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ADHDADHDADHDADHD

WhatWhat’’s a teacher to do?s a teacher to do?

2Dedication in the American Academy of Pediatrics ADHD A Complete and

Authoritative Guide as quoted by Shel Silverstein:

Listen to the Mustn’ts, child, listen to the Don’ts

Listen to the Shouldn’ts, the Impossibles, the Won’ts.

Listen to the Never Haves, then listen close to me.

Anything can happen, Anything can be.

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Identification - DSM-V

• PersistentPersistent pattern of inattention or hyperactivity-impulsivity that is more frequentfrequent and severesevere than is typically observed in individuals at a comparable level of development.

• Several symptoms must have been present before the age of 12before the age of 12

• Occurs in at least 2 settings2 settings.

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Identification - DSM-V (cont.)

• Clear evidence of interference with or interference with or

reduce the quality of social, schoolreduce the quality of social, school, or

work function

• NotNot better explained by another mental

disorder

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Types

1. Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive presentation

2. Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive presentation

3. Attention-Deficit/Hyperactivity Disorder, Combined presentation

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What to look for:What to look for:A. Inattention

– Problems with details; careless mistakes– Difficulty sustaining attention – Doesn’t seem to listen even when spoken to

directly

– Doesn’t follow through– Disorganized– Avoids work– Loses things– Easily distracted– Forgetful

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What to look for:What to look for:

B. Hyperactivity– Fidgets/squirms– Out of seat– Runs/climbs– Difficulty playing quietly– “On the go”- Talks excessively

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What to look for:What to look for:

C. Impulsivity

– Blurts out answers– Difficulty waiting for a turn– Interrupts or intrudes

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Treatment: Best Practices

• Behavior Therapy

• Medication

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Behavior Therapy

Team work with parents, teacher, child, physician and school support personnel (RtI team, social worker, psychologist, principal, mentor teacher…)

• Communicate

• Devise plans

• Revise plans based on results

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Some General Classroom Procedures• Be calm, clear, concise, consistent and caring.

• Rules should be clear, brief and consistent.

• Give the student jobs.

• Build in short active times for the whole class.

• Clarify quiet work and active work and set student expectations for each.

• Provide a predictable structure and prepare for changes.

• Limit distractions, but create excitement in learning.

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Examples of Interventions

• Physical accommodations – preferential seating, good role models, lessen distractions, visual schedules, sound prompts, darken room and use light to highlight focus of attention…

• Organization – mini-schedules, picture cues, color coding, highlighting, assignment books, peer assistance, lists, calendars, charts, pictures…

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Examples of Interventions

• Communication – daily behavior chart/report, phone calls, emails, meetings, collaboration with physician/nurse/counselor/school team members, rating scales …

• Rewards –activities, phone calls home, peer read to student, student read to younger child, extra privileges, note home and/or to partner teacher and/or to principal; daily, weekly, hourly; given at school and/or at home; tied with charts

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Examples of Interventions

• Daily Behavior Charts – to reinforce appropriate behaviors (raising hand, waiting turn, hands to self, just-right voice, work completion, careful work, compromising with a peer, showing respect, following class and school expectations…)

• Information Delivery – One instruction at a time, visual directions on the board or on a handout, repeat directions or have students do so, highlight core information, use movement…

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Examples of Interventions

• Adjust work expectations – reduce amount, work with a peer, do or do not time, build in reinforcers, divide long assignments into shorter ones that are turned in for feedback, directly teach organization structures, coordinate expectations with any resource services, work on a computer when possible, use a calculator if appropriate, accept late work, allow student to make corrections, have a peer tape readings, work with a volunteer, provide written or pictorial steps and/or a model, complete

unfinished work at home, provide “hurdle help”, physical proximity to the

student, alternate testing area.

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Examples of Interventions

• Provide Movement – provide movement breaks, 15 second breaks, “Brain gym”.

• Social Success – Set up positive social situations with peers and adults. Assist with friendship skills, set up “lunch buddies”. Be proactive

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You are the teacher.

• Find what works for your student with ADHD in your classroom.

• Keep track of progress.

• Adjust interventions based on results.

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I still need help with this student…

1. Discuss specific concerns with parents about inattention, high activity level and/or impulsivity in concrete terms. Describe what you observe in the classroom and provide data if possible. Compare your student of concern with your “average” student. (Don’t tell the parent to get their child on meds.)

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but I still need help with this student…

2. Refer your student of concern to your building problem solving team. Bring your data (including objective data such as time on task compared to an average student, percent of completed assignments…) to the meeting . The team will likely come up with more interventions, maybe tweak the data collection system and maybe increase communication with the parent. There might be some discussion to rule out other possible medical or and/or environmental conditions (too little sleep, possible seizure disorder

or diabetes, skipping meals…)

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I STILL need help with this student…

3. The RtI team and teacher might meet with the parent to further the team’s understanding of the issues at hand, to find out more medical information and/or to brainstorm. The team might ask the parent to talk with the physician and find out if they want any forms completed by the school. If the parent prefers, with his/her permission, a team member can directly contact the physician. Permission for screening might be requested in order to send a report to the physician or to give more specific data to the parent.

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Diagnosis and Medical Treatment

The physician will likely gather information from parents, the child and the school in order make an accurate diagnosis. The teacher is often asked to complete some type of rating scales which vary by physician preference. Carle has a rather involved one, likely for the purpose of ruling out other possible conditions. Please follow the directions even though many things might not seem to apply to your

student.

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Diagnosis and Medical Treatment

If the physician diagnoses your student with ADHD, he/she might try medication. Initial doses might be low in order to check for possible side effects. Some medications are effective immediately (once the correct dosage is determined) and some medications take time to build up in a student’s body. Medication is not a cure, but might help the student be more available to learn. Accommodations and interventions should continue as needed.

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Diagnosis and Medical Treatment

Keep in good communication with parents and any involved medical personnel. The physician will adjust medication based on information he/she receives. It is common that medication adjustments are needed, particularly at the beginning. Your student will likely continue to have medication checks with his physician monthly at first and then every 3 months or so. Medication needs change over time. If you see a change in your student, be sure to communicate this to the parent or physician.

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Some Medications

Some Stimulant Medications:• Methylphenidate (Concerta, Daytrana, Ritalin,

Metadate-CD, Focalin)• Mixed amphetamine salts (Adderall, Vyvanse)

Some Nonstimulant Medications:• Atomoxetine (Strattera)• Clonidine (Catapres) • Guanfacine (Tenex)

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Some possible side effects of medication

• Decreased appetite/weight loss• Stomachache• Headache• Sleeplessness• Dizziness• Restlessness• Increased heart rate, liver damage

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Upfront discussion of possible side effects

To help parents be prepared for and better “manage” side effects, the social worker might choose to discuss some possible side effects, what a parent might expect and ways to work around these.

• Medication might take a while to build up in the child before becoming effective

• It is common for physicians to prescribe a low dose to ensure that there are no side effects. It might take weeks or months to figure out the optimal level and type of medication that works best for a particular student.

• The side effects from the medication might dissipate in a few weeks.

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Examples of Ways to Manage Side Effects

• Loss of appetite – This is not an uncommon side effect, but there are ways to work around this. The child can take medication after meals, take medication earlier in the day so the medication is out of their system before dinner, provide high protein or high calorie healthy snacks. Some physicians adjust the amount of medication given on the weekends to increase appetite.

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Disorders that sometimes accompany ADHD

• Oppositional defiant disorder• Conduct disorder• Learning and language disabilities• Anxiety disorders• Depressive disorders• Bipolar disorder• Tourette’s Disorder

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Your most effective tool, however, in helping a student with ADD/ADHD is a positive attitude. Make the student your partner by saying, “Let’s figure out ways together to help you get your work done”, get along

with others, be better organized....

quoted from: www.helpguide.org

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• American Academy of Child and Adolescent Psychiatry and American Psychiatric Association. ADHD: Parents Medication Guide. ParentsMedGuide.org. downloaded 7/5/2010.

• American Academy of Family Practitioners. ADHD Medicines as provided by Linda Cox, MS, APN, CNP, Family Nurse Practitioner at Urbana School Based Health Clinic.

• American Academy of Pediatrics and the National Initiative for Children’s Healthcare Quality. (2002). For Parents of Children with ADHD. “Common Daily Problems” adapted from material developed by Laurel K. Leslie, MD, San Diego ADHD Project.

• American Academy of Pediatrics and the National Initiative for Children’s Healthcare Quality. (2002). How to Establish a School-Home Daily Report Card.. Used with permission of William E. Pelham, Jr. in expanded format at http://summertreatmentprogram.

• American Psychiatric Association. (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. (DSM-IV).

• Dendy, Chris A. Zeigler (2006). CHADD Educator’s Manual on Attention Deficit/Hyperactivity Disorder (AD/HD) An In-Depth Look From an Educational Perspective. Lynchburg, VA: Progress Printing.

• Frank, Kim T. and Susan J. Smith-Rex. (1996) ADHD 102 Practical Strategies for “Reducing the Deficit”. Chapin: SC: Youthlight, Inc.

• Reiff, Michael with Sherill Tippin. (2004) ADHD: A Complete and Authoritative Guide. American Academy of Pediatrics.

• Rief, Sandra. (1997). The ADD/ADHD Checklist: An Easy Reference for Parents and Teachers. Paramus, NJ: Prentice Hall.

• U.S. Department of Education, Office of Special Education and Rehabilitative Services, Office of Special Education Programs. (2004) Teaching Children with Attention Deficit Hyperactivity Disorder: Instructional Strategies and Practices. (2004). Washington, D.C.: Education Publications.

• http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

• www. helpguide.org• www.psych.org• http://familydoctor.org/online/famdocen/home/children/parents/behavior