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What is Attention Deficit Disorder?

Your Go-To Guide for the most up-to-date strategies for understanding ADD/ADHD and attention skills. This page is designed to help you move along the ADD spectrum from frustration to elation and to give you a better understanding of what it really means to pay attention.

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What is Attention Deficit Disorder?

  2. 2. A New Way Of Thinking About Paying Attention A PARENT’S GUIDE TO UNDERSTANDING ATTENTION DEFICIT DISORDER He can’t focus. She can’t sit still. The teacher called and said he is disruptive in the classroom. If you are thinking that it sounds like Attention Deficit Disorder (ADD), you might be right. But then again, maybe not. As parents, we want our children to be successful, happy, contributing members of society. So when we suspect that our child might have ADD, it can be very discouraging. But the good news is that suspecting that your child might have ADD is not an endpoint—it’s a starting point. For the past 20 years, Oxford Learning has worked with children who have problems paying attention. We’ve implemented a unique hands-on approach that has allowed for the development of many wonderful programs and ideas. Our unique strategies help parents and teachers work with distractible and inattentive children who have gone on to become effective, successful students. -2-
  3. 3. We know that every child can learn and grow. We also believe that all children—even those with a severe ADD—can learn to develop new methods of control, awareness, and thought, and that they can become fully functional members in their classrooms and ultimately in society. So, how does a child get an attention deficit? Is there anything you can do about it? Whose fault is it? Until now, too much attention has been paid to the disability part of ADD and too little to the ability part. That’s the part we can work with. Even though the development of better concepts is ...very few the primary area of damage for children with ADD, very few programs actually exist that teach programs ADD kids how to think more clearly. actually exist Teachers often complain that ADD kids fall behind in school. But it really doesn’t matter how that teach much stuff from the curriculum that students miss. The real problem is that they fail to develop ADD kids efficient thinking processes. More to the point, most teachers and students do not know that paying attention is a learned skill. Your child can learn it. how to think more clearly. Does My Child Have ADD? Let’s begin with a critical distinction. A simple attention deficit (Attention Deficit Disorder, or ADD) is one that involves the child’s ability to pay attention even when she or he is sitting still. Hyperactivity and impulsivity (Attention Deficit Hyperactivity Disorder, or ADHD) refers to the child who always fidgets or moves or suddenly bursts into unexplained action. According to the most up-to-date diagnostic checklists, certain behaviors are considered to be warning signs that a child may be suffering from ADD or from ADHD. Read the Symptoms List -3-
  4. 4. and Early Warning Signs List and ask yourself if you noticed any of the symptoms they describe when your child was younger. If you did, you can then obtain copies of the Teacher’s Checklists and use the Tracking List that is provided in section 5. Use the results from these checklists—which address early warning signs and symptoms—along with the results from any formal assessments or medical consultations to get a comprehensive evaluation of your child’s attention skills. This information can help you and your family doctor make the correct diagnosis. 1. Symptoms Attention Deficit Disorder Attention Deficit Hyperactivity Disorder √ Has difficulty following directions and √ Has trouble remaining seated completing assignments √ Fidgets, squirms, and moves constantly √ Has difficulty organizing tasks, activities, √ May talk excessively and time √ May have trouble playing alone √ Misses details or makes careless mistakes in √ May seem to be always “on the go” as if schoolwork “driven by a motor” √ Avoids or dislikes tasks requiring sustained √ May have trouble playing quietly mental effort √ Seems to run and climb everywhere √ Often loses things or is forgetful √ Interrupts adults, teachers or other children √ Prefers uncomplicated tasks √ Blurts out answers √ Does not seem to listen √ Has trouble waiting turn √ Is easily distracted √ Can be impulsive -4-
  6. 6. 3. Resources for Your Child’s Teacher The ADD-H Comprehensive Teacher’s Rating Scale (ACTeRS) This is a new scale that focuses primarily on the twin issues of attention deficit and hyperactivity. This makes a great distinction between the hyperactivity component and the attentional component. Contrary to popular belief, these two issues are found together in less than 20% of the population of diagnosed ADD children today. The Conners Teacher Rating Scale (CTRS) This is probably the most widely used and best-known checklist for teachers. It consists of 28 questions that measure four factors: hyperactivity, hyperactivity index, behavior, inattention, or passivity. Used in conjunction with the Conners Parent Rating Scale (CPRS), the two allow a comparison that will help identify the child who is struggling in the class but not with the rest of his or her life. The Child Behavior Checklist (CBCL) by Achenbach This is another popular teacher checklist consisting of 112 questions that yields ratings on anxiety, aggressiveness, delinquency, depression, withdrawal, obsessiveness, somatic complaints, and hyperactivity. The CBCL is much more diagnostic than the CTRS in rating and defining emotional and behavioral factors, but it lacks the comparative checklist for the parent. -6-
  7. 7. 4. Diagnostic Questionnaires for the Parent The Conners Parent Rating Scale (CPRS) This is the most widely used parent questionnaire. We recommend the longer version as it yields some information on anxiety, behavior, psychosomatic issues, learning problems, impulsivity, and hyperactivity. As well, it provides a hyperactivity index. The Home Situation Questionnaire (HSQ) This is an easy-to-use checklist that may help you to distinguish between normal behavior and ADHD behavior. There are 16 categories in which parents are asked to judge behavior in each category. If children exhibit excessive behavior in seven or more areas, it is considered that the behavior parallels that of ADHD children. However, there is one possible difficulty with this instrument. Children with high scores prompted by emotional issues may appear to be ADHD, so care must be taken in interpreting the results. 5. Make a Tracking List In our early years, we worked with a terrific young man by the name of Ryan. He had flaming red hair, couldn’t sit still, and would eat only peanut butter sandwiches. When we started to work with Ryan at the teaching stations, he would suddenly disappear below the table. His school had warned us that he was probably ADD. His family doctor had asked us to help. Mom had been given a prescription for medication (Ritalin), but wanted more for Ryan than just medication. We used a Tracking List to observe his behavior and concluded that he was not ADD. When he ducked under the table or ran around the room, he was responding to his emotional needs. We -7-
  8. 8. believed that, with help, he could learn to control this behavior by himself. It was triggered by anxiety. We needed to develop new strategies to help Ryan deal with this anxiety. We decided that there was to be no judgment involved. It was neither right nor was it wrong when Ryan dove under the table or ran around the room. Rather than get upset and engage in a struggle for control, we climbed under the table with Ryan and announced that we were going to teach him to read in either place! Soon, his anxiety lessened and he began to trust us. He was willing to work above ground a little more. Sometimes we still had to climb under the table just to show him that we were serious, but it was not judgmental, it was respectful. If Ryan needed to be there, so did we. We believed that he could regulate his own behavior. It worked. The point of this story is that Ryan’s mom never had the prescription for Ritalin filled. She gave him a little time and he overcame the problem himself. He was not a true ADD child. Today, Ryan is in high school and getting A’s! Without the Tracking List, we might have agreed with the ADD suggestion, and Ryan’s story would have been totally different. Use the Tracking List included. Make lots of copies, and use it to observe behavior over at least a four month period and in many different situations. Do not observe your child always doing the same activity. If there is a real ADD, it will come through. Make a mark every time you observe an actual incidence of the behavior. Do not overkill—we are all somewhat distractible, so give your kid a break. You have to do this many times. If there is an actual ADD, you will not have to invent it. -8-
  9. 9. TRACKING LIST (make lots of copies) Date:_________Time:_________ Activity:_____________________________________________ Using the numbered scale, estimate the occurrences of this behavior that you observed on this date. (1: occurred rarely; 10: occurred frequently) DOES THIS BEHAVIOR DESCRIBE THE STUDENT? (1 2 3 4 5 6 7 8 9 10) • Has trouble following directions, completing work ____ • Has trouble organizing tasks, activities and time ____ • Misses details or makes careless mistakes ____ • Avoids or dislikes tasks requiring sustained effort ____ • Often loses things or is forgetful ____ • Often does not seem to listen ____ • Is easily distracted ____ • Can be impulsive ____ DOES THIS BEHAVIOR DESCRIBE THE STUDENT? (1 2 3 4 5 6 7 8 9 10) • May have trouble remaining seated ____ • Moves constantly ___ • May talk excessively ____ • May have trouble playing by self ____ • May have trouble playing quietly ____ • Seems to run and climb everywhere ____ • Interrupts adults, teacher, other children ____ • Blurts out answers ____ -9-
  10. 10. 6. Psychoeducational Assessment Observing behavior alone is often insufficient to identify ADD. Testing can be extremely valuable in making the final diagnosis. For a complete psychoeducational evaluation, it will be necessary to use test instruments that measure the following: √ Oral Language: Since the development of good language skills is essential for efficient thinking and is most often affected by ADD, this evaluation will help you to determine the depth of the problem. √ Non-Verbal Intelligence: Many students show great promise in this area yet exhibit many Observing signs of ADD. Scoring in the above average range would be difficult for a child with a significant behavior attentional weakness. This test may help you discover much about your child’s potential. √ Various Cognitive Skills: Thinking skills such as visual memory, verbal memory, combined alone is often memory, short-term and long-term memory, analysis, synthesis, and abstract reasoning are insufficient to covered. Clues to the areas most affected by the attentional weakness are exhibited here. identify ADD. √ Central Auditory Processing (CAP): There are a variety of simple CAP tests appropriate for the psychoeducational test situation. This will not be as complete an evaluation as the audiologist will give, yet a CAP weakness masquerading as ADD may become evident here. If so, ask your family doctor to refer your child for CAP testing immediately. √ Academic Evaluation: It will be important to know just how basic skills—reading, writing, spelling, grammar and math—have been affected by the problem. Take the results of the testing with you when you confer with your family physician or learning professional. - 10 -
  11. 11. Don’t Think of Attentional Weaknesses as a Disability It is time to stop making kids into victims. Using the most modern tests and checklists, competent professionals are identifying kids with ADD at an alarming rate. Once this diagnosis has been made, these kids are identified as having a deficit! When we are confronted with a child who does not seem to Why then, be able to pay attention, our first assumption should not be when a child that they cannot pay attention, but rather that they are just cannot pay not paying attention. attention, Consider the following: You would never say, “My child cannot play the piano! He must have piano do we first disability!” If your child cannot play the piano, the reason is usually that he has never learned how! assume that Why then, when a child cannot pay attention, do we first assume that he must have a deficit? he must have We need to adopt a major paradigm shift. A change in our thinking keeps paying attention in the a deficit? realm of the possible. It assumes that, before we panic and turn to medicine and other drastic measures, we will attempt to teach the child how to pay attention. It assumes that the child has something to do with this, that the child will be, and has to be, a willing and major participant in the process. It is an active process, not a passive one. - 11 -
  12. 12. Can Someone Learn to Pay Attention? Many children do suffer from legitimate attention deficits. But that finding just hides the main issue— that many, if not most, of the attentional problems encountered in today’s classrooms are the result of learned behavior and not true disabilities. Most kids can’t pay attention because they have not learned how. We don’t need to stop measuring and testing kids, but we do need to reconsider our lifestyles and the ways that we teach children. The Pace of Family Life Recently, I opted to leave work a few minutes early and spent the entire evening reading and talking with my two younger children. It just happened to be a night without a hockey practice, a dance lesson, a piano lesson, or a friend visiting. My 11-year-old son wanted to know about factors, and I had the time to figure it out and teach him. That was fun! There is a message in this: We all need to take time in our lives for quiet moments and to properly pace our lives. Television, Movies and Video Games Take out a stopwatch and time the intervals between cuts in any TV show or movie. (A cut is the length of time the camera keeps the same focus or viewpoint.) Most intervals are broken into 3 and - 12 -
  13. 13. 4 second units! That’s right, a few seconds is all you usually get before a new image is flashed on the screen in front of you. Watch enough television and you may be training your conscious mind to work in similar short, fast bursts. The same thing happens in shows that teach children how to read! Seconds is all that we are giving our children to see, integrate, and learn. And who could have imagined that even kids who seem unable to follow simple instructions in class are able to progress to the 87th level of the video game of the year? Processing information simultaneously and instantly, our children are often glued to these games for hours. While this may Students help them become fighter pilots, it may not be helping them learn to concentrate and integrate certainly information in a classroom. need more Generally, teachers require more than three or four seconds to teach a concept. Students certainly need more than a few seconds to understand and integrate. than a few seconds to The Death of Reflection understand and integrate. Last weekend, my daughter filled our house with friends. They created forts and nurseries and schools and stores. Every kid was assigned a task. Some were storekeepers. Some were parents. Some were infants. Before assuming their roles, almost every child went about preparing for their role. Many rearranged their space while talking to themselves about who they were and how they would act. This was very interesting for me. They made time to reflect and consider… they prepared! They created their own space and demanded enough personal time to get ready to have fun. Compare this with the typical classroom. There is little time for quiet reflection and even less personal - 13 -
  14. 14. space. My daughter had more time to prepare for play than most kids have to learn math or reading. She and her friends knew that they needed to concentrate, so they created an environment where that would be possible. When her older brother tried to intrude and rush the pace of the game, he was roundly defeated and shooed off to his corner until everybody was ready. It seems that, left to their own devices, kids understand the need for quiet reflection, concentration, and paying attention. We are jamming so Crowded Curriculums and Classrooms much useless Classrooms are getting more and more crowded as governments try to balance education budgets. and irrelevant In one high school in my district, there are neither enough books nor enough desks for the kids. information Many sit on the floor and share textbooks. With this crowding, the noise level has increased and into their students are having difficulty concentrating. heads , there Add to this the demands of our enlightened society. We demand that schools teach whatever is no time for ethical values are currently popular in our politically correct society. Unfortunately, this just creates reflection or crowded minds to go along with the crowded classrooms. We are jamming so much useless and irrelevant information (facts, dates, figures, names, formulas, etc.) into the heads of our children so concentration. quickly, with no time for reflection and no place for concentration, that they are not learning—they They are not are just memorizing. learning, just In fact, this is creating two classes of kids—those who can figure out the school game (memorizing memorizing. without necessarily understanding) and those who cannot. Sadly, if you have a good memory for unrelated information and you are willing to cram as much as the curriculum requires into your mind without questioning, or perhaps even understanding, you will be a good student today. - 14 -
  15. 15. Is It Any Wonder? I am not arguing that attention deficits do not exist. Some real attention deficits exist and require treatment and programming. Children with true ADD or Central Auditory Processing Deficits cannot pay attention, but most kids today do not suffer from these disorders – they merely have a short attention span – because paying attention is a learned skill. These kids are trained to be that way by the way they acquire language and develop concepts; by the pace of modern life; and by the influence of television, movies, and video games. The forces of brief TV cuts, constant motion, and their busy, busy lives have trained their cognitive process to look for quick bites and fast answers. And our early development of language as a tool of communication rather than of thinking has internalized the way in which we pay attention and think. We are creating children with passive minds and short attention spans. Go and sit in a Kindergarten, Grade 1, 2, or 3 classroom for two hours. You will see that programs are based on the Activity Based Learning Theory. This theory says that kids who can do what they want, who are given a chance to roam between many different tasks, will eventually choose something and will discover wisdom. The actual formula is: Interest + Activity = Discovery + Knowledge. So in many classrooms today kids can be found moving endlessly from one centre to another. An amazing noise level! Confusion, disruptions, and lots of botherment, as Eeyore might say! - 15 -
  16. 16. A Simple Game For years we have been working with ADD children at Oxford Learning by using a simple game. We begin by placing a small device consisting of approximately 20 beads strung out on a wire that has been embedded into a piece of wood in front of the student. We do this before we begin to work on any school-related task, such as reading, writing, or math. We push all the beads to the left side of the wire, and as soon as the student becomes distracted or goes off-task, we click one bead over to the right side. We do not explain to the kids what we are doing. We do not tell them that we want them to learn new skills. We merely want to make them aware of how their minds work. Significant It is important to us that we never imply that it is wrong to become distracted. Kids who are change must distractible are merely following their own truths. That is how they are. Accept this, because come from significant change must come from within or it will not come at all. within or it Awareness is the key. After working with kids in this environment for a few months, they begin to be aware of the fact that their attention drifts. will not come at all. Most kids accept the workings of their minds as a given. Just as we do not fret about how to make our Unfortunately, hearts pump, so too do we not express concern about how our brains work. while the rest of our bodies work more or less automatically, our brains require training and exercise. By the time a child is in school and is having difficulty with attention, many undesirable behaviors have become automatic. The road back is through awareness. Help kids to become aware of what their minds are doing. - 16 -
  17. 17. A Plan of Action Play the Attention Game Most children are unaware of the actions of their minds, so they are unaware of being off-task. By the time your child is school age, self-awareness is a concept that can be readily understood. You can model awareness of what the mind is doing earlier, and many children will get it, but don’t be discouraged if your child does not. Guides for Reading. Younger Children: Use activities that your child understands—for instance, the game of catch played with a soft ball—and demonstrate both paying attention and not paying attention…and their 1. Keep your eyes consequences. Throw the ball to your partner. When it is caught, tell your child “See, Mom was on the page. paying attention and she was able to catch the ball.” Then have someone throw you the ball when 2. Ask, “Am I on you are looking somewhere else. After it bounces off your face, say “Oh! I wasn’t paying attention.” the correct page?” Do it again with a story. Describe what it means to pay attention, and then read the story aloud. Discuss the events of the story. “I remember that stuff because I was paying attention.” 3. Ask, “Am I listening? Can I School-Age Children: Have someone read to you. Begin by having a small monologue with answer questions yourself. “OK, now I am going to hear a story. I am going to pay attention because I am interested about the story?” in the story.” Let the reading begin for a few moments then ask your child to tell you how well she thinks you are paying attention. If she doesn’t know, teach theses guides for reading. 1. Keep your eyes on the page. 2. Ask yourself, “Am I on the correct page?” 3. Ask yourself, “Am I listening? Can I answer questions about the story?” - 17 -
  18. 18. Continue with the exercise, but look away from the reader after a few more moments. Begin to hum a tune and tap your fingers. Then ask your child how you are doing. By teaching kids how to observe and grade our performance, we will be helping them to automate the process and principles of paying attention. When your child tells you that you weren’t paying very good attention, agree and explain, “ Yes, I started out OK, but soon I started to hum a song that I enjoy, and I forgot to listen.” The last element to introduce is the mental holiday: day-dreaming. This is when you look like you are paying attention, but you really are not. Laugh when you catch her not paying attention. This game can go on for months. While you are playing, your child will be learning the deep methods and rules without stress. Play this game often and in many different situations. Be goofy! Be outrageous! It’s not homework—it’s fun. When your child doesn’t want to play, stop immediately. Eventually you will be able to generalize the rules to: 1. “Am I watching (the page, the teacher, etc.)?” 2. “Am I doing the right activity?” 3. “Am I paying attention? Can I answer questions about this activity?” Measure the Attention Span After you have played the Attention Game until your child is a master, you will be ready to move on to the next phase: measuring his or her attention span. Once again, the object of this phase is awareness. Set goals. Write the following on a 3’ x 5’ card. - 18 -
  19. 19. I Can Pay Attention! My goal is to pay attention for _______ seconds or _______ minutes To do this, I must: 1.____________________________________________________________ 2.____________________________________________________________ 3.____________________________________________________________ 4.____________________________________________________________ # I Can Pay Attention! My goal is to pay attention for _______ seconds or _______ minutes To do this, I must: 1.____________________________________________________________ 2.____________________________________________________________ 3.____________________________________________________________ 4.____________________________________________________________ - 19 -
  20. 20. DEALING WITH ATTENTION PROBLEMS AT HOME Begin by making sure that your child actually has ADD. We have already discovered that most kids simply have not learned to pay attention. This lack of skill, when combined with anxiety, lack of confidence or low self-esteem, can produce a condition that looks like ADD. Here are some rules and suggestions that should help around the home. Get everybody involved. It is a family project. A NEW WAY OF THINKING Most kids It’s Not Your Fault simply have ADD is not your fault. It was not caused by something you ate while pregnant or something you said. not learned In many cases, the primary symptoms disappear after your child has learned new attention skills. Do to pay not personalize your child’s problem. It has nothing to do with you! Your self-worth is not tied to his or her achievements or behaviors. Stay calm, be objective and try to maintain a sense of humor. attention. Do Not Battle For Control Do not get into control battles with your child. He or she is just trying to survive and is not trying to make you crazy. Be careful not to structure situations where control will be an issue. Do not offer choices where one choice is good and the other bad. Offer two good choices only. - 20 -
  21. 21. Share Your Time Sometimes, it will seem as if the ADD child requires all of your attention. Not so. Share your time evenly. ADD kids must learn the lessons of self-responsibility at some point. It is better and safer to learn this at home than at school. Focus On Success Encourage positive statements. Break the cycle of negativity that surrounds your child. Too much emphasis has already been placed on what she or he cannot do. Forget that. Look at what she or he can do and celebrate it. Add Is Not A Disability. Don’t Make It One Kids can change. They do. Do not let ADD become a crutch. “I can do it!” should always be the standard. If you have a child who appears to be ADD, do not let the rest of the family or friends brand the child as different. Get rid of the expectations that this child will screw up or have trouble. These expectations often become self-fulfilling prophecies. Even if your child does have ADD, it can become more of a blessing than a curse if it is handled suitably. Distinguish Behavior From The Child Remember that the behavior you do not like is just behavior, not the child! Separate the behavior from the child. For example, say “I love you but it upsets me when you leave your toys all over the living room.” Responsibility Is For Everyone Do not excuse the ADD child from responsibilities. This may cause stress with the other children. Have clear expectations and ensure that your child understands these expectations. - 21 -
  22. 22. OVERCOMING STRESS You may be suffering from more stress than you think. Raising a child with ADD can be stressful! Let’s try to become aware of what causes our stress reactions and then make a plan to help lessen them. In most cases, behaviors that cause stress are actually great teaching opportunities. Bearing in mind that you are trying to help your child learn how to develop better control, you can use stressful situations to teach cause and effect. Raising a Delay Your Response: OK, you turned your head for a split second and your kid just pulled the display stand over in the restaurant. Adrenaline shoots into your blood stream, quickening your child with heart rate, causing you to feel embarrassed and, finally, you get mad at your kid. Don’t! Instead, ADD can be delay your response. Remain calm and reason your options out. stressful ... Understand the Outcome: During a stressful situation, keep your positive goals in mind. This will remain calm help to lessen the intensity of your reaction and help you to remain calm and focused. and reason Change Your Perspective: It is important to understand and hold the full context in your mind at out your all times or else you will feel like a hamster options. ADVICE FOR PARENTS spinning on a wheel. Cut out the Advice It’s Not Your Fault for Parents card and keep it close, so you Do Not Battle For Control # can review and apply it. If you can hold Share Your Time Focus On Success your own goals in mind, you will be more Add Is Not A Disability. Don’t Make It One able to understand the situation that has Distinguish Behavior From The Child occurred in relation to those goals. Responsibility Is For Everyone - 22 -
  23. 23. DOING SCHOOL WORK Establish Routines Schedule a consistent study time and stick to it. Before you choose the time, review your child’s commitments—hockey, ballet, music, and so on. Pick a time that is free from commitments. One hour is usually more than enough. Provide Personal Space If possible, dedicate one small part of the home as a special study area. Keep clutter to a minimum. Create a quiet work environment. Sorry kids, no radios, TV, or phones! New research clearly shows Schedule a that they distract and lower school scores. consistent Demonstrate study time When teaching new tasks, demonstrate them. Combine and stick to it. repeated displays of actions with short, clear, simple instructions. Patiently repeat the demonstration until your child learns. Getting Started Kids with ADD, like most kids, are usually disorganized. If you expect quality work from ADD kids, you will have to teach and re-teach organization skills. The major problem is often that students do not know how to begin. This leads to frustration, which leads to distractions. - 23 -
  24. 24. Before beginning homework or assignments: review the instructions, break them down into simple sequential tasks of three, if possible. Have your child repeat the instructions before beginning. Most students do not know how to break a task down into its component parts and then schedule some work time for each part. You can help them to learn this skill by having them work on outlining and recognizing main ideas, underlining key words and highlighting the instructions before starting homework. Build Confidence Understand that students with ADD lack confidence. They are often afraid to try and their self- esteem is battered. You can help by removing judgment from their lives. Change your attitude. You may be amazed at the quality results you will get when you help your child learn how to do the work. The Family That Plays Together… We want to be able to help our kids learn how to focus and pay attention. This may seem like a daunting task, but it is not! Giggles and laughs, as well as serious conversations, are all part of the solution. Paying attention means learning to stretch the attention span – and that can be improved by playing games! Yep, some family fun time can help your child develop a major skill. A number of hearing, listening and comprehensive games can be found on our website. Go to—and have fun! - 24 -