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Attention-Deficit / Hyperactivity Disorder

  • Using rewards to emphasize appropriate behavior.
  • The more interested they are for the reward, they are more likely to work for it.

Tangible Rewards

Self-management procedure includes the following:

  • A set of procedures designed to develop the self-regulation of behavior
  • Allows children to work responsible and independently, enabling them to select appropriate choices based on probable consequences

Teach Self-Management

Definition

  • Pointers - used to track words visually on the page while reading aloud

  • Egg Timers - used to allow the child to keep track of how much

time left in the lesson

  • Classroom Lights - lights provide a visual stimulus to know when

voices are too high or time for transition in the lesson

  • Music - effective way of timing transitions by playing a few chords

to signal transitions in lessons or setting tone of activity level

dependent on the types of work

  • Create an accepting climate
  • Provide structure, routine, predictability, and consistency
  • Seat the child near the teacher to monitor behavior
  • Provide a quiet work area
  • Use peer tutoring, peer assistance and cooperative learning
  • Make sure their desks are free of distractions
  • Positive reinforcement for on-task behavior
  • Use physical contact to focus attention (e.g., hand on a shoulder)
  • Provide a "way-out" - allowing the ADHD child to run errands outside of classroom (allows the child to settle down and ease restlessness)
  • Systematically and gradually teach self-control

Instructional Tools to Use for an ADHD Student

Behavior modification techniques

Restructure the learning environment

Personalities with ADHD

Do not punish. Do not assume students are lazy. Do not give up.

Michael Phelps

Academic Intervention Strategies & Accommodations

Swimming isn't just a winning sport for Phelps; it's a way for him to cope with his ADHD.

His simptoms were not sitting still or being able to focus. However, he channeled that into swimming, and with "continuous praise and positive reinforcement" Phelps had the encouragement he needed to score the golds.

Paris Hilton

The socialite TV star said that she takes Adderall to manage her ADHD, which she's struggled with since she was 12.

Persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and is more severe than is typically observed in individuals at comparable level of development.

(DSM-IV-TR)

Diagnosis

No diagnostic test for ADHD is currently available, only symptoms that suggest an individual has ADHD.

DSM-IV Criteria for ADHD

I. Symptoms

Present for at least six (6) months to a point that is inappropriate for developmental level.

or six or more of these

II. Some symptoms present before age 7

III. Symptoms cause impairment in two or

more settings

IV. Must be clear evidence of clinically

significant impairment in functioning

V. Symptoms do not happen only during the

course of another disorder

Hyperactivity Impulsivity

Six or more of these:

Children with ADHD need:

Inattention

  • Often blurts out answers before questions have been finished
  • Often has trouble waiting one's turn
  • Often interrupts or intrudes on others
  • Often fidgets or squirms
  • Often gets up from seat
  • Often excessively runs about or climbs
  • Often has trouble playing quietly
  • Is often "on the go"
  • Often talks excessively
  • Often does not follow through on instructions, fails to finish schoolwork, chores, or duties
  • Often does not give close attention to details or makes careless mistakes
  • Often avoids or dislikes tasks that demand prolonged mental effort
  • Often has trouble keeping attention on tasks
  • Often does not seem to listen when spoken to directly
  • Often has trouble organizing activities
  • Often loses things needed for tasks
  • Is often forgetful in daily activities
  • Is often easily distracted

1. The unconditional love and acceptance of their families

2. Empathy, tolerance, and forgiveness

3. Positive attention and feedback

4. Fair, clear, and reasonable rules and expectations

5. Predictability of schedules and routines

6. Reminders and prompts without nagging, screaming,

criticism, or sarcasm

7. To be able to let down their guard at home and express their needs,

thoughts, and emotions openly

8. To feel they have choices and options and are involved in some decision-making

9. Escape valve outlets

10. Structuring of their work environment, tasks, and materials

11. Parents’ involvement and close communication with the school

12. Parents to become knowledgeable about ADHD so that they will be well equipped

to manage, support, and advocate effectively on their behalf

Prevalence

(DSM-IV: 3-7% of all school-aged children)

  • ADHD is the most commonly diagnosed psychiatric distinction of childhood.

  • Far more boys (13.2%) than girls (5.6%) have ever been diagnosed.

Drug Therapy

Prescription Stimulant Meds

  • Methylphenidate (Ritalin) is the most frequently prescribed

Causes

The specific causes of ADHD

are not known.

There are, however, a number of factors that may contribute to, or exacerbate ADHD.

They include genetics, diet and the social and physical environments.

Behavioral Intervention

Parent Training

Statistics (2010) from the ADHD Society of the Philippines says:

80% of the adolescents have the symptoms of ADHD

60% of adults have the symptoms of ADHD

40% - 50% of children with ADHD have learning disabilities

30% - 50% of children with ADHD engage in disorderly conduct

35% of children with ADHD do not finish high school

25% of children with ADHD oftentimes fight with other kids

20% - 25% of children experience hyperactivity

3% - 5% of the world population has ADHD

  • Teach parents behavioral strategies.
  • Teach techniques to target and monitor problematic behaviors.
  • Reward pro/social behavior.
  • Address parental risk factors (e.g., depression, marital distress, poor coping skills, lack of support).

Placement Options for Children with ADHD

Regular Education Classroom

Resource Room Programs

  • Students with ADHD are in contact with their peers without ADHD for much of the school day

  • Accommodation plan should be worked out by the parents and the school.
  • Children with ADHD are 'pulled-out of their regular classrooms to go to a separate room in the school for supportive instructions

  • Main objective is to remediate, on a regularly scheduled basis, difficulties in language, reading, math, and social behaviors so that a child can perform more effectively

Special Day School Programs

  • Small student-teacher ratio
  • Highly individualized instruction
  • Opportunities to acquire and observe socialization skills suffer in this set-up since the child with ADHD has less contact with peers without ADHD
  • Break assignments into manageable parts
  • Give extra time to complete tasks
  • Simplify complex directions

Modify assignments to promote success

Jim Carrey

He remembers coping by being the class clown, and said that "it's hard for me to come down from what I do."

Sugar and ADHD

Many parents fully believe that their children become unmanageable when they eat too much sugar.

Another study was conducted by Richard Milich and William Pelham wherein they carefully examined twenty five different aspects of behaviour in young boys with ADHD, including academic performance, social behavior, rule violations and body movements. They found no differences between the boys who were given a diet with extra sugar and those who are not.

Allergies and ADHD

Dr. Doris Rapp

  • a pediatrician and allergist who practices in Buffalo, New York
  • has proposed that hyperactivity and many other problems are caused by allergies to certain foods such as milk, chocolates, eggs, wheat, corn , peanuts, pork and sugar.
  • Her theories have not been confirmed by any scientific studies.

Treatment

There is no concrete evidence that sugar causes ADHD.

Refined sugar does exacerbate some of the ADHD symptoms such as inattentiveness and possibly aggression in many children

A study by Drs. Daniel Hoover and Richard Milich in 1994 studied 35 children whose mothers had described them as sugar sensitive. All of the children were given a sugar-free drink, but half of the mothers were told the drink contained sugars. All of those mothers rated their children as more hyperactive after consuming the beverage. Milich concluded that the problem was parental expectations, not sugar.

Efficacy of Stimulant Meds

  • Short-term studies show that stimulant medication improves the behaviors associated with ADHD in 70-80% of school-aged children.

  • No clear evidence indicates that stimulant medications lead to improved academic achievement.

based on these criteria,

three types of ADHD were identified

Issues

Conduct Disorder vs. ADHD

There is a generalization such as the statement:

“Jails are full of people with ADHD”

because people say that

if you have conduct disorder, automatically,

you will also have ADHD.

"mental restlessness"

  • minimal brain damage
  • minimal brain dysfunction (or disorder)
  • learning/behavioral disabilities and
  • hyperactivity

Alexander Crichton 

describes

in his book  

written in 1798.

"An Inquiry into the Nature and Origin of Mental Derangement" 

Dr. George Still

  • British doctor
  • believed to be the first person to recognize and diagnose the condition in 1902
  • he did not call it ADHD, but rather a "Defect of Moral Control" disorder.
  • Most children with ADHD do not have conduct disorder.
  • If about 5% of the population has ADHD, then a much smaller percentage has conduct disorder (less than 1 %)
  • Give oral exams
  • Use more objective items (fewer essay responses)
  • Give frequent short quizzes, not long exams

Test - Taking

  • child is taught to verbalize questions and answers needed to identify problems, generate potential answers, evaluate solutions, and determine the most effective solution

Self-Instruction

  • child is taught to monitor the adequacy of their answers and record them

Self-Assessment

Predominantly

Inattentive Type

Combined Type

Predominantly

Hyperactive-Impulsive Type

Points are gained whenever the child demonstrated appropriate behavior. Points are then redeemed for tangible rewards.

Token economy systems, however, are usually made for whole classrooms rather than individual students.

Token Economy

Food Additives and ADHD

Dr. Benjamin Feingold

  • a pediatrician and allergist from California
  • published a book “Why Your Child is Hyperactive” in 1975.
  • The book contained no research to back up his assertions that artificial food coloring, flavoring, and flavor enhancers cause hyperactivity (only anecdotes from his own practice)
  • child is taught to monitor and evaluate their own behavior and self-selected rewards where appropriate.
  • the child chooses the reward and determines the scheduling for assessment

Self-Reinforcement

  • the ADHD child is taught to monitor their own behavior, attention, and performance through data collection (graphing, charts, anecdotal notes)

Self-Monitoring

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