, after teaching an introductory algebra class and coaching 7 grade boys basketball, I see that it is real. From having to remind kids 7 times in a 45 minute period, to having to explain a drill in basketball practice 5 times, I see that this is more than just a lack of attention.

Some things that I have to done to try and help these students include posting of class rules, writing assignments out on the board, separating assignments into smaller tasks and doing more computer related projects.

While tailoring lessons and classes for students with ADD and ADHD has increased my work load, the results I've gotten with these students and improved.

Brad Frey - Johnsburg High School

Related Websites

Attention Deficit Disorder Association

Children and Adults with Attention Deficit Hyperactivity Disorder

Adult Attention Deficit Disorder

References

http://www.add.org/

http://www.chadd.org/

http://www.strattera.com/1_3_childhood_adhd/1_3_4_treatment.jsp

Phelan, T.W. (1993). All About Attention Deficit Disorder. Glen Ellyn, IL: Child Management Inc.

Bluestein, J. (2004). Practical Strategies for Working Successfully with Difficult Students. Bellevue, WA: Bureau of Education and Research.

Lawlis, F. (2004). The ADD Answer: How to help your child now. New York, New York: Viking Books.

Reid, R. Focus on Exceptional Children. 1999, 32, 1.

Rief, S. (1993). How to Reach and Teach ADD / ADHD Children: Practical Techniques, Strategies, and Interventions for Helping Children with Attention Problems and Hyperactivity. West Nyack, NY: The Center for Applied Research in Education.

Rief, S. (2003). The ADHD Book of Lists: A Practical Guide for Helping Children and Teens with Attention Deficit Disorders. San Francisco, CA: Jossey-Bass.