Chapter 5: Learners
with Attention Deficit
Hyperactivity Disorder
Jason Cumming
TECP 50
Dr. Dunn
31 July 2013
History of ADHD
1798: Sir Alexander Crichton defines attention and
inattention in “On Attention and its Diseases.”
• Disti...
1899: Psychiatrist Thomas Smith Clouston writes on the “state
of excitability and mental explosivness in children”
1902: D...
1940s: Heinz Werner and Alfred Strauss conduct study
on children with Minimal Brain Damage, leading to
the diagnosis of th...
1957: Laufer and Denoff define as “Hyperkinetic Impulse Disorder
in Children’s Behavior Problems” in Psychosomatic Journal...
Identification of ADHD: Ruling out all
other options
 Medical Examination
 Is there a medical reason (tumors, thyroid
co...
Identification of ADHD: Ruling out all
other options (con’t)
 Behavioral Observations
 Continous Performance Test
 Stim...
Diagnostic Criteria
Either one of the following:
• Inattention
• At least 6 of 9 criteria set forth by DSM-IV must have
pe...
Other Criteria for Diagnosis of ADHD
 Any symptoms that caused impairment prior to age 7
 Any symptoms cause impairment ...
Diagnosis of ADHD: Coding the Condition
 Attention-Deficit/Hyperactivity Disorder, Combined Type
 Both conditions for Di...
What Causes ADHD?
 Neurological Dysfunction -Consistent Abnormalities found in
areas of the brain.
 Prefrontal and Front...
What causes ADHD? (con’t)
 Heredity
 Parents of ADHD children have a greater chance of also
having ADHD
 Siblings of ch...
Characteristics of ADHD
 Lack of Behavorial Inhibition
 Inability to control responses in
social, academic, and/or occup...
Characteristics of ADHD (con’t)
 Lack of Executive Functions
 Inability/difficulty manipulating working memory
 Forgetf...
Characteristics of ADHD (con’t)
 Time Awareness / Management
 Diminished problem-solving ability
 Inability to navigate...
Characteristics of ADHD (con’t)
 Lack of Persistent Goal-Directed Behavior
 Problematic manipulation of executive functi...
Characteristics of ADHD (con’t)
 Problems Socializing with Peers
 Negative Social Status
 Long-lasting reaction to peer...
Educational Consideration
Effective Educational Programming
 Classroom Structure / Direction
 Reduce irrelevant stimulus...
Educational Considerations (con’t)
Classroom Structure / Direction
Introduction of Lessons
Provide an organizer and hel...
Educational Considerations (con’t)
 Classroom Structure / Direction
 Conducting Lessons
 Consistent structure and routi...
Educational Consideration (con’t)
 Functional Behavior Assessment (FBA)
 Know the antecedents to undesired behavior
 Co...
Educational Considerations (con’t)
U.S. Department of Education doesn’t recognize ADHD as
a special education category.
 ...
Medicating ADHD
History
 Benzadrine (1932)
 Originally thought disorder was to be a result of
encephalitis
 Charles Bra...
Effectiveness of Medicating ADHD
Psychiatry Journals have been documenting the success of
medicating disorder patients sin...
Cautions Regarding Medicating ADHD
 Premature Medication Determination
 Don’t prescribe at the first sign; go through fu...
Assessing Progress of the ADHD Student
 Progress Monitoring
 Students with ADHD commonly are diagnosed with learning
dis...
Transitioning to Adulthood
 Studies completed as late as 2008 have shown that about
50% of those diagnosed as children re...
QUESTIONS?
Thank you!
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Chapter 5

  1. 1. Chapter 5: Learners with Attention Deficit Hyperactivity Disorder Jason Cumming TECP 50 Dr. Dunn 31 July 2013
  2. 2. History of ADHD 1798: Sir Alexander Crichton defines attention and inattention in “On Attention and its Diseases.” • Distinguishes abnormal inattention as “oppositional poles of pathologically increased or decreased “sensibility of the nerves” 1865: Dr. Heinrich Hoffmann composes “The Story of Fidgety Philip” in his book, Struwwelpeter. It is the first work of literature that alluded to observation of behaviors similar to today’s definition of ADHD
  3. 3. 1899: Psychiatrist Thomas Smith Clouston writes on the “state of excitability and mental explosivness in children” 1902: Dr. George Frederic Still presents the concept of psychical conditions with “abnormal defect of moral control” in children during the “Goulstonian Lectures” at the Royal College of Physicians of London, calling for his colleagues to scientifically investigate the condition. 1932: Dr. Franz Kramer and Dr. Hans Pullnow provide their first reference to the disorder, “Über eine hyperkinetische Erkrankung im Kindesalter“ (Hyperkinetic Disorder in Children). 1934: Eugene Kahn and Louis Cohen publish Organic Driveness in the New England Journal of Medicine from observations of hyperkinesis in children who had encephalitis that affected parts of the brain, and left resulting characteristics that are now the basis for diagnosis of ADHD.
  4. 4. 1940s: Heinz Werner and Alfred Strauss conduct study on children with Minimal Brain Damage, leading to the diagnosis of the Strauss Syndrome. 1957: William Chuickshank conducts a study using children with Cerebral Palsy to discover that children without Mental Retardation can still display distractability and hyperactivity characteristics. 1957: Dr. Leon Eisenberg summarizes prominent Clinical Features in the Psychiatric Journal with his article, Psychiatric Implications in Brain Damaged Children.
  5. 5. 1957: Laufer and Denoff define as “Hyperkinetic Impulse Disorder in Children’s Behavior Problems” in Psychosomatic Journal 1958: APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM-II) establishes first diagnostic criteria for professionals/practioners. 1970: Canadian Virginia Douglas writes “Specific Disabilities of Hyperactive Children”, naming the condition we currently know as “Attention Deficit Disorder, with or without hyperactivity”. 1980: APA’s DSM-III first uses “Attention Deficit Disorder, with or without hyperactivity” in the APA’s DSM. 2000: DSM-IV-TR provides the Contemporary Concept of ADHD and establishes the diagnostic criteria currently in use.
  6. 6. Identification of ADHD: Ruling out all other options  Medical Examination  Is there a medical reason (tumors, thyroid condition, seizures) for inattentiveness/hyperactivity?  Clinical Interviews  Interview is conducted with parents and child (separately)  Provides information on physical and psychological characteristics, family dynamics and home life, and social skills  Ratings Scales  Completed by teachers, parents, and children  Based upon 18 criteria set forth by DSM-IV
  7. 7. Identification of ADHD: Ruling out all other options (con’t)  Behavioral Observations  Continous Performance Test  Stimuli flashing on the screen; Measures reaction to stimuli and attentive ability.  Tracks correct and incorrect responses, omissions, and responses to wrong stimulus  Classroom Observations  May have student brought into specially designed classroom to observe tasks completed and the manner/time tasks are completed.
  8. 8. Diagnostic Criteria Either one of the following: • Inattention • At least 6 of 9 criteria set forth by DSM-IV must have persisted for at least 6 months. • Hyperactivity-Impulsivity • At least 6 criteria of the 6 Hyperactivity and 3 Impulsivity (combined) must have persisted for 6 months • All Behaviors must exist to a degree that hinders the ability to function and learn consistently at the developmental level expected of age and normal capability.
  9. 9. Other Criteria for Diagnosis of ADHD  Any symptoms that caused impairment prior to age 7  Any symptoms cause impairment in two or more settings (home, work, school, social settings)  Clear evidence of significant impairment on ability to function in settings such as social, academic, or occupation.  The symptoms do not occur during the presence of or are accounted for in other mental disorders
  10. 10. Diagnosis of ADHD: Coding the Condition  Attention-Deficit/Hyperactivity Disorder, Combined Type  Both conditions for Diagnosis are met  Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type  “Inattention” conditions are met, but “Hyperactivity- Impulsivity” conditions are not met  Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive  “Hyperactivity-Impulsivity” conditions are met, but “Inattention” conditions are not  “In Partial Remission” when some symptoms are no longer met
  11. 11. What Causes ADHD?  Neurological Dysfunction -Consistent Abnormalities found in areas of the brain.  Prefrontal and Frontal Lobes – Controls the functions to regulate behavior.  Basal Ganglia – Controls coordination and motor behavior.  Caudate and globus pallidus; present in the brain behind the frontal lobes.  Cerebellum – Assists in control of motor skills, contains half of all neuron’s in the brain.  Corpus Callosum – Connects the brain’s hemispheres for cognitive functions.
  12. 12. What causes ADHD? (con’t)  Heredity  Parents of ADHD children have a greater chance of also having ADHD  Siblings of children with ADHD have 32% chance of having ADHD  Children of Adults with ADHD have 57% chance of having ADHD  Twins: Identical Twins more likely to share disorder than fraternal twins  Toxins and Medical Factors  Consumption and/or use of drugs and/or tobacco place the unborn child at an increased risk of ADHD.
  13. 13. Characteristics of ADHD  Lack of Behavorial Inhibition  Inability to control responses in social, academic, and/or occupational settings  Waiting in line or in turn  Response elicits interruptions of class, situations, or settings  Hold normal level of attention on task when subordinate distractions arise.  Evidence points to abnormalities in the caudate of the basal ganglia.
  14. 14. Characteristics of ADHD (con’t)  Lack of Executive Functions  Inability/difficulty manipulating working memory  Forgetfulness, time management, thought processes  Inability/difficulty following rules, guidelines, and/or instructions  Inability/difficulty managing emotions and reactions to stimuli (positive or negative).  Overreactions, over-dramatizations
  15. 15. Characteristics of ADHD (con’t)  Time Awareness / Management  Diminished problem-solving ability  Inability to navigate or overcome obstacles in goals  Diminished ingenuity  Tendency to give up when tasks become more difficult  Diminished flexibility  Greater tendency to react on impulse because of inability to control emotions  Inability to assemble thoughts in an organized and coherent manner, taking longer or unable to complete goals. Lack of
  16. 16. Characteristics of ADHD (con’t)  Lack of Persistent Goal-Directed Behavior  Problematic manipulation of executive functions lead to inability or difficulty navigating, participating, and/or completing goal-directed activities  High variability in progression and production rates during work strategies.  Inconsistent accuracy, performance, or quality of work  Lack of ability for Adaptive Behavior
  17. 17. Characteristics of ADHD (con’t)  Problems Socializing with Peers  Negative Social Status  Long-lasting reaction to peer rejection  Stemming from the inability to control emotions
  18. 18. Educational Consideration Effective Educational Programming  Classroom Structure / Direction  Reduce irrelevant stimulus in the classroom  Bright colored posters, shining objects near or opposite windows  Clear, defined routines  Concrete directions, expectations, and guidelines  Loose timelines to reduce the distraction of tight deadlines.  Displayed schedule and timetables for easy reference by students
  19. 19. Educational Considerations (con’t) Classroom Structure / Direction Introduction of Lessons Provide an organizer and help them to use it Working towards establishment of independence with self-monitoring Review lessons Set Expectations and Needed Materials/Resources Simple directions, choices, scheduling
  20. 20. Educational Considerations (con’t)  Classroom Structure / Direction  Conducting Lessons  Consistent structure and routine  Encourage participation with cues for tasks, calling upon, etc. (Teach like a Champion is a great book for strategies on this subject)  Keeping tasks in smaller units to allow for evaluation and self-monitoring  Eliminate Timed Tests  Students won’t be preoccupied with time elapsed or time remaining; reduce stressors/pressure
  21. 21. Educational Consideration (con’t)  Functional Behavior Assessment (FBA)  Know the antecedents to undesired behavior  Confirm the consequences for undesirable behavior  Develop strategies for maximizing occurrence of positive/desired behaviors  Contingency-based self-management  Student tracks own behavior, receive rewards and consequences based upon behavior  Use together for maximum awareness and performance independence
  22. 22. Educational Considerations (con’t) U.S. Department of Education doesn’t recognize ADHD as a special education category.  Actual statistics relating to diagnosed students, actual students, and students receiving services is a giant disparity in number from the students who should be receiving services.  While some students respond well with inclusion (mainstreaming), others respond better in self- contained environments with other ADHD students
  23. 23. Medicating ADHD History  Benzadrine (1932)  Originally thought disorder was to be a result of encephalitis  Charles Bradley’s “The Behavior of Children Receiving Benzadrine” documents the increased performance of students taking Benzedrine sulfate; also discusses dosage, side effects, unfavorable responses, and duration effects. (1937)  Methylphenidate  Trademarked as “Ritaline” in 1954  Helps to control the neurotransmitters, dopamine and norepinephrine  Most common medication prescribed; psychostimulant
  24. 24. Effectiveness of Medicating ADHD Psychiatry Journals have been documenting the success of medicating disorder patients since 1937:  Charles Bradley, “The Behaviour of Children Receiving Benzedrine” (1937)  Matthew Molitch and John Sullivan, “The Effect of Benzedrine Sulfate on Children Taking the New Stanford Achievement Test” (1937)  Maurice Laufer and Eric Denhoff: “Hyperkinetic Impulse Disorder in Children’s Behavior Problems” (1956)  C. Keith Connors and Leon Eisenberg; “The Effects of Methylphenidate on Symptomatology and Learning in Disturbed Children (1963)
  25. 25. Cautions Regarding Medicating ADHD  Premature Medication Determination  Don’t prescribe at the first sign; go through full diagnosis procedures, ratings, criteria, and tests.  Medicating doesn’t increase accuracy on achievement tests. Behavior may improve, rate of task completion may increase, but there has been very little increase in the results of standardized achievement tests  There should be a level of responsibility for taking the medications and reinforcement of taking self- responsibility of the student’s actions and initiative.  Communicating dosage between school, parents, physicians, and student, as well as the
  26. 26. Assessing Progress of the ADHD Student  Progress Monitoring  Students with ADHD commonly are diagnosed with learning disabilities or intellectual disabilities.  Monitoring of all aspects of the student’s experiences during the school day needs to be paramount to insure strategies are working.  Curriculum-based measurement (CBM)  Minimal time and task-focused measurement caters to the ADHD student in a positive way.  Monitoring Behavior  Rating scales  Direct observation  Can work with FBAs for Reward Consequence
  27. 27. Transitioning to Adulthood  Studies completed as late as 2008 have shown that about 50% of those diagnosed as children retain ADHD symptoms into adulthood.  Prevalence Rate of 4 -5% of adult ADHD diagnosis (similar to that of youth)  ADHD Coaching is very important for success in employment, relationships, and personal triumphs.
  28. 28. QUESTIONS? Thank you!

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