Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
ADD & the College Student Issues, Problems, Solutions Dr. Sean P. Barrett, Ph.D Overview • • • • • • What is ADD? ADD in a Community College Context How to make your class ADD friendly Assessment Issues in College Students Treatment Issues in College Students Question/Answer What is ADD? • Attention Deficit Disorder • Deficit: insufficiency, shortcoming • Disorder: disease, dysfunction • Brain Malfunction OR Brain Style? • Inherited differences in the way brain is ‘wired’ • Well suited for some tasks/ environments not others • Causes difficulties in many areas but may also have some positive aspects An ADD ‘brain style’ is usually not a good fit for the types of tasks required to do well in college Diagnostic Criteria for ADD • Persistent symptoms of inattention and/or impulsivity/hyperactivity • Must be evidence of symptoms during early childhood • Symptoms cause significant impairment Specific Symptoms Inattention • fails to give attention to details/makes careless mistakes • difficulty sustaining attention • doesn’t seem to listen when spoken to directly • doesn’t follow through on instructions • difficulty organizing tasks & activities • avoids / dislikes tasks that require sustained mental effort • loses things necessary for activities • easily distracted by extraneous stimuli • forgetful in daily activities Hyperactivity-Impulsivity • often fidgets or squirms in seat • leaves seat when sitting is expected • runs or climbs in inappropriate situations • difficulty doing activities quietly • is often "on the go" or acts as if "driven by a motor“ • talks excessively • blurts out answers before questions have been completed • has difficulty awaiting turn • interrupts or intrudes on others 6 of 9 symptoms for either or both clusters are required for diagnosis. • Initially conceptualized as childhood disorder that could be outgrown • Now recognized to persist across lifetime • Many criteria are still defined in terms of childhood symptoms • Growing evidence that symptoms may be expressed differently in adulthood Symptoms/Features in ADD in Adults Cut to the chase… • Focus on big picture, gist or main point not details • Rapid-transit processing • Skimming/skipping ahead when reading • Impatient when listening/waiting/ interacting Need for stimulation • Seeking out stimulation • Thrill seeking • Accident prone • Addiction prone Procrastination • Difficulty starting a task in absence of immediate pressure/deadlines • Difficulty staying on task – frequent breaks, e-mail checking etc • Need to see the big picture before working on details The On/Off Switch • Lack of control of “on/off switch” for attention • Difficulty getting started • Once engaged can’t stop or ‘shift gears’ • Hyper-focus • ‘Attention variability disorder’ - Hallowell Juggling act • Tendency to take on many tasks at once • Starting new projects without finishing old ones – procrastination? Seeking novelty or stimulation? What were we talking about again… • Going off on tangents • Loosing track of original point when speaking • Something you see/hear/read sets your mind off in another direction • Difficulty focusing on conversations when not actively involved • ‘Tuning out’ during conversations • Uh-huh phenomenon • Often distracted by ‘internal’ world ‘I need to get organized…’ • Difficulty getting (staying) organized • Messy • Organized mess? • Loosing things – Put things down without thinking That took HOW long • Poor sense of time • Late (early) for appointments etc. • Missed deadlines (bills, assignments etc.) • Misjudging how long it takes to do something Can’t keep that foot out of my mouth… • Saying whatever comes to mind when it comes to mind • Poor sense of impact on others Low Self-Esteem • Feelings of inadequacy for having so much trouble with things that seem to come naturally to others • Sense of underachievement – “I just can’t seem to get my act together” Positive attributes of ADD? • • • • • • Creativity Enthusiasm & Energy Spontaneity Liveliness Flexibility Open-minded How does ADD Impact a College Student? • Performance usually does not match knowledge/ability in ADD students • ADD often impairs an individual’s performance on tasks that typically form the basis for assigning grades Problems Associated with Tests/Exams - Following exam instructions - Instructions often not carefully read (answer 3 of 5) - Multiple choice - Impulsive responding - Misaligned answers - Problems with negative wording Problems Associated with Tests/Exams - Time management - Too much time on some sections - Repeated checking for mistakes - Arriving late - Penmanship - Often illegible - Printing takes longer - Distractibility - Distracted by others in room, noises etc. Test/Exam Preparation Procrastination • Last minute crammers Reading difficulties • Wavering attention when reading • Skimming/jumping around Test/Exam Preparation Knowing what to study • Focus on big picture • What details are important? Study materials • Disorganized or lacking Papers & Assignments -unrealistic goals -poor attention to ‘nit-picky’ details -organizational issues • difficulty creating/following outlines • failure to follow steps necessary for task completion In Class Behaviors -Note taking • Difficulty listening and writing at same time • Illegible notes -Disruptive behaviors -Coming to class without necessary materials (paper, pen etc.) Making an ADD friendly classroom Testing: • Test preparation – Tell students what they should focus on when studying – In class before test let students know what they can expect • Test Instructions – Verbally go over instructions Testing: • Timed tests – If possible do not have timed tests – Always provide more time than you think the average student will need – Provide time for students to check over work – Provide guidelines for how long each section should take – Occasionally announce time remaining Testing: • Distractibility – Exams should be written in an environment with few distractions (front of class, other room) • Multiple choice – Have students circle answers on exam paper as well as on bubble sheet – Avoid use of double negatives in questions Testing: • Scheduling – ADD students often become hyper-focused when studying and have great difficulty shifting attention to new topics – Students with ADD should not write more than one exam per day and ideally have one day in between exams. • Alternate exam formats – Oral exams, practical demonstrations, takehome exams Classroom: • Allocate time for class discussion – Active engagement helps sustain attention • Communicate expectations for participation – Set clear limits and rules Classroom: • Organize material in 15-20 minute blocks • Incorporate hands-on activities – Tend to learn best by ‘doing’ • Make lecture notes available – Post on web ct, allow for recordings Assignments: • Provide concrete guidelines and limits • Vary assignment formats – Oral presentations, debates, group-work etc. • Component deadlines – Make individual components of assignments separate end goals of themselves Assignments: • Allow for choice/creativity – Focus tends to be better when ADD students are actively involved in creating or deciding what to do • Use of Web CT – Reminders about due dates, assignment instructions – Ease of submission of multiple assignment components Students: • Take manageable course loads – Consider taking an extra semester to meet requirements • Select an appropriate field of study – Find something that interests you! • Use medication properly Other Tips for Students: • • • • Speak with your instructor Ask for help Utilize available resources If not already done so get a proper assessment How do I know it is ADD? Assessing ADD in College Students • A proper assessment is critical to: – Establish the presence or absence of ADD – Distinguish ADD symptoms from symptoms of other disorders Essential components to a valid ADD assessment • • • • • • Life history interview Self-reported symptoms Objective cognitive assessment Collateral reports School report cards Screening for other psychiatric disorders Faking ADD? • 20% of college students evaluated for ADD at an Ontario clinic were suspected of faking (Harrison, 2006) • Why Fake ADD? – Access to accommodations/resources – Access to drugs – Escape responsibility • Be reluctant to accept diagnoses based strictly on self-report checklists • Don’t be afraid to ask for additional documentation/clarification • But remember the MAJORITY of cases are genuine! Treatment Issues for ADD in College Students • Stimulant medications (e.g. Ritalin, Dexedrine) are usually the first line of treatment • When used as prescribed medications are typically very effective in treating some (though not all) ADD symptoms • Immediate transient improvements • Few serious side effects • Stimulants have abuse potential • High demand from non-ADD students – Study aid, partying • Poor compliance and monitoring • Stigma of medication use – Diversion/misuse as means of fitting in • Non-stimulant medications – Typically less effective – Better at addressing inattention than impulsivity/hyperactivity Non-medication options • Coaching – Organizational & study skills • Psychotherapy – Especially helpful for self-esteem • Support groups – If there aren’t any consider starting your own! Non-medication options • Diet – Less junk; more omega 3 • Exercise – Regular cardiovascular exercise has been demonstrated to improve symptoms Questions?