Chapter 6 extended

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Chapter 6 extended

  1. 1. <ul><li>At the end of this presentation you should be able to: </li></ul><ul><li>Describe the characteristics of attention deficit/hyperactivity disorder. </li></ul><ul><li>Understand the different terminology and probable causes of ADHD. </li></ul><ul><li>Understand the characteristics of ADHD and it’s educational implications. </li></ul><ul><li>Describe the educational strategies that are commonly used with this population. </li></ul>Chapter 5 Objectives ADD/ADHD Chapter Objectives
  2. 2. Definition <ul><li>Neurological condition </li></ul><ul><ul><li>Failure of brain circuitry that monitors inhibition and self-control </li></ul></ul><ul><ul><li>Impairs ability to defer immediate rewards for later gain </li></ul></ul><ul><li>Inattention </li></ul><ul><li>Hyperactivity/impulsivity </li></ul><ul><li>Excessive motor activity which may be seen as non-compliance </li></ul><ul><li>Developmentally inconsistent with age of child </li></ul><ul><li>Runs in families </li></ul>
  3. 3. Case Study <ul><li>Attention video </li></ul><ul><li>http://www.pbs.org/wgbh/misunderstoodminds/attention.html </li></ul><ul><li>Nate’s story </li></ul><ul><li>http://www.pbs.org/wgbh/misunderstoodminds/meetnathanS.html </li></ul>
  4. 4. Subtypes <ul><li>ADHD (with hyperactivity) </li></ul><ul><ul><li>easier to diagnose </li></ul></ul><ul><ul><li>move continuously </li></ul></ul><ul><ul><li>trouble sitting still </li></ul></ul><ul><ul><li>poor impulse control </li></ul></ul><ul><ul><li>temper outbursts </li></ul></ul><ul><li>ADHD without hyperactivity (impulsive and inattentive form) </li></ul><ul><ul><li>withdrawn or &quot;spaced-out&quot; </li></ul></ul><ul><ul><li>poor academic achievers </li></ul></ul><ul><ul><li>occur concurrently with Learning Disabilities </li></ul></ul><ul><ul><li>excessive anxiety or shyness </li></ul></ul>
  5. 5. DSM-IV <ul><li>Three sub-types </li></ul><ul><ul><li>Predominantly inattentive </li></ul></ul><ul><ul><li>Predominantly hyperactive-impulsive </li></ul></ul><ul><ul><li>Combined types </li></ul></ul>
  6. 6. DSM-IV <ul><li>Must exhibit several characteristics </li></ul><ul><ul><li>Severity </li></ul></ul><ul><ul><li>Early onset </li></ul></ul><ul><ul><li>Duration </li></ul></ul><ul><ul><li>Impact </li></ul></ul><ul><ul><li>Settings </li></ul></ul><ul><li>At least 6 symptoms of one or both of the following: </li></ul><ul><ul><li>Inattention </li></ul></ul><ul><ul><li>Hyperactivity </li></ul></ul>
  7. 7. Symptoms <ul><li>Inattention </li></ul><ul><ul><li>Lacks of attention to detail, careless </li></ul></ul><ul><ul><li>Has difficulty sustaining attention </li></ul></ul><ul><ul><li>Does not appear to be listening when spoken to directly </li></ul></ul><ul><ul><li>Is not able to follow through on instructions </li></ul></ul><ul><ul><li>Difficulty organizing </li></ul></ul><ul><ul><li>Avoids tasks requiring mental effort </li></ul></ul><ul><ul><li>Often loses things </li></ul></ul><ul><ul><li>Easily distracted </li></ul></ul><ul><ul><li>Forgetful </li></ul></ul>
  8. 8. Symptoms <ul><li>Hyperactivity </li></ul><ul><ul><li>Fidgets/squirms </li></ul></ul><ul><ul><li>Difficulty remaining seated </li></ul></ul><ul><ul><li>Runs or climbs excessively </li></ul></ul><ul><ul><li>Difficulty playing quietly </li></ul></ul><ul><ul><li>“ On the go” </li></ul></ul><ul><ul><li>Talks excessively </li></ul></ul><ul><ul><li>Blurts out answers </li></ul></ul><ul><ul><li>Difficulty awaiting turn </li></ul></ul><ul><ul><li>Interrupts or intrudes on others </li></ul></ul>
  9. 9. Causes <ul><li>Inability of brain to filter competing sensory inputs </li></ul><ul><li>Inability to inhibit impulsive motor responses to sensory inputs </li></ul><ul><li>Possible genetic and/or biological </li></ul><ul><ul><li>Certain portion of brain (basal ganglia) is smaller in some children </li></ul></ul><ul><ul><li>Area which regulates impulses </li></ul></ul><ul><li>Non-genetic factors </li></ul><ul><ul><li>Prematurity </li></ul></ul><ul><ul><li>Maternal chemical use </li></ul></ul><ul><ul><li>Exposure to lead </li></ul></ul><ul><ul><li>Prenatal neurological damage </li></ul></ul><ul><ul><li>Influence of environment </li></ul></ul>
  10. 10. Incidence <ul><li>Symptoms apparent before 7 years of age </li></ul><ul><li>Symptoms present in two or more settings </li></ul><ul><li>Significant impairment in social, academic, or occupational functioning </li></ul><ul><li>Symptoms not occurring exclusively during a course of a mental health condition </li></ul>
  11. 11. Incidence <ul><li>1.5-2.5 million in U.S. </li></ul><ul><li>Boys - 4-9 times more likely to be diagnosed </li></ul><ul><li>Found in all cultures </li></ul><ul><li>1/3 identified with LD </li></ul><ul><li>40-60% co-exist with other conditions </li></ul>
  12. 12. Historical Account <ul><li>ADHD has been known by many names over the last century: </li></ul><ul><ul><li>Hyperactive Impulse Disorder </li></ul></ul><ul><ul><li>Hyperactive Child Syndrome </li></ul></ul><ul><ul><li>Developmental Hyperactivity </li></ul></ul><ul><ul><li>Hyper-kinetic Syndrome </li></ul></ul><ul><ul><li>Minimal Brain Dysfunction </li></ul></ul><ul><ul><li>Minimal Brain Damage Syndrome </li></ul></ul><ul><ul><li>Moral Control Deficit </li></ul></ul><ul><ul><li>Organic Drivenness (1930) </li></ul></ul>
  13. 13. Historical Account <ul><li>2500 years ago, the great physician-scientist, Hippocrates described a condition that seems to be compatible with what we now know as ADHD. </li></ul><ul><li>He described patients who had.... &quot;quickened responses to sensory experience, but also less tenaciousness because the soul moves on quickly to the next impression&quot;. </li></ul><ul><li>Hippocrates attributed this condition to an &quot;overbalance of fire over water&quot;. His remedy for this &quot;overbalance&quot; was &quot;barley rather than wheat bread, fish rather than meat, water drinks, and many natural and diverse physical activities&quot;. </li></ul>From Hippocrates: Aphorisms. In The Genuine Works of Hippocrates (Translated from greek by Fancis Adams).
  14. 14. Diagnosis <ul><li>mental health professionals </li></ul><ul><ul><li>parents and teachers observations of child </li></ul></ul><ul><ul><li>rate behavior using specific questionnaires </li></ul></ul>
  15. 15. Evaluation <ul><li>Behavioral </li></ul><ul><ul><li>Questionnaires and rating scales </li></ul></ul><ul><li>Educational </li></ul><ul><ul><li>Impact on educational progress </li></ul></ul><ul><ul><li>Classroom observation </li></ul></ul><ul><ul><li>Measurement of productivity </li></ul></ul><ul><li>Medical </li></ul><ul><ul><li>Medical exam </li></ul></ul><ul><ul><li>Questionnaires </li></ul></ul><ul><ul><li>DSM-IV criteria </li></ul></ul><ul><ul><li>Assessment of co-existing conditions </li></ul></ul>
  16. 16. Legal/Educational Requirements <ul><li>Free and Appropriate Public Education (FAPE) </li></ul><ul><ul><li>IDEA </li></ul></ul><ul><ul><li>Section 504 of Rehabilitation Act of 1973 </li></ul></ul><ul><li>Categorical placement </li></ul><ul><ul><li>“ other health impaired” </li></ul></ul><ul><ul><li>Limits strength, vitality, or alertness (response to environmental stimuli) </li></ul></ul><ul><ul><li>Significant impact on educational performance </li></ul></ul>
  17. 17. Treatment Options <ul><li>Behavioral approach </li></ul><ul><ul><li>Modify physical and social environment to alter behavior </li></ul></ul><ul><ul><li>Behavioral training </li></ul></ul><ul><li>Pharmacological approach </li></ul><ul><ul><li>Most common and controversial </li></ul></ul><ul><ul><li>Prescribing is responsibility of qualified health care provider </li></ul></ul><ul><ul><ul><li>Psychostimulants </li></ul></ul></ul><ul><ul><ul><li>Antidepressants </li></ul></ul></ul><ul><ul><ul><li>Anti-anxiety medications </li></ul></ul></ul><ul><ul><ul><li>Antipsychotics </li></ul></ul></ul><ul><ul><ul><li>Mood stabilizers </li></ul></ul></ul>
  18. 18. Treatment Options <ul><li>Multimodal approach </li></ul><ul><ul><li>Combination of approaches </li></ul></ul><ul><li>Educational approach </li></ul><ul><li>http://www.pbs.org/wgbh/misunderstoodminds/attentionstrats.html#suggestions </li></ul><ul><ul><li>Mental energy </li></ul></ul><ul><ul><li>Processing </li></ul></ul><ul><ul><li>Production </li></ul></ul>
  19. 19. Discussion <ul><li>Parent perspective </li></ul><ul><li>http://www.pbs.org/wgbh/misunderstoodminds/attentionbasics.html </li></ul><ul><li>Does AD/HD exist? </li></ul><ul><li>http://www.pbs.org/wgbh/misunderstoodminds/attentiondiffs.html </li></ul><ul><li>Medication debate </li></ul><ul><li>http://www.pbs.org/wgbh/misunderstoodminds/attentionstrats.html </li></ul>
  20. 20. Educational Implications <ul><li>Consistent failure to understand or follow school rules </li></ul><ul><li>Frequent classroom interruptions </li></ul><ul><li>Poor academic performance </li></ul><ul><li>Lower daily grades </li></ul><ul><li>Failed courses </li></ul><ul><li>Expulsions </li></ul><ul><li>Increased dropout rates </li></ul><ul><li>Low rate of college-bound students </li></ul>
  21. 21. Inattention <ul><li>Missing important details </li></ul><ul><li>Daydreaming </li></ul><ul><li>Difficulty organizing materials/assignments </li></ul>
  22. 22. Hyperactivity <ul><li>Verbal or physical disruptions </li></ul><ul><li>Constant movement </li></ul><ul><li>Blurting/interrupting </li></ul>
  23. 23. Impulsivity <ul><li>Careless errors </li></ul><ul><li>Giving answers before thinking </li></ul><ul><li>Attending only to entertaining or novel activities </li></ul>
  24. 24. Approach to AD/HD in the classroom <ul><li>Collaborate between home and school </li></ul><ul><li>Develop a behavior plan </li></ul><ul><li>Feedback on response to medications </li></ul><ul><li>Positive behavioral intervention plan </li></ul><ul><li>Student input </li></ul><ul><li>Work on most difficult concepts early in the day </li></ul><ul><li>One assignment at a time </li></ul><ul><li>Vary pace and types of activities </li></ul><ul><li>Structure student environment </li></ul>
  25. 25. Approach to ADHD at home <ul><li>Discreet rewards and consequences </li></ul><ul><li>Daily routine </li></ul><ul><li>Time-out from reinforcing behaviors </li></ul><ul><li>Use tangible reminders </li></ul><ul><li>Be consistent when responding to inappropriate behaviors </li></ul><ul><li>Avoid surprise consequences </li></ul>
  26. 26. Activity <ul><li>http://www.pbs.org/wgbh/misunderstoodminds/attention.html </li></ul>

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