Chapter 9: ADHD

Adapted from a presentation by James J. Messina, Ph.D.

Chapter 9 Questions How common is ADHD and what causes

it? How is ADHD defined and classified? What are the primary characteristics of

students with ADHD? How are students with ADHD identified? What interventions are effective for

students with ADHD?

Prevalence and Causes of ADHD

About 3-7% of school-aged population Approximately 75% boys 50-60% have a coexisting disability Differences found in frontal brain and brain

chemistry (i.e., neurotransmitters) Often heredity Poor parenting is NOT a cause!

DSM V Definition of ADHD

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

DSM V - Types of ADHD Predominantly

Hyperactive-Impulsive Predominantly

Inattentive Combined

Inattention Inattention to details / careless mistakes Difficulty sustaining attention Doesn’t seem to listen Fails to follow directions or finish tasks Avoids tasks requiring sustained effort Easily distracted / daydreams Disorganized / forgetful Often loses things

Hyperactivity Restless / Fidgets Can’t stay in seat Runs / climbs when inappropriate Difficulty playing quietly On the go – driven Talks excessively

Impulsivity Blurts out answers Trouble taking turns Interrupts / intrudes Impatient / rushes Careless errors Risk taking / taking dares Accidents / injury prone

Other Major Characteristics

Social and behavioral difficulties: Difficulty getting along with peers Interactions more negative and unskilled Disruptive in the classroom

Academic difficulties: 70% have problems learning in reading,

math, writing, or spelling Lack of sustained attention, organization,

and behavioral control lead to lower achievement.

Identification Teacher may consult school psychologist, if

ADHD suspected. Multidisciplinary team (NOT teachers) should

refer parents to a physician. Multidisciplinary team evaluates behavior

and achievement using multiple measures.

Physician (e.g., psychiatrist, neurologist) diagnoses using multiple measures.

Criteria for Diagnosis Six or more symptoms (figure 9.1) At least 6 months Two or more settings Present before age 12 More extreme than age-level peers Significant impairment in social,

academic, or occupational functioning Not accounted for by other disorders

Eligibility May qualify for special education

under Other Health Impaired if educational performance adversely affected.

May qualify for accommodations under Section 504.

Usually placed in general education classroom.

Medication Stimulants or amphetamines help control

behavioral symptoms. May reduce risk of future substance abuse. Teachers should monitor effects. Behavioral interventions help address

academic and social problems. Little research on alternative treatments

(diet, supplements, etc.)

Classroom Accommodations

Preferential seating Provide movement opportunities / breaks Shorter, more frequent tasks or tests Extended time for tests, with breaks if

needed Provide support for organization skills Increase novelty

Classroom Interventions Explicit instruction Strategy instruction Peer tutoring Computer-assisted instruction Behavior modification (e.g., token economy) Functional behavior assessment Social skills training Self-regulation

Classroom Management Provide structure, consistency, and predictability Prepare students for transitions Present instructions briefly, clearly, and visually Provide frequent, systematic and immediate

feedback, rewards, and punishments Use more rewards than punishments (3:1 ratio) Consequences must be sufficiently potent Rewards should be varied