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Transcript
CHAPTER 6
STUDENTS WITH ATTENTION DEFICITHYPERACTIVITY DISORDER
Copyright © Allyn & Bacon 2008
DEFINITION OF ADHD
A pervasive pattern of inattention,
impulsivity,
and/or
hyperactivityimpulsivity that is more frequent and
severe than is typically observed in
individuals at a comparable level of
development. (American Psychological Association,
2013)
PREVALENCE
2-3 times as many boys identified as girls
No difference in frequency among races
Caucasian children more likely to receive
medication for ADHD
KEY ELEMENTS OF ADHD
Neurological
Developmental
Chronic
Not situational
Production deficits, not
acquisition deficits
CAUSES OF ADHD
Physiological causes
Heredity
Brain differences
Environmental Causes
Maternal prenatal smoking
and alcohol consumption
CAUSATION
“COPYRIGHT© ALLYN & BACON 2006”
The striatum receives
input from the frontal
cortex and is responsible
for the regulation of
behavior. It consists of
the caudate (top),
putamen (lower right),
and globus pallidus
(lower left). Development
of the striatum is often
delayed in children with
ADHD.
Courtesy L. Hanford and
G. Hall.
Behavioral Disinhibition
Working
Memory
Internalized
Speech
Emotion
Regulation
Creative
Problem Solving
ADHD:
Inattention, Hyperactivity & Impulsivity
Barkley’s neurodevelopmental model for ADHD. Early problems with behavioral
inhibition can adversely affect the development of the four executive functions.
Executive functioning deficits underlie symptoms of ADHD.
COGNITIVE CHARACTERISTICS
Problems with Executive Functioning
Issues with ability to control impulses
Working memory is not efficient
Self-directed speech not utilized effectively
Difficulty controlling emotions or motivation
Reconstitution – the ability to break down what is
observed and to combine parts to carry out new
actions
ACADEMIC CHARACTERISTICS
Some students are very successful
academically
Other students consistently achieve below their
potential
Academic self-concept is important
SOCIAL/EMOTIONAL CHARACTERISTICS
Self-esteem is a problem for some, but not all,
students with ADHD
Students often have problems coping with
social functioning
Developing and maintaining friendships
Rejection by peers
BEHAVIOR CHARACTERISTICS
Failure to attend to details
Make careless mistakes in work
Failure to complete schoolwork
Failure to listen when spoken to directly
Difficulty organizing tasks and materials
Avoidance of tasks that require sustained mental
effort
COMORBIDITY WITH OTHER DISORDERS
ADHD may occur simultaneously with other disorders such as:
 Learning disabilities
 Tourette’s syndrome
 Emotional disabilities
 Autism
 Traumatic brain injury
 Psychiatric disorders
 Sleep disorders
 Substance abuse problems
Initial Referral for Eligibility
Medical Diagnosis
Pediatrician, family physician, psychiatrist
Diagnosis may occur before child enters school
Educational referrals may come from
Child’s classroom teacher
Special education teacher
ASSESSMENTS MAY INCLUDE:
Medical assessment
Continuous performance tests
DISC IV (Diagnostic Interview Schedule for
Children)
Parent rating scales and checklists
Teacher rating scales and checklists
Samples of student’s work
Anecdotal information
GIFTED OR ADHD?
Behavior
Gifted Students
ADHD
Poor sustained
attention
Only in specific
situations, e.g., when
bored
Difficulty in most
situations
Impulsivity
Good judgment lags
behind intellectual
development
Primary characteristic of
ADHD
Problems with
Rules
Question rules and
create their own
Inability to regulate
behavior
ELIGIBILITY FOR IDEA SERVICES
Does the ADHD “adversely affect” the
student’s educational performance?
Not all students with ADHD are eligible
Students who are not eligible for IDEA may
qualify for accommodations under Section
504
Students may be eligible because they also
have a learning or emotional disability
EARLY CHILDHOOD EDUCATION
Diagnosis at an early age is
difficult.
If children’s symptoms of ADHD
are severe, early intervention
is crucial.
Children may need a highly
structured environment,
immediate and consistent
feedback, and ageappropriate rewards.
ELEMENTARY AND SECONDARY SCHOOL
SERVICES
Many students receive their education in
general education classrooms.
Professionals must collaborate with parents to
find effective techniques for students with
ADHD.
TRANSITION AND ADULTHOOD
66% of students with ADHD
continue to have the disorder
into adulthood
Many adults with ADHD are
disorganized, impulsive, and
have poor work skills
Students need to have a clear
understanding of their disorder
and learn to advocate for
themselves
MEDICATION IS THE MOST CLEARLY
EFFECTIVE INTERVENTION
The use of medication is controversial.
The decision to prescribe medication only
indirectly involves school personnel.
Medication is helpful for many (70-80%)
students for whom it is prescribed.
Medication alone is not sufficient to improve
academic performance
PSYCHOSTIMULANTS
Ritalin
Concerta
Focalin
Adderall
Strattera
70
60
Percent Improved
50
40
Clinician Ratings
Parent Ratings
30
20
10
0
Placebo
Adderall 10mg Adderall 20mg
Treatment
Adderall 30mg
Stimulant medication is efficacious at reducing ADHD symptoms. Based on
Biederman, Lopez et al. (2002).
30
Child Noncompliance
25
20
15
10
5
0
Treatment 1
Withdrawal
Treatment Phase
Treatment 2
Summer Treatment Program for youth with ADHD. Chronis and colleagues
(2004) used direct contingency management during treatment phases 1 and
2, but withdrew contingencies in between treatment phases. Children’s
noncompliance increased during treatment withdrawal, indicating that
treatment was efficacious.
BEST EDUCATIONAL PRACTICES
Parent and professional education
Environmental supports for students
Behavior interventions
Rewards
Token economy systems
Structure
Quick Pace
Variety
12
Number of ADHD Symptoms
10
8
Medication
Medication + MPT
Medication + ACT
6
4
2
0
Baseline
6 Months
12 Months
24 Months
Time
Should we combine medication and behavior therapy? Results of one large study
indicated that combining medication with Multimodal Psychosocial Treatment (MPT) or
Attention Control Treatment (ACT) did not lead to better improvement than using
medication alone. Based on Abikoff et al (2004).
70%
Percent (%) Youth Improving
60%
50%
40%
30%
20%
10%
0%
Combined Treatment
Medication
Management
Behavioral Treatment
Community Care
Treatment Group
The MTA Study. Combining medication with behavior therapy, or using medication alone,
is superior to behavior therapy alone to treat ADHD. Based on Swanson and colleagues
(2001).
SUPPORTING PARENTS OF CHILDREN
WITH ADHD
Have realistic expectations of parents
Encourage parents to be good role models
Help parents have realistic expectations