Attention-Deficit /Hyperactivity Disorder

(ADHD)

Kristian, Krista, Tiffany & Kristina

Definition of ADHD

Attention-deficit/hyperactivity disorder describes children who display persistent age-inappropriate symptoms of inattention, hyperactivity, and impulsivity that are sufficient to cause impairment in major life activities.

(American Psychiatric Association [APA], 2000)

DSM-IV Criteria for Diagnosis

• Six or more inattention symptoms or six or more hyperactivity-impulsivity symptoms

• Symptoms must be inconsistent with the child’s current developmental level

• Must persist to a degree that is considered maladaptive for at least six months

Additional DSM Criteria

• Some symptoms present before age 7

• Impairment from symptoms must be present in at least two types of settings

• Clinically significant impairment in school, social or occupational functioning

• Symptoms do not occur solely during a pervasive developmental disorder or psychotic disorder

• Symptoms are not accounted for better by another mental disorder

Inattention

1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.

2. Often has trouble keeping attention on tasks or play activities.

3. Often does not seem to listen when spoken to directly.

4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace

5. Often has trouble organizing activities.

6. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time

7. Often loses things needed for tasks and activities

8. Is often easily distracted.

9. Is often forgetful in daily activities.

Hyperactivity

1. Often fidgets with hands or feet or squirms in seat.

2. Often gets up from seat when remaining in seat is expected.

3. Often runs about or climbs when and where it is not appropriate

4. Often has trouble playing or enjoying leisure activities quietly.

5. Is often "on the go" or often acts as if "driven by a motor".

6. Often talks excessively.

Impulsivity

1. Often blurts out answers before questions have been finished.

2. Often has trouble waiting one's turn.

3. Often interrupts or intrudes on others (e.g., butts into conversations or games).

Subtypes

Predominantly Inattentive Type

• children who only meet the criteria for inattention

Predominantly Hyperactive-Impulsive Type

• children who only meet the criteria for hyperactivity-impulsivity

Combined Type

• children who meet the criteria for both inattention and hyperactivity-impulsivity

Causes of ADHD

• ADHD is a medical disorder despite many myths

• early theories thought minor head injuries or brain damage were the cause

• the exact cause is currently unknown, but it is now thought to be caused by biological factors that influence neurological activity

• genetic influence

• toxins in the environment

• the use of drugs/alcohol during pregnancy

• environmental/family influence

Treatment

•A complete medical evaluation should be conducted

•The condition can be diagnosed when appropriate guidelines are used.

•The treatment of ADHD must involve a multimodal approach.

Medication

•Stimulant (most commonly used)

•Non-stimulant

•Antidepressants

•Antihypertensives

•Mood Stabilizers

•Neuroleptic drugs

Stimulant Medication

•Variety of forms:

•Methylphenidate

•Dextroamphetamine

•Amphetamine

•Lisdexamfetaime

•For 80% of children with ADHD, Stimulants produce dramatic increases in:

•Sustained attention

•Impulsive control

•Persistence of work effort

•Decrease in task-irrelevant behavior

•Cooperation

•Physical Coordination

Behavior Therapies

•Parent Management Training (PMT)

•Parents are taught about ADHD

•Given guidelines for raising a child with ADHD

•For disruptive behavior parents are taught to use penalties

•Studies support PMT

Educational Interventions

•Focus on managing inattentive and hyperactive-impulsive behaviors

•Techniques are similar to those recommended to parents

•Reward system

-Considerable support for school based interventions

Intensive Interventions

•Summer Treatment Programs

•Provided to children between 5-15

•Classroom and recreational activates

•Advantages: peer relationships, and progress made during school year is not lost

•Used with medication, PMT, and Educational Interventions

Additional Interventions

•Family Counseling and Support Groups

•Helps everyone develop new skills, and attitudes, and teaches them how to relate more effectively

•Local and National support groups

•On-line bulletin boards

•Individual Counseling

•Teach children with ADHD how to feel better about one’s self

•Build strengths, cope with daily problems, and control attention and aggression

• ADHD is equally common among boys and girls, and at all ages.

• ADHD is usually outgrown

• Children with ADHD are less intelligent

• Faulty parenting is the primary cause of ADHD

• Sugar ingestion is a primary cause of ADHD

Common Myths About ADHD

• ADHD rating scales follow the same standards for boys and girls.

• Due to the increase in prevalence rates and rise in prescriptions, ADHD is highly over-diagnosed

• ADHD symptoms often do not show up in the preschool years

• Private school is a better option for ADHD children

Common Myths About ADHD

Prevalence: range from 1-10% of children under the age of 18

• North American prevalence rate range from 3-5%

• Worldwide prevalence study: 5.29%

• Higher rates in North America

• Culture does have an impact on the prevalence of ADHD

• Higher prevalence rates when using teacher reports, lower prevalence rates when using parent reports

Prevalence Rates

Facts

• In every classroom of 30 students, up to 3 children may have ADHD

• ADHD children tend to show emotional development that is 30% slower than children without the disorder

• Up to 65% of children with ADHD show problems with defiance, non-compliance, problems with authority figures, show verbal hostility, and have temper tantrums

• 40% of children with ADHD have at least one parent with the disorder

• 50% of children with ADHD display sleeping problems as well

• Parents of ADHD children are 3 times more likely to divorce than parents of non-ADHD children

• Teenagers with ADHD on average have 4 times as many traffic tickets as non-ADHD teenagers

• 75% of boys display the hyperactive-impulsive type of ADHD, while only 60% of girls are hyperactive

Facts

Often positive qualities are overlooked

• A high level of energy

• Oriented towards an active lifestyle

• Outgoing and personable

• Creative thinkers, tend to ‘think outside the box’

Many of these qualities prepare ADHD students for successful professional lives

Positive Effects of ADHD

A Parent’s Perspective

Trevor’s Story

http://www.adhd.ca/portals/adhd/eng/1215450158163.html

Teaching Students with ADHD

The Process of Ongoing Learning and Developing

• It is crucial for teachers, parents, and students to be fully aware of the child’s disorders and the effective management strategies

available

• Enhance home-school

communications

• Implementation of I.E.P.s and Behaviour Plans

Developing Positive Attitudes in Students with ADHD

• Don’t Let Your Students Get Burnt Out!

• Students with ADHD will often face self-esteem issues as they cannot control their behaviour and have trouble completing tasks. So it is important to help these children gain confidence in themselves by providing ways to show their accomplishments and abilities

• Sport Teams/Activity Groups

• Reading Buddies

• Volunteering in the school/community

• Display completed work and artwork

Common Problems Associated with ADHD

Students with ADHD will typically have underdeveloped self-

management skills which would usually hinder the following skills;

• Time management

• Finding materials

• Beginning independent work

• Maintaining on-task behaviour long enough to finish work

• Remembering the requirements and time frame for handing in assignments

• Attending school regularly

How We Can Help

• Providing management structure and routines for students can help combat some of the problems through the use of:

• Checklists of required materials

• Agenda to keep track of requirements

• Classroom routines to provide consistency for students

• "Learning how to learn" and study skills strategies that provide structures for completion of assignments

• Breaking assignments down into manageable parts that can be checked and reinforced

Behaviour Plans:

1. One is more likely to succeed in changing behaviour by rewarding what is seen as desired behaviour than by punishing what is seen as undesirable behaviour

2. For a plan to work, the responses to acceptable and to unacceptable behaviours must be consistent and must occur each time. Inconsistent response patterns may reinforce the negative behaviour

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