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Chapter 7 Learners with Attention Deficit Hyperactivity Disorder

Chapter 7 Learners with Attention Deficit Hyperactivity Disorder

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Chapter 7

Learners with Attention Deficit Hyperactivity Disorder

History

Discovered mid-nineteenth century

Dr. George F. Still, credited as being one of the first authorities to being ADHD to attention

Behavioral inhibition is still one of the components of ADHD that is still discussed today

History

Still’s cases similar to today’s population Children had mild brain pathology Some had normal intelligence More prevalent in males than females Some basis as hereditary condition Some had comorbid disorders such as

depression Many of his cases would still be labeled with

ADHD or ADHD with conduct disorder

History

Goldstein’s Brain-Injured Soldiers of WWI Noticed symptoms such as

Disorganized behavior Hyperactivity Perseveration Forced responsiveness to stimuli Lack of ability to focus on figure, instead attention

was paid to ground Laid the work for Strauss and Werner in 1930s-40s

Strauss Syndrome Figure background task

History

William Cruickshank Children with CP more likely to respond to

background than figure in figure/background task

All children had normal intelligence Brought to light that distractibility and

hyperactivity could occur in “normal” children First to establish educational program for

children with ADHD

Progression of Terms

1950’s-1960’s-Minimal brain injury

1960’s-1970’s-Hyperactive child syndrome

1980’s-ADHD

Definition

American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) Fourth edition (DSM-IV) ADHD, Predominantly Inattentive Type ADHD, Predominantly Hyperactivity Type ADHD, Combined Type

Criteria on p. 229

Prevalence

Most frequent reason children are referred for behavior problems

3-7% of school-age population Hard to have accurate percentage since

ADHD is served under “other health impaired” (OHI)

3:1 males to females Males have hyperactivity or impulsive type Females have inattentive type

Identification of ADHD

4 main components Medical examination Clinical interview Teacher and parent rating scales

Conners Rating Scales-Revised ADHD Rating Scale-IV

Behavioral observations Continuous performance test (CPT) stimuli presented

one at a time on a screen rapidly, with child pressing button when a particular stimulus is shown

Causes

Strong evidence of neurological abnormalities Prefrontal lobes & Frontal Lobes

Executive functions

Basal ganglia (caudate & globus pallidus) & Cerebellum Coordination & control of motor behavior

Corpus callosum Communication between hemispheres

The size of these areas is smaller Suggested reduced metabolic activity in the frontal lobes

and basal ganglia

Hereditary Factors

Family studies indicate 32% chance if sibling has ADHD 57% chance if parent has ADHD 2-8 more times likely if parent has ADHD than a

parent that does not In identical twins, increased chance versus

fraternal twins No single gene cause of ADHD Possible link to gene that regulates dopamine

Medical Factors

Not as strong a link as heredity Exposure to lead Alcohol abuse during pregnancy Tobacco use during pregnancy Low birthweight Complications at birth

Barkley’s Model of ADHD

Behavioral inhibition is the critical element leads to problems with executive functioning

time awareness and management

Disrupts person’s ability to persist in goal-directed behavior Problem’s with wait for turn Refraining from interrupting conversations Inability to resist distractions Inability to delay immediate gratification In the classroom, problems with transitions/switching

tasks

Executive Functions

Ability to regulate one’s behavior Children with ADHD have problems with

Working memory Forgetfulness, lack of hindsight, time management

Delayed inner speech Following rules or instructions

Controlling emotions and arousal levels Overreact to negative/positive experiences Quick to show anger/frustration

Analyzing problems and communicating solutions to others

Responds impulsivity to the first solution that comes to mind

Other Areas of Deficits

Adaptive skills Usually discussed when talking about intellectual disabilities New research shows children with ADHD have difficulties with these

skills

Socializing with peers More often rejected by peers Fewer close friends Disliked by students who enjoy high social status Research indicates this could be a defining characteristic of ADHD Difficult to overcome and is long lasting Can lead to social isolation

Comorbid Conditions

Learning disabilities Overlap of 10-25 percent Suggest strongest link ADHD, predominately inattentive

type

Emotional or behavioral disorders 25-50% exhibit some form of EBD 25-35% anxiety is present

Substance abuse Adolescents are more likely to experiment Twice as likely to abuse alcohol or drugs

Educational Considerations

Classroom Structure Reduce irrelevant stimuli/distractions

Teacher Direction Clear breakdown of instructional day

Functional Behavior Assessment Identifies ABC-antecedent, behavior, consequence

Contingency-based self management Students keep track of own behavior, then receive

consequences

Introducing Lessons

Provide an advance organizer Review previous lessons Set learning expectations State needed materials Explain additional resources Simplify instructions, choices and scheduling

Conducting Lessons

Be predictable Support the student’s participation in class Check student performance Perform ongoing student evaluation Follow-up directions

Written oral

Divide work into smaller units Eliminate or reduce frequency of timed tests

Concluding Lessons

Provide advance warnings Can use overhead timer Visual timer

Check assignments Preview the next lesson Remember break the work into smaller

chunks helps the children focus and limit distractions

Medical Considerations

Controversial topic Psychostimulants

Stimulate or activate neurological functioning Ritalin

Takes about one hour to take effect Optimal effect in 2 hours Wears off in 4 hours

Adderall Stratera-non stimulant

What Research Says

Ritalin has positive effects in helping students have more normalized behavioral inhibition and executive functioning

Leads to increased results on parent-teacher rating scales and academic achievement

Increased classroom behaviors Better at taking notes On-task behavior Quiz scores Homework completion Written-langauge work

What the Research Says

Not effective for everyone Around 30% do not have favorable response Side effects

Insomnia, reduced appetite, abdominal pain, headaches, and irritability

Some reports can cause tics or increase tics that children already have

Can have rebound effect Some studies suggest taking Ritalin can decrease

adolescent use of drugs

Monitoring Progress

Curriculum-based measurement (CBM) Attention & Behavior

Momentary time sampling Allows the teacher to conduct brief observations and

collect data on a specific set of behaviors Observer determines length of observation & divides

it into intervals At beginning of interval, observer notes whether the

student is exhibiting the target behavior & then waits until the beginning of the next interval to document behavior

Testing Accommodations

Small-group or individual administration in a quiet location

Extended time Frequent breaks Presentation format Response format

Early Intervention

Diagnosis is difficult at an early age Most commonly will see a great deal of motor activity and a

lack of impulse control Stronger use of contingencies such as praise, points, and

tangible rewards Intensive, structured methods of applying behavioral

management can be successful in improving behavior and pre-academic skills

Symptoms such as strong aggression can not remediate completely the symptoms of ADHD, will need long-term programming

Transition into Adulthood

2/3 of children with ADHD will continue to have significant symptoms in adulthood 4-5%, similar to the rate in children

Person’s history is important in determining adult ADHD

Some adults also exhibit antisocial, anxiety, and depression disorders, including employment Comorbid conditions lead to poorer outcomes compared

to those who do not have them

Transition into Adulthood

Employment difficulties Getting along with others Being bored Being disciplined by supervisors

Solution is for the person to choose a job/career that maximizes individual’s strengths

Coaching-identifying someone whom the person with ADHD can rely on for support