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ADHD in the classroom

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R Witt

on 27 November 2012

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Transcript of ADHD in the classroom

Why talk about ADHD? AttentIon DIsorders
In the
Classroom Co-occurring
Disorders impulsivity hyperactivity inattention Time Concept Challenges Sleep Challenges Risky Behavior Clarifying points

-working with averages

- organic vs. environment Low Achievement Social
Challenges Motor Incoordination Language Challenges - Rates of diagnosis for school-aged children= 7%

- BC struggles to support students appropriately

- Teacher frustration/confusion and feeling
unsupported 1-3 children per Canadian classrooms Grouping GOAL:
To build ADHD awareness and change our understanding of ADHD from that of a behavioural disorder to a brain development disorder or even an Executive Functions Deficit Disorder ADHD students In BC Schools Diagnosing ADHD * 6 or more symptoms of inattention,hyperactivity, impulsivity * Persisting for longer than a 6 month period * Significant impairment in social and academic (or occupational) functioning * Impairment observed across 2 or more settings * Onset symptoms present before the age of 7 ADHD Subtypes 1. ADHD-PHI --> ADHD predominantly hyperactive-impulsive type * Symptoms cannot be better explained by another mental health disorder 2. ADHD-PI --> ADHD predominantly inattentive type 3. ADHD-C --> ADHD combined type Predominantly hyperactive-impulsive In the classroom... - symptoms at 3-4 yrs old
- excessive movement (restless/fidgeting/wandering) and vocal activity (talking, humming, singing etc...)
- touching everything
- running/climbing at inappropriate times, on inapropriate things
- difficulty engaging in leisure time
- unable to delay gratification
- quick responses
- appears thoughtless, harmful to others at times
- blurting/unable to wait turns
- invasive/overbearing: invading the personal space of others, interrupting frequently
- appears rude and immature In the classroom... Predominantly inattentive - symptoms present around age 5-8

- cannot persist at assigned tasks so difficulty
completing play activities/ school work/chores

- difficulty with multiple step instructions

- difficulty resisting distractions

- unable to shift between tasks easily

- disorganized / loses things / misses details

- avoidant of tasks requiring mental effort
and is often forgetful

- can appear 'spacey', day-dreaming
(even when spoken to directly) Combined Bart Simpson was actually diagnosed with ADHD in the 11th season of the Simpsons. Negative Emotionality Irregular Brain Development Students with ADHD.... up to 75% have co-occurring disorders, disabilities 60% will have Oppositional Definance Disorder
30% will have Conduct Disorder
25% will have an Anxiety Disorder
25% will have some form of depression
40% (or more) will demonstrate a Learning Disability

** Children with autism, OCD, Tourette's have significantly higher rates (50% and up) of demonstrating ADHD Students with ADHD... * Have significantly less brain matter, globally

* Have less electrical activity in key brain regions

* Have less metabolic activity in the brain - More difficulty with gross and fine motor sequences
- Less acurate in measurements of eye-hand
- More likely to have poor balance and overall difficulty
with motor planning
- 4x more likely to be accident prone Students with ADHD
are more likely to... - Break bones (4x)
- Suffer accidental poisonings
- Engage in drug and alcohol abuse
- Become pregnant as a teenager
- Contract STDs
- Speed, be ticketed and have car accidents
- Engage in anti-social activity (criminal behaviour) Students with ADHD... - More likely to have learning disabilities
- Consistently perform lower academically (through to adulthood)
- Academics often impacted before entering Gr. 1
- 80% performing below grade level (even 2 grades)
- Score an avg. 7-10 pnts lower on IQ measurements
- 30-40% drop out of school Up to 60% of students with ADHD can have poor motor
coordination or Developmental Coordination Disorder. Students with ADHD... - Have much LOWER emotional regulation skills
- Prone to overreacting
- Frustrate easily
- Limted perspective taking skills, during conflict
* Less emotionally responsive to negative feedback / consequences Students with ADHD... - 2x more likely to have sleep problems
- Have more difficulty falling asleep and waking up
- Show more involuntary movement
- Have interrupted REM sleep
- Experience more sleep issues when medication and anxiety issues exist
- Sleep disorder?? Students with ADHD - Perform lower on lnaguage comprehension tasks
- Demonstrate weakness in expressive language abilities
- Show more difficulty imitating language in preschool
- Overall difficulties with social aspects of language Students with ADHD... - Find conceptualizing time difficult (sequencing, referencing...)
- Lack forethought/hindsight for anticipating future events
- Have difficulty persisting over time
- Have poor time management skills
- Often late, loses track of time or is imaptient with time Students with ADHD... - Are plagued by poor social functioning skills
- Have difficulty reading and identifying social/environmental cues
- Have difficulty imitating complex social behaviour
- Have higher negative emotionality = higher negative peer interactions
- Show overbearing/Invasive behaviour, aversive to peers
- Experience more peer rejection (80% by 7 yrs old)
- Have inflated views of their social interactions
- Are at greater risk for being bullied or bullying Impaired "delay" abilities = Self-Regulation Deficits = Executive Functions Deficits Executive Functions The control center of processes that underlie goal-directed behavior 1. Inhibition (impulse control)
2. Working memory (information processes)
3. Shifting (flexibility) severe case more likely... Medication? When student
are on
medication Research supported Strategies Field Tested Strategies 1. Stimulants 2. Antidepressants 3. Antihypertensives used as a multimodal approach
80% respond observable decrease in ADHD symptoms
improves work at school
increase in positive social interactions not a cure,
it gives a start/chance
still need other supports
will decrease 2-3 yrs 3 important notes
30 min start
rebound effect
common side effects InterventIon Medical
Management Behaviour Intervention Academic
Accommodations Psychological
Support Spiritual Parents report... Medication - DIET


- SLEEP DIrect SkIll
InstructIon Computer ASSISTED
InstructIon PeER TUTORING IncreasIng
StImulatIon 1.Increasing stimulation
2.Computer AssistedInstruction
3.Peer Tutoring
4.Direct Skill Instruction Academic Interventions Allowing student meaningful choice Changing materials to be visually stimulating Varying the way in which lessons
are presented Consistently adding a kinesthetic component to lesson plans Always used in a multimodal approach to ADHD 80% of students will respond favorably Consistently supported by decades of resrearch This treatment is NOT a cure! When your student Is on medIcatIon... 3 main types 1.Stimulants
3.Antihypertensives Side effects Effectiveness - 30-60 mins. for influence

- Rebound effect can be 3x worse Don't forget to consider... http://pbskids.org/curiousgeorge/busyday/ http://www.learn4good.com/games/mathforkids/middletohighschool.htm Students engage longer with the educational task Increased effectiveness if presented in game format Allows for immediate and continuous feedback Significantly increased task engagement & improved test
performance Can be done as a Peer Tutoring Program OR as Class Wide Peer Tutoring activities Provides immediate and continuous feedback and increased reinforcement opportunities a. splitting class into 2 grps
b. form tutoring pairs
c. take turns tutoring
d. provide academic script
e. tutors provide praise/reward
f. tutors provide immediate correction
on errors and only proceed when
correct response is reached
g. teachers monitor pairs and reward
those following procedure
h. tally individual or group points
for class reward Directly teaching a step by step guide to perform a skill Providing external cues to relieve working memory Reinforcing use of cue and fading
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