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Learners with Attention Deficit Hyperactivity Disorder (ADHD)

Chapter 6

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Topics

• Brief History• Definition• Prevalence• Assessment• Causes• Psychological and

Behavioral Characteristics

• Educational Considerations

• Medication Considerations

• Service Delivery Models

• Early Intervention• Transition

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Brief History of ADHD

• Still’s Children with “Defective Moral Control”

• Goldstein’s brain-injured soldiers of World War I

• The Strauss Syndrome• Cruickshank’s work• Minimal brain injury and Hyperactive

Child Syndrome

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Definition of ADHD

• American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) ADHD, Predominantly Inattentive Type ADHD, Predominantly Hyperactive-

Impulsive Type ADHD, Combined Type

Basic Concepts About ADHD

• ADHD is a developmental disability that becomes apparent before the age of seven.

• ADHD may have an impact on academic success.• ADHD is not hard to spot in the classroom.• Many behaviors associated with ADHD may be

misunderstood and misinterpreted as lazy, unorganized, and even disrespectful.

• For 2/3s of individuals with ADHD, the disorder continues to cause problems in adulthood.

• ADHD occurs across all cultural, racial, and socioeconomic groups.

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Prevalence• ADHD is the most common childhood

psychiatric disorder.• Estimates of 3 to 5 percent of school-age

population• Boys outnumber girls. Girls and children from

minority families may be underidentified. • Hyperactivity and impulsivity are most likely to

be observed in preschool and elementary children; inattention is more common in adolescents.

Prevalence of ADHD

• Results of one study (Reid et al., 1994) suggested that: approximately 52% are identified as behaviorally

disordered (BD). approximately 29% are identified as LD. approximately 9% are identified as MR.

Assessment

• For years, the diagnosis of ADHD was considered the responsibility of psychologists, psychiatrists, and physicians.

• The mandates of Section 504 suggest that public school personnel have a responsibility to assess students suspected of having ADHD.

• Although assessment is performed by trained school personnel, teachers play an important role in the assessment process.

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Assessment

• Components Medical examination Clinical interview Teacher and parent rating scales Observation Review of school records Review of IQ & academic testing results

• Subjectivity of some components “Doctor’s office effect”

Steps in the Assessment Process (Burnley, 1993)

• Preliminary Assessment and Initial Child Study Meeting

• Formal Assessment Process: Follow-Up Meeting of the Child Study Team

• Collaborative Meeting for Strategy Development

• Follow-Up and Progress Review

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Causes

• For most children, the precise cause of ADHD is unknown.

• ADHD is not due to poor parenting.• Areas of the brain affected: frontal lobes, basal

ganglia, cerebellum• Neurotransmitter involved: Dopamine• Hereditary factors

Family studies Twin studies Molecular genetic factors

• Toxins and medical factors

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Psychological and Behavioral Characteristics

• Barkley’s model of ADHD Behavioral inhibition Executive functions Persistent goal-directed behavior

• Adaptive skills• Problems socializing with peers• Co-existing conditions

Learning disabilities Emotional or behavioral disorders Substance abuse

Psychological and Behavioral Characteristics

• Limited sustained attention or persistence of attention to tasks

• Reduced impulse control or limited delay of gratification

• Excessive task-irrelevant activity or activity poorly regulated to match situational demands

• Deficient rule following • Greater than normal variability during task

performance

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Educational Considerations

• Classroom structure and teacher direction• Making instructional modifications• Developing students self regulated strategies• Use of medication• Functional assessment and contingency-based

self-management The role of reinforcement Developing IEP

Characteristics of Effective Teachers of Students with ADHD

• Positive academic expectations

• Frequent review • Clarity of teaching • Flexibility • Fairness• Active interaction w/

students• Responsiveness• Warmth• Willingness to work

collaboratively with other teachers

• Patience• Humor • Structured &

predictable approach• Consistency • Firmness• Positive attitude

toward inclusion • Knowledge/willingness

to work w/ students w/ exceptional needs

• Knowledge of effective interventions

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Service Delivery Models

• Continuum of placement• Difficult to determine• Presumption that less than half receive

special education• Individual determination

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Early Intervention

• Difficult to determine in young children because of behavioral similarity.

• Children who are identified typically have extreme behaviors and require special management and will need long-term programming.

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Transition to Adulthood

Diagnosis in adulthoodAdult outcomes

EmploymentMarriage and family

Importance of coaching