Download Attention Deficit Disorder - ADD with hyperactivity

Attention Deficit Disorder - ADD with hyperactivity
ADHD with aggression
[IDEA places ADD and ADHD in the over-all category of Health Impairment]
ADD and ADHD create uncomfortable conditions for parents and teachers. It
can also be frustration for youngsters. Many students have a hard time
focusing on school work. Indeed, each of us has times when we get
distracted or fail to pay attention to things, and later realize that we did not
fully experience or remember or attend to all the was occurring. With ADD, it
happens more of the time. Some ADD youngsters cannot watch TV - not
even a commercial, before losing concentration or focus. Like LD (learning
disabilities), ADD and ADHD cover a multitude of related, interrelated and
unrelated acts, sort of a laundry basket of acts and failures to act.
For the past decade, I have asked students at the college level to define
ADD. This "street" list is a typical example of responses. Next to it, I put the
list I generated through 20 years of working with the students or children
who are at the extreme in the continuum. Continuum is an important
concept. Think of yourself at WalMart. How much of the street list would
apply to you? Nearly all of us have times when some of these statements
apply. Most of us can get control, or move out of these extremely stimulating
situations and seek calm settings or settle ourselves. The ADD and ADHD
youth often lacks the desire or ability, the insight or understanding of what it
is doing to others and relationship, fails to recognize or embrace the
consequences of actions and does not self modulate.
"Street" list of
ADD"
My common sense definition
Unfocused
Ego development seems stalled at seeing self and
meeting personal agenda, seldom gets subtle
clues about others' needs or wishes
Moving a lot
Often does not sleep through the night - wakeful
periods
Not able to sit still
Quiets self through self stimulation and busy
body behaviors
Easily distracted
Messy and disorganized coupled with odd ways
of organizing - including some odd or bizarre
compulsive reactions and perseveration
Doesn't finish
tasks
Passive and intentional power struggles common,
almost willful
Doesn't mind
Frequently calmed by stimulants - Ritalin, coffee,
tea
Doesn't follow
through
Doesn't see consequences, so doesn't understand
need to follow through
Impulsive
Personal needs are foremost and crowd out
social needs
Angry or irritable
Many youngsters move on to have personality
disorders
Over do things
Substance abuse - perhaps self medicating - is
quite common
Picks and fiddles
Often have a lot of anger and difficulty managing
anger
Often involved in
fights
May be openly combative with parents or siblings
and tends not to care for pets constructively
National Viewpoint on Defining ADD
Definitions
Attention Deficit Disorder (ADD) and Attention Deficit/Hyperactivity
Disorder (ADHD): are diagnoses applied to children and adults who
consistently display certain characteristic behaviors over a period of time.
The most common behaviors fall into three categories: inattention,
hyperactivity, impulsivity. People who are inattentive have a hard time
keeping their mind on any one thing and may get bored with a task after
only a few minutes. People who are hyperactive always seem to be in
motion. They can't sit still and may feel constantly restless. People who are
overly impulsive seem unable to curb their immediate reactions or think
before they act. For more information on ADD and ADHD please visit ADD
and ADHD in our LD In-depth section. National Institutes of Health
The essential feature of Attention-Deficit/Hyperactivity Disorder is a
persistent pattern of inattention and/or hyperactivity-impulsivity that is more
frequent and severe than is typically observed in individuals at a comparable
level of development.
Some hyperactive-impulsive or inattentive symptoms that cause impairment
must have been present before age 7 years, although many individuals are
diagnosed after the symptoms have been present for a number of years.
Some impairment from the symptoms but be present in at least two settings
(e.g., at home and at school or work)
There must be clear evidence of interference with developmentally
appropriate social, academic or occupational functioning.
The disturbance does not occur exclusively during the course of a Pervasive
Developmental Disorder, Schizophrenia or other Psychotic Disorder and is not
better accounted for by another mental disorder (e.g., a Mood Disorder,
Anxiety Disorder, Dissociate Disorder, or Personality Disorder). - APA (1994).
DSM-IV
Guiding Principles for the Diagnosis and Treatment of Attention Deficit Hyperactivity
presented by The National Attention Deficit Disorder Association
Over the past two decades there has been an explosion of diagnosis, treatment and
research regarding Attention Deficit Hyperactivity Disorder (ADHD). As clinicians and
researchers have gained more experience working with ADHD, it has become clearer
that its impact on life is far greater than we had ever appreciated.
ADHD not only can interfere with learning and behavior control in childhood, but, as
a critical neurobehavioral condition, it can profoundly compromise functioning in
multiple areas throughout the life span. Research and clinical experience suggest
that ADHD difficulties can lead to significant educational, occupational, and family
dysfunction and can be a significant contributor to a variety of health, social, and
economic problems.
ADHD is a common disorder. The Diagnostic and Statistical Manual of the American
Psychiatric Association, Fourth Edition (DSM-IV) estimates that ADHD is found in
3%-5% of school-age children. A recent review of thirteen community studies of the
prevalence of ADHD indicated that between 1.7% and 16% of children have ADHD,
depending upon the populations and the diagnostic methods.
As more and more is written and broadcast about ADHD, increasing numbers of
adults and parents wonder whether ADHD might be underlying the problems they or
their children are experiencing. As a national organization whose role is to educate
and advocate for the needs of individuals with ADHD, we talk with thousands of
individuals each month who are seeking help regarding the diagnosis and treatment
of ADHD. From these conversations we know that most first turn to their family
physician, pediatrician, or a mental health professional for help. We also know that
the care they receive varies greatly, ranging from a brief office visit that ends with a
prescription for medication to a thorough evaluation cooperatively conducted by
members of several different disciplines. We are concerned that paradoxically, ADHD
is both over diagnosed and under diagnosed; ADHD is both over treated and under
treated.
National ADDA believes that one of the most critical steps in properly addressing the
significant impact that ADHD has on contemporary society is to establish a standard
of care for its diagnosis and treatment. While gaps exist in our knowledge about the
precise cause of ADHD and controversy abounds about aspects of its diagnosis and
treatment, research and clinical experience over the past few decades have been
sufficient to begin to identify certain principles regarding the evaluation and
treatment of ADHD. The National ADDA Guiding Principles for the diagnosis and
treatment of ADHD represent an attempt to enhance the overall health care of
individuals and their families who are affected by ADHD.
These Guiding Principles seek to define the essential elements of diagnosis and
treatment that are necessary for realizing a high quality of care. The Guiding
Principles should not be viewed as a diagnostic tool or a therapeutic cookbook.
Rather, they represent an organizational framework to guide consumers in
navigating the health care maze and to focus on our understanding of the essential
ingredients of diagnosis and treatment. In addition, we hope that these Guiding
Principles will positively impact the activities of health care providers, educators, and
clinicians, as well as, the policy making decisions of health insurance companies,
governmental agencies, educational administrators and corporate executives whose
actions can have a profound impact on the lives of individuals with ADHD.
These Guiding Principles represent a synthesis of lay and professional literature, the
experiences of clinicians and conversations with thousands of patients and families.
This is National ADDA’s working philosophy regarding some critical components of
high quality assessment and treatment. As a consumer advocacy organization,
National ADDA’s goal is that these Guiding Principles serve as a step towards
identifying the essential components of assessment and treatment of ADHD. We
hope that they will improve the quality of life for everyone affected by ADHD.
1. Evaluate and treat the whole person. A comprehensive diagnostic protocol for
ADHD provides a description of the whole person. That is, it should seek to identify
how a person’s ADHD symptoms interact and contribute to his or her physical and
mental functioning, as well as his or her personality. Each person is unique, with
unique strengths and weaknesses. Making a diagnosis based solely on "plugging"
attentional symptoms into a diagnostic checklist, for example, is inadequate. After
considering the complete person, the role of ADHD, if present, can be placed in its
proper context. The success of treatment is dependent upon understanding and
managing ADHD within the context of an understanding of the whole person.
2. ADHD should be suspected but not presumed. ADHD is a common problem
and may be suspected as a contributing factor whenever a child or an adult
experiences problems in learning, self-control, addiction, independent functioning,
social interaction, or health maintenance. ADHD symptoms present across a wide
spectrum- from extremely mild to extremely severe. The appropriate diagnosis of
ADHD can help clarify the presence of other physical, learning, and emotional
disorders, or may be present in combination with any number of these.
The professional will need to identify and address potentially coexisting conditions.
These may include: Depressive and Bipolar disorders Anxiety Disorders Chemical and
Behavioral Addictions- Drugs, alcohol, disordered eating, gambling, sexual
addictions, etc. Oppositional Defiant and Conduct Disorders Learning Disorders,
including receptive and expressive language problems, reading and written language
Psychotic Disorders and Pervasive Developmental Disorders Obsessive/Compulsive
Disorders Personality Disorders Tic Disorders Hypo and Hyperthyroidism Sleep
Disturbances Chromosomal anomalies and other Developmental Syndromes Brain
Trauma
3. ADHD may present across the life span. ADHD is the result of biological
differences in the parts of the brain associated with paying attention, impulse
control, and activity level. While ADHD is biologically-based and usually present from
birth, symptoms may not become problematic until the individual begins to struggle
trying to meet life’s expectations. As a result, ADHD can present clinically anywhere
along the life span and in any life domain. Even though the symptoms of ADHD may
not impair an individual until later in life, some of these symptoms must be present
since childhood to make a positive diagnosis. Thus, an early history of ADHD
symptoms is essential in making a diagnosis of ADHD in an adult. The evaluator
should look for evidence of a childhood onset of ADHD symptoms through third party
interviews, transcripts, report cards, teacher comments, medical records, past
psycho educational testing, and other archival data.
ADHD often negatively affects a person’s educational achievements. Lack of school
success can contribute to a myriad of economic, social and life adjustment problems
throughout a person’s life. Educational functioning should be reviewed carefully. In
children, adolescents, or adult students, a review of educational functioning should
include administration of intelligence and achievement tests. However, it should be
noted that success in the educational arena is not by itself a reason to rule out the
diagnosis of ADHD.
4. A comprehensive assessment is necessary for an accurate diagnosis.
ADHD is complex and impacts all aspects of a person’s life. It can coexist and/or
mimic a variety of health, emotional, learning, cognitive, and language problems. An
appropriate, comprehensive evaluation for ADHD includes a medical, educational,
and behavioral history, evidence of normal vision and hearing, recognition of
systemic illness and a developmental survey. The diagnosis of ADHD should never be
made based exclusively on rating scales, questionnaires, or tests. The evaluation
should be designed to answer three basic questions:
(1) Are a sufficient number of ADHD symptoms occurring, pervasively and
causing impairment, at the present time in the person’s life;
(2) Have these symptoms been present since childhood;
(3) Is there any alternative explanation for the presence of these ADHD
symptoms?
5. The evaluation and treatment of ADHD should be conducted by a qualified
professional. A qualified professional may be from any one of the following
disciplines and would have the appropriate license to practice this discipline:
psychiatrist, pediatrician, internist, family physician, other qualified physician,
psychologist, social worker, professional counselor, and psychiatric nurse. A qualified
professional not only has a license to practice but has training and experience in the
differential diagnosis and treatment of ADHD and the full range of psychiatric
disorders.
6. Response to medication should not be used as the basis to diagnose
ADHD. There are a number of reasons why an individual’s response to a stimulant or
other medication is not a valid indication of the presence of ADHD. First, stimulant
medications doesn’t just work for people with ADHD; individuals with other disorders
and without any disorders may respond positively to them. Second, failure to
respond to medication may be because the dose was incorrect or the person’s body
is not responsive to that drug, rather than because the person does not have the
diagnosis of ADHD. Third, a positive response to medication may the result of a
placebo effect rather than a true indication of the presence of ADHD. Fourth, the use
of medication as a diagnostic tool may lead the physician to prematurely conclude
the diagnostic process without considering disorders that coexist with ADHD and
jointly interfere with the individual’s functioning.
7. Diagnosis should be based primarily upon the DSM-IV ADHD criteria. In
order to promote standardization, the diagnosis of ADHD should be based upon the
prevailing professional criteria for the diagnosis of mental conditions. At the present
time, the prevailing criteria are the Diagnostic and Statistical Manual of the American
Psychiatric Association, Fourth Edition, known as DSM-IV. A number of professionals
have justifiably criticized the DSM-IV ADHD criteria, noting several problems. In
particular, they are not adjusted for age, making them too stringent in their
published form for diagnosis of adults, e.g. adults will be under diagnosed. Minor
adjustments have been suggested in the professional literature, but nonetheless, it is
strongly recommended that diagnosis be based primarily upon these criteria.
8. Diagnosis and treatment of ADHD should involve others familiar with the
person undergoing the evaluation. Proper diagnosis and treatment of ADHD should
involve others such as parents, spouses, teachers, and when appropriate, employers.
These individuals can corroborate and provide information and can be enormously
helpful in the diagnostic and treatment process. When guided to better understand
and accept ADHD, they can also become positive supports for the person with ADHD.
9. Treatment should often involve more than one discipline working cooperatively.
Since there is currently no way to cure ADHD, the goal of treatment is to enhance
the individual’s ability to cope with it. Coping successfully with ADHD often requires a
combination of treatments provided by specialists from different disciplines. The
physician prescribes stimulant or other types of medication. The mental health
professional and/or the coach provides supportive counseling for the individual with
ADHD and the family, teaches the individual compensatory strategies for home and
school/workplace, and provides training in behavior management. The educator
helps to remediate school-based problems, and often provides feedback to the
parents and the physician about the effectiveness of medication. Members of
different disciplines should communicate with each other to coordinate their efforts
to help the individual cope with ADHD.
10. Generally, medication should not be started until a comprehensive
evaluation has been completed and the need for other forms of treatment has
been evaluated. Coordinated treatment by physicians, mental health professionals,
educators, coaches, and other health care professionals will maximize the individual’s
opportunities for treatment success.
10. Practitioners should become familiar with current research and diagnostic
tools. It is the responsibility of each professional involved in the evaluation and
management of ADHD to continually integrate the most up to date understanding of
ADHD into his/her repertoire of clinical skills. The improved understanding of the
cause, diagnosis, and treatment of ADHD which comes from a review of the current
literature will improve the quality of care. National ADDA urges all professionals to
become familiar with updated diagnostic tools and treatment methods, as well as
standards for a comprehensive assessment. National ADDA is committed to
facilitating the process of keeping professionals abreast of the latest developments in
the field of ADHD through its conferences and publications.
Notes Goldman, L.S., Genel, M., Bezman, R.J., and Slanetz, P.J. (1998). Council report of diagnosis and
treatment of Attention -Deficit Hyperactivity Disorder in children and adolescents. Journal of the American
Medical Association, 279, 1100-1107.
(c) 1998 National Attention Deficit Disorder Association. This document may be reproduced for personal
nonprofit use, otherwise expressed permission from National ADDA is required.
Questions and inquiries should be directed to: National Attention Deficit Disorder Association P.O. Box
1303 Northbrook, IL 60065-1303 E-MAIL: [email protected] WEBSITE: www.add.org
LDA of Canada Checklist
This check list is designed to alert the classroom teacher to the possible presence of
ADD among one or more of his/her students. It is on the web at The Learning
Disabilities Association of Canada site and was developed by Foothills Academy in
Calgary.
ATTENTIONAL DISABILITIES
Hyperactivity:
1. Acts impulsively: eg. acts first, thinks later
Yes
No
2. Is moving constantly
Yes
No
3. Behavior is inconsistent from day to day
Yes
No
4. Is disruptive in class
Yes
No
5. Has a short attention span
Yes
No
Disinhibition
1. Attention seems to wander
Yes
No
2. Daydreams
Yes
No
3. Comments are off topic
Yes
No
4. Starts assignments without having listened to
directions
Yes
No
Distractibility:
1. Is easily distracted by sights and sounds around
him/her
Yes
No
2. Can't discriminate between what is important and
what isn't
Yes
No
Perseveration:
1. Persists in an activity or a train of thought to an
obsessive level
Yes
No
Organization:
Yes
No
1. Is rarely prepared for class
Yes
No
2. Loses assignments and personal belongings
Yes
No
3. Has a messy locker and/or desk
Yes
No
4. Notes are disorganized
Yes
No
5. Is often late or forgetful
Yes
No
Social Perception:
1. Dislikes school, complains frequently
Yes
No
2. Seldom takes responsibility for his own actions: eg.
blames others
Yes
No
3. Loses his temper easily
Yes
No
4. Insensitive to the feelings of others
Yes
No
5. Has few friends
Yes
No
6. Is withdrawn
Yes
No
7. Does not participate in group activities
Yes
No
8. Does not like change
Yes
No
Meeting Student Needs and Promoting Communication and Personal Growth
Many teachers believe that a classroom needs to be a quiet place. For the
student who is impulse driven or hyperactive, being still may be a lot like asking
someone who is visually impaired to squint harder until they see. ADD is real and it
is important to support the student in efforts to learn self control rather than to
impose control on them. .
Ms. Roberts stated that the test of a marriage may be the depth of the tooth
marks from biting the tongue. It sounds funny in a way, but the truly successful
teacher learns self-control - to control her or his own impulses rather than giving
way to anger and frustration when working with the ADD student.
.
It is crucial to stay out of anger issues with students who are ADD/ADHD. One
can build a great relationship with youngsters if the approach is adult to adult rather
than parent or teacher (boss) to child. As the relationship strengthens, the student
will be much more likely to do the difficult work of learning self control if a bond has
been established - and if there is hope for pleasing and being appreciated for self.
This chart gives an example of a positive and supportive way to approach this.
Student action
Needs
Creative solution
Provide areas in the class where the
Student - to be student may move around without
soothed distracting others. Consider alternative
teaching processes when other
Student does not seem Safety - or in
students are being asked to stay still.
some
to be able to stay still
situations,
during discussions or
control
lessons in class.
Consistency and safety issues - solid
structure that is agreed upon with
student self monitoring is a crucial part
of a workable plan.
Student fluency
Student refuses to
work on an assignment
Student raises hand
and talks off the
subject during
instructional question
and answer time
Student - may
have be easily
distracted,
have problems
with impulse
control, need
for attention,
need for
control, lack of
social
awareness, or
think and
process slowly
enough that by
the time the
thoughts are
framed, the
class has gone
on.
Refusal may be one way to save face.
"I won't" may mean, "I can't." It may
also be an "automatic" response, much
as "no" is to the two-year-old. Promote
self management, self control and offer
options and choices when getting the
student to work.
Work to determine the reason for
inappropriate responses. The student
may not realize that when s/he is not
talking, thinking and being is still
occurring, may not pick up social
context, may have issues with impulse
control, may not be hearing, or
organizing the content or context. This
is actually a wonderful symptom that
can alert the teacher to the need to
focus on supporting a child's learning
needs.
Fill in the next three cell rows, using the ideas you gain from experience, from
materials in the text and in your web searches. Identify a likely student behavior that
may hamper learning and then go through the process of defining needs, then
finding a solution that allows everyone to get needs met
Finding out about a student's individual learning style
can support your work with students who are having
trouble staying focused, getting started or
completing assignments.
List materials and methods you might use to support
students with ADD/ADHD.