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ADHD Females: The challenges they face academically and socially

Dr. Katherine Nell McNeilJune 28 – 29, 2005

Paraeducator ConferenceAll Paras Aboard: Sailing Beyond Requirements

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What is ADHD?

According to the 2000 American Psychiatric Association's Diagnostic and Statistical Manual ofMental Disorders-IV, ADHD is a disruptive behavior disorder characterized by on-goinginattention and/or hyperactivity-impulsivity occurring in several settings and more frequentlyand severely than is typical for individuals in the same stage of development.

Symptoms begin before age 7 years and can cause serious difficulties in home, school or worklife. ADHD can be managed through behavioral or medical interventions or a combination of thetwo. It is most commonly diagnosed when students reach school age.

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most misunderstood,misdiagnosed and incorrectly managed disorders. It is also one of the most commonly diagnosedstudent psychiatric disorders. According to the Centers for Disease Control's new NationalResource Center for ADHD, it affects 4-6 percent of school-age students, and between 2-4percent of adults. It is diagnosed more frequently in boys as in girls, perhaps because girls mayhave less of a tendency to be hyperactive. ADHD can affect relationships and schoolperformance, thereby leading to self esteem problems. It may contribute to learning, social andemotional difficulties as well as career problems.

The causes of ADHD

The cause of ADHD is not known. Many working theories assume that brain chemistry is out ofbalance. There seems to be a genetic component to ADHD. Students who have ADHD oftenhave at least one relative who also has it.

Similarly, little is known about whether ADHD is related to diet. Foods sometimes linked toADHD, such as chocolate, sugar and food additives do not cause ADHD; though they mightmake symptoms worse in people who have the disorder.

Factors that are not causes of ADHD include:

• Poor parenting• Family problems• Bad teachers / ineffective schools• Too much television• Refined sugar• Food allergies• Diet

Identifying the disorder

ADHD does not look the same in every individual

No two people are alike. Individuals may show varying degrees of symptoms of hyperactivity,impulsiveness and distractibility.

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Some people are very distractible, but not very hyperactive or impulsive. They may have nohyperactive signs. They are often described as "daydreamers" or "spacey."

Other people are very hyperactive and impulsive, but not inattentive. In fact, they may have noinattentive signs. Still others are very distractible, hyperactive and impulsive.

How is ADHD determined?

A reliable diagnosis of ADHD must be made by a team of qualified professionals. Apsychologist, medical doctor or psychiatrist should make the diagnosis because ADHD can bemistaken for other psychological problems, learning disabilities or physical problems (vision,hearing).

If the student is in a public school, the school can refer the student for an evaluation. A doctormaking a diagnosis should ask for input from the student, parents, teachers and other health careproviders. The doctor should also collect information about medical, developmental, school,psychosocial and family histories and the history of the symptoms. He or she should considercauses other than ADHD for the problem and review other conditions that could be present.

There is no single test or person to diagnose ADHD. One way professionals confirm ADHDdiagnosis is that a student's symptoms are present all day long, in a variety of environments andsituations.

Managing ADHD

Why is it important to treat ADHD?

It is often difficult for students with ADHD to function in school. This can lead to low selfesteem and an inability to succeed at a very young age. Students with ADHD often have troublemaking friends. In adults, untreated ADHD can continue to promote difficulties withrelationships, marriage, and function in work and academic settings. Family conflict can increasedue to stress and frustration associated with the disorder.

How is ADHD managed?

The management of ADHD in students requires the coordinated efforts of a team of healthcareprofessionals, doctors, educators and parents. A management program may include:

• Parent training in behavior management and social skills development• An appropriate education program/plan• Individual and family counseling when needed• Medication when required• Regulation of diet and exercise

What can I do to help my student?

Respect your student. Treat your student as you would any other student with respect anddignity. Accept your student for who he or she is. Be realistic in your expectations and demands.

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Organize a schedule. Set up a specific schedule and post it where the student can see it. Explainany changes in routine in advance.

Use consistent discipline. Avoid repeating directions and requests. If the student breaks a rule,only give one warning. Let the student know what the consequence will be and follow throughwith the consequence if the rule is broken.

Speak softly and get down on the student’s level when you talk to him or her. Avoid yellingat the student; he or she may not be able to "hear" what you are saying when you are yelling.

Use positive language. Tell the student what you want rather than what you don't want. (Don'tnag!) Reward your student for good behavior as often as you can.

Make sure your student understands your directions. Get your student's attention. Tell him orher in a clear, calm voice exactly what you want. Give simple and short directions in a series oftwo to three tasks per request. Ask your student to repeat the directions.

Limit choice, but do not dictate. If you make all the decisions for your student, he or she maybe unable to make his or her own decisions later. Give your student choices when appropriate. Itis best to give two choices to pick from so he or she does not get confused or frustrated.

Learn to establish a "quiet zone" in his or her life. Help your student to learn stressmanagement techniques and to understand that he or she needs emotional "time outs" to regroupafter an upset.

Minimize corrections and criticism. It may be with the best intentions that you give correctionsand criticism. However, you may actually be contributing to your student's feelings ofinadequacy and low self worth.

Help your student look for ways to excel. Student with ADHD often feel that they are not goodat anything. Encourage their strengths, interests and abilities. Help your student to use his or herskills as compensations for any limitations.

Consult with teachers or other specialists. Whenever you feel it is necessary in order to betterunderstand what might be done to help your student learn, talk with the appropriate teacher orspecialist.(http://www.distanthealer.co.uk/ADHD_ADD.htm)

ADHD in WomenNational Resource Center on AD/HDwww.help4adhd.org

Knowledge of ADHD in women at this time is extremely limited as few studies have beenconducted on this population1,2. Women have only recently begun to be diagnosed and treatedfor ADHD, and today, most of what we know about this population is based on the clinicalexperience of mental health professionals who have specialized in treating women.

This information and resource sheet will discuss:

• Common symptoms and patterns of ADHD in adult women

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• Treatment of ADHD in adult women• Strategies for daily living

Impact of ADHD in Women

Females with ADHD are often overlooked when they are young girls3,4, the reasons for whichremain unclear, and are not diagnosed until they are adults. Frequently, a woman comes torecognize her own ADHD after one of her children has received a diagnosis. As she learns moreabout ADHD, she begins to see many similar patterns in herself.

Some women seek treatment for ADHD because their lives are out of control—their financesmay be in chaos; their paperwork and record–keeping are often poorly managed; they maystruggle unsuccessfully to keep up with the demands of their jobs; and they may feel even lessable to keep up with the daily tasks of meals, laundry, and life management5. Other women aremore successful in hiding their ADHD, struggling valiantly to keep up with increasingly difficultdemands by working into the night and spending their free time trying to "get organized." Butwhether a woman's life is clearly in chaos or whether she is able to hide her struggles, she oftendescribes herself as feeling overwhelmed and exhausted6.

While research in women continues to lag behind that in adult males with ADHD, manyclinicians are finding significant concerns and co–existing conditions in women with ADHD.Compulsive overeating, alcohol abuse, and chronic sleep deprivation may be present in womenwith ADHD7,8,9.

Women with ADHD often experience dysphoria (unpleasant mood), major depression andanxiety disorders, with rates of depressive and anxiety disorders similar to those in men withADHD10. However, women with ADHD appear to experience more psychological distress andhave lower self–image than men with ADHD11,12.

Compared to women without ADHD, women diagnosed with ADHD in adulthood are morelikely to have depressive symptoms, are more stressed and anxious, have more external locus ofcontrol (tendency to attribute success and difficulties to external factors such as chance), havelower self–esteem, and are engaged more in coping strategies that are emotion–oriented (useself–protective measures to reduce stress) than task–oriented (take action to solve problems)2.

Studies show that ADHD in a family member causes stress for the entire family13. However,stress levels may be higher for women than men because they bear more responsibility for homeand children. In addition, recent research suggests that husbands of women with ADHD are lesstolerant of their spouse's ADHD patterns than wives of men with ADHD14. Chronic stress takesits toll on women with ADHD, affecting them both physically and psychologically. Women whosuffer chronic stress like that associated with ADHD are more at risk for diseases related tochronic stress such as fibromyalgia15.

Thus, it is becoming increasingly clear that the lack of appropriate identification and treatment ofADHD in women is a significant public health concern.

The Challenge of Receiving Appropriate Treatment

ADHD is a condition that affects multiple aspects of mood, cognitive abilities, behaviors, anddaily life. Effective treatment for ADHD in adult women may involve a multimodal approach

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that includes medication, psychotherapy, stress management, as well as ADHD coaching and/orprofessional organizing.

Even those women fortunate enough to receive an accurate ADHD diagnosis often face thesubsequent challenge of finding a professional who can provide appropriate treatment. There arevery few clinicians experienced in treating adult ADHD, and even fewer who are familiar withthe unique issues faced by women with ADHD. As a result, most clinicians use standardpsychotherapeutic approaches. Although these approaches can be helpful in providing insightinto emotional and interpersonal issues, they do not help a woman with ADHD learn to bettermanage her ADHD on a daily basis or learn strategies to lead a more productive and satisfyinglife.

ADHD–focused therapies are being developed to address a broad range of issues includingself–esteem, interpersonal and family issues, daily health habits, daily stress level, and lifemanagement skills. Such interventions are often referred to as "neurocognitive psychotherapy,"which combines cognitive behavior therapy with cognitive rehabilitation techniques5,16.Cognitive behavior therapy focuses on the psychological issues of ADHD (for example,self–esteem, self–acceptance, self–blame) while the cognitive rehabilitation approach focuses onlife management skills for improving cognitive functions (remembering, reasoning,understanding, problem solving, evaluating, and using judgment), learning compensatorystrategies, and restructuring the environment.

Medication Management in Women with ADHD

Medication issues are often more complicated for women with ADHD than for men. Anymedication approach needs to take into consideration all aspects of the woman's life, includingthe treatment of co–existing conditions. Women with ADHD are more likely to suffer fromco–existing anxiety and/or depression as well as a range of other conditions including learningdisabilities17,18,19. Since alcohol and drug use disorders are common in women with ADHD,and may be present at an early age, a careful history of substance use is important20.

Medication may be further complicated by hormone fluctuations across the menstrual cycle andacross the lifespan (e.g., puberty, perimenopause, and menopause) with an increase in ADHDsymptoms whenever estrogen levels fall21. In some cases, hormone replacement may need to beintegrated into the medication regimen used to treat ADHD.

Childhood Issues for Girls with ADHD

Let's read the recollections of two women with ADHD in childhood and adolescence. Marie is anintroverted, "primarily inattentive" ADHD female, who has struggled with anxiety anddepression, in addition to ADHD, both in childhood and in adulthood.

"The thing I remember the most was always getting my feelings hurt. I was a lot happier when Iplayed with just one friend. When someone teased me I never knew how to defend myself. Ireally tried in school, but I hated it when the teacher called on me. Half the time I didn't evenknow what the question was. Sometimes I would get stomach aches and beg my mother to let mestay home from school." Marie, age 34

These recollections are very different from those of a typical elementary school aged ADHDboy. She was hypersensitive to criticism, had difficulty with the rapid give and take of group

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interactions, and felt socially "out of it" except in the company of her one best friend. Secondly,she was a compliant girl whose greatest desire was to conform to teacher expectations and not todraw attention to herself. Her distractibility caused agonizing feelings for her due to teacherdisapproval and embarrassment in front of her peers.

Lauren's "hyperactive-impulsive" ADHD patterns are more similar to those seen in many ADHDboys. She also recalls being stubborn, angry, defiant and rebellious and physically hyperactive.She was also hypersocial. Although we don't yet have adequate statistics for patterns in ADHDgirls, it seems likely that women like Lauren are in the minority when we examine ADHDpatterns.

"I can remember in grade school that everything felt frantic. I had a fight with my mom almostevery morning. At school I was always jumping around, talking and passing notes. Some of myteachers liked me, but some of them - the really strict ones - didn't like me. And I hated them. Iargued a lot and lost my temper. I cried really easily too, and some of the mean kids in the classliked to tease me and make me cry. Lauren, age 27

Although we see the argumentativeness and defiance in Lauren which we see more often inADHD boys, we also see that, like many ADHD girls, she was hyper-social and hyperemotional.Life for Lauren, as for some other girls with ADHD, was an emotional roller coaster. She wasvery disorganized, and had very low tolerance for stress.

ADHD Adolescent Girls

Let's take a look at the recollections of Marie and Lauren during their adolescence. Life, for eachof them, seemed to become even more difficult. Adolescence is difficult in general. WhenADHD is added to the mix, problems are amplified and stresses are intense.

"High school just overwhelmed me. None of my teachers knew me because I never spoke up inclass. Exams terrified me. I hated to study and write papers. They were really hard for me and Iput them off to the last minute. I didn't date at all in high school. People didn't dislike me, but Ibet if I went back to a class reunion that no-one would remember who I was. I was prettyemotional, and it got ten times worse just before my period." Mariel, age 34

"I was totally out of control in high school. I was smart, but a terrible student. I guess I workedon being a "party animal" to make up for all the things I wasn't good at. At home I was angry,totally rebellious. I snuck out of the house after my parents went to sleep at night. I lied all thetime. My parents tried to control me or punish me, but nothing worked. I couldn't sleep at night,and was exhausted all day in school. Things were bad most of the time, but when I had PMS Ireally lost it. School meant nothing to me. Lauren, age 27.

Marie and Lauren present very different pictures during their teenage years. Marie was shy,withdrawn, a daydreamer who was disorganized and felt overwhelmed. Lauren was hyperactive,hyperemotional, and lived her life in a high stimulation, high risk mode. What do they show incommon?

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Severe Premenstrual Syndrome

In teenage years, the neurochemical problems caused by ADHD are greatly compounded byhormonal fluctuations. These combined dysregulated systems result in tremendous mood swings,hyper-irritability, and emotional overreaction. Peer problems

Girls with ADHD seem to suffer more as a result of peer problems than do boys with ADHD.Although Lauren had many friends her emotionality got in the way repeatedly. Marie, bycontrast, felt overwhelmed, withdrew, and felt most comfortable in the company of one closefriend. Both, however, had a strong sense of "being different" from their peers.

Among Impulsive-hyperactive Girls: A Sense of Shame

Adolescent boys who are impulsive and hyperactive may be viewed as simply "sowing theiroats." They may even gain much peer approval as they rebel against authority, or as a result oftheir hard drinking, fast driving, sexually active lifestyle. Girls tend to receive much morenegative feedback from parents, teachers, and peers. Later, as young women, they often join thechorus of accusation and outrage, blaming themselves and feeling a strong sense of shame fortheir earlier behavior.

Ways to Help Girls with ADHD

Establish a "quiet zone" in their life

Emotionally overwhelmed

Whether shy and withdrawn, or hyper and impulsive, these girls often feel emotionallyoverwhelmed. They need to learn stress management techniques from an early age, and tounderstand that they need emotional "time out" to regroup after an upset.

Minimize corrections and criticism

Too often parents, with the best of intentions, shower ADHD girls with corrections andcriticisms. "Don't let them hurt your feelings like that.'" 'You'd forget your head if it wasn'tattached to your shoulders." "How do you expect to go to college with grades like that?" Thesegirls, whether loud and rebellious, or shy and retiring, typically suffer from low self-esteem.Home is an important place to refuel, and to rebuild the confidence that is so frequently erodedduring the day at school.

Help them find ways to excel

Girls with ADHD typically feel that they are "not good at anything." Their distractibility,impulsivity and disorganization often results in mediocre grades. Likewise, they often don't havethe stick-to-itiveness to develop skills and talents like many of their friends. Helping them to finda skill or ability, and then praising them and recognizing them for it are terrific positive boosts.Often the life of an adolescent girl with ADHD reaches a positive turning-point when she islucky enough to find an activity to feel good about.

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Special Issues Faced by Women with ADHD

The same themes, related to social and physiological differences between males and femaleswith ADHD, play themselves out again as adolescent girls become women with jobs, marriagesand families.

Social expectations/Being the support system

For a woman with ADHD her most painful challenge may be a struggle with her ownoverwhelming sense of inadequacy in fulfilling the roles she feels are expected of her by herfamily and by society. Both on the job and at home, women are often placed in the role ofcaretakers. While men with ADHD are advised to build a support system around themselves, notonly do few women have access to such a support system, society had traditionally expectedwomen to be the support system.

Dual-career stresses

The struggles for women with ADHD have been intensified with the emergence of "dual careercouples." During much of the past two decades more and more women have been required to notonly fulfill most if not all of the more traditional roles of wife and mother, but also to functionefficiently and tirelessly as they juggle the demands of a full time career.

Single parenting

Divorce rates are close to fifty percent among all marriages in the United States. Divorcebecomes even more likely when ADHD is added to the list of marital stressors. Followingdivorce, it continues to be predominantly the mothers who are left as primary parent for children.By adding ADHD to the huge burden of single-parenting, the result is often chronic exhaustionand emotional depletion.

Physiological differences—Hormonal fluctuations

The hormonal fluctuations which commence at puberty continue to play a strong role the lives ofwomen with ADHD. The problems they experience due to ADHD are greatly exacerbated bytheir monthly hormonal fluctuations. Some women report that the stresses of being the primaryparent of children with ADHD while attempting to struggle with their own ADHD reaches crisisproportions on a monthly basis as they go through their premenstrual phase, often lasting as longas a week.

Although the number of older women yet identified with ADHD is small, it seems quitereasonable to assume that the hormonal changes associated with menopause would be expectedto, once again, exacerbate ADHD symptoms of emotional reactivity.http://www.addresources.org/article_women_add_nadeau.php

Examples of Accommodations which educators can make to adapt to the needs of studentswith ADHD

Inattention

seat student in quiet area

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seat student near good role model seat student near "study buddy" increase distance between desks allow extra time to complete assigned work shorten assignments or work periods to coincide with span of attention; use timer break long assignments into smaller parts so student can see end to work assist student in setting short term goals give assignments one at a time to avoid work overload require fewer correct responses for grade reduce amount of homework instruct student in self-monitoring using cueing pair written instructions with oral instructions provide peer assistance in note taking give clear, concise instructions seek to involve student in lesson presentation cue student to stay on task, i.e. private signal

Impulsiveness

ignore minor, inappropriate behavior increase immediacy of rewards and consequences use time-out procedure for misbehavior supervise closely during transition times use "prudent" reprimands for misbehavior (i.e. avoid lecturing or criticism) attend to positive behavior with compliments etc.. acknowledge positive behavior of nearby students seat student near role model or near teacher set up behavior contract instruct student in self monitoring of behavior, i.e. hand raising, calling out call on only when hand is raised in appropriate manner praise when hand raised to answer question

Motor Activity

allow student to stand at times while working provide opportunity for "seat breaks" i.e. run errands, etc. provide short break between assignments supervise closely during transition times remind student to check over work product if performance is rushed and careless give extra time to complete tasks (especially for students with slow motor tempo)

Moodiness

provide reassurance and encouragement frequently compliment positive behavior and work product speak softly in non-threatening manner if student shows nervousness review instructions when giving new assignments to make sure student comprehends

directions look for opportunities for student to display leadership role in class

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conference frequently with parents to learn about student's interests and achievementsoutside of school

send positive notes home make time to talk alone with student encourage social interactions with classmates if student is withdrawn or excessively shy reinforce frequently when signs of frustration are noticed look for signs of stress build up and provide encouragement or reduced work load to

alleviate pressure and avoid temper outburst spend more time talking to students who seem pent up or display anger easily . provide brief training in anger control: encourage student to walk away; use calming

strategies; tell nearby adult if getting angry

Academic Skills

if reading is weak: provide additional reading time; use "previewing" strategies; selecttext with less on a page; shorten amount of required reading; avoid oral reading

if oral expression is weak: accept all oral responses; substitute display for oral report;encourage student to tell about new ideas or experiences; pick topics easy for student totalk about

if written language is weak: accept non-written forms for reports (i.e. displays, oral,projects); accept use of typewriter, word processor, tape recorder; do not assign largequantity of written work; test with multiple choice or fill-in questions

if math is weak: allow use of calculator; use graph paper to space numbers; provideadditional math time; provide immediate correctness feedback and instruction viamodeling of the correct computational procedure

Organization

ask for parental help in encouraging organization, provide organization rules encourage student to have notebook with dividers and folders for work provide student with homework assignment book supervise writing down of homework assignments send daily/weekly progress reports home regularly check desk and notebook for neatness, encourage neatness rather than penalize

sloppiness allow student to have extra set of books at home give assignments one at a time assist student in setting short term goals do not penalize for poor handwriting if visual-motor defects are present encourage learning of keyboarding skills allow student to tape record assignments or homework

Compliance

praise compliant behavior provide immediate feedback ignore minor misbehavior use teacher attention to reinforce positive behavior

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use "prudent" reprimands for misbehavior (i.e. avoid lecturing or criticism) acknowledge positive behavior of nearby student supervise student closely during transition times seat student near teacher set up behavior contract implement classroom behavior management system instruct student in self-monitoring of behavior

Socialization

praise appropriate behavior monitor social interactions set up social behavior goals with student and implement a reward program. prompt appropriate social behavior either verbally or with private signal encourage cooperative learning tasks with other students provide small group social skills training praise student frequently assign special responsibilities to student in presence of peer group so others observe

student in a positive light.

Ideas for Attention Deficit Children

1. Pause and create suspense by looking around before asking questions.2. Randomly pick reciters so the students cannot time their attention.3. Signal that someone is going to have to answer a question about what is being said.4. Use the student’s name in a question or in the material being covered.5. Ask a simple question (not even related to the topic at hand) to a student whose attention

is beginning to wander.6. Develop a private running joke between you and the student that can be invoked to re-

involve you with the student.7. Stand close to an inattentive student and touch him or her on the shoulder as you are

teaching.8. Walk around the classroom as the lesson is progressing and tap the place in the child’s

book that is currently being read or discussed.9. Decrease the length of assignments or lessons.10. Alternate physical and mental activities.11. Increase the novelty of lessons by using films, tapes, flash cards, or small group work or

by having a child call on others.12. Incorporate the student’s interests into a lesson plan.13. Structure in some guided daydreaming time.14. Give simple, concrete instructions, once.15. Investigate the use of simple mechanical devices that indicate attention versus inattention.16. Teach students self monitoring strategies.17. Use a soft voice to give direction.18. Employ peers or older students or volunteer parents as tutors.

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Strategies for Cognitively Impulsive Students

Some students have difficulty staying with the task at hand. Their verbalizations seem irrelevantand their performance indicates that they are not thinking reflectively about what they are doing.Some possible ideas to try out in this situation include the following.

19. Provide as much positive attention and recognition as possible.20. Clarify the social rules and external demands of the classroom.21. Establish a cue between teacher and student.22. Spend personal discussion times with these students emphasizing the similarities between

the teacher and student.23. Get in a habit of pausing 10 to 16 seconds before answering.24. Probe irrelevant responses for possible connections to the question.25. Have students repeat questions before answering.26. Choose a student to be the "question keeper."27. Using a well known story, have the class orally recite it as a chain story.28. When introducing a new topic in any academic area, have the students generate questions

about it before providing them with much information.29. Distinguish between reality and fantasy by telling stories with a mix of fact and fiction

and asking the students to critique them.30. Assign a written project that is to contain elements that are "true," "could happen but

didn’t," and "pretend, can’t happen."31. Do not confront lying by making students admit they have been untruthful.32. Play attention and listening games.33. Remove un-needed stimulation from the classroom environment.34. Keep assignments short.35. Communicate the value of accuracy over speed.36. Evaluate your own tempo as teacher.37. Using the wall clock, tell students how long they are to work on an assignment.38. Require that students keep a file of their completed work.39. Teach students self talk.40. Encourage planning by frequently using lists, calendars, charts, pictures, and finished

products in the classroom.

Suggested Classroom Accommodationsfor Specific Behaviors

When you see this behavior Try this accommodation

1. Difficulty following a plan (has highaspirations but lacks follow-through); setsout to "get straight A’s, ends up with F’s"(sets unrealistic goals)

+Assist student in setting long-range goals: break the goal into realistic parts.+Use a questioning strategy with the student; ask, What do you need to be able to dothis?+Keep asking that question until the student has reached an obtainable goal.+Have student set clear timelines of what he needs to do to accomplish each step(monitor student progress frequently).

2. Difficulty sequencing and completingsteps to accomplish specific tasks (e.g.writing a book report, term paper,organized paragraphs, division problem,etc.)

+ Break up task into workable and obtainable steps.+ Provide examples and specific steps to accomplish task.

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3. Shifting from one uncompleted activity toanother without closure.

+ Define the requirements of a completed activity (e.g. your math is finished when all sixproblems are complete and corrected; do not begin on the next task until it is finished).

4. Difficulty following through oninstructions from others.

+ Gain student’s attention before giving directions. Use alerting cues. Accompany oraldirections with written directions.+ Give one direction at a time. Quietly repeat directions to the student after they havebeen given to the rest of the class. Check for understanding by having the student repeatthe directions.

5. Difficulty prioritizing from most to leastimportant.

+ Prioritize assignment and activities.+ Provide a model to help students. Post the model and refer to it often.

6. Difficulty sustaining effort and accuracyover time.

+ Reduce assignment length and strive for quality (rather that quantity).+ Increase the frequency of positive reinforcements (catch the student doing it right andlet him know it.

7. Difficulty completing assignments. + List and/or post (and say) all steps necessary to complete each assignment.+ Reduce the assignment into manageable sections with specific due dates.+ Make frequent checks for work/assignment completion.+ Arrange for the student to have a "study buddy" with phone number in each subjectarea.

8. Difficulty with any task that requiresmemory.

+ Combine seeing, saying, writing and doing; student may need to sub vocalize toremember.+ Teach memory techniques as a study strategy (e.g. mnemonics, visualization, oralrehearsal, numerous repetitions).

9. Difficulty with test taking. + Allow extra time for testing; teach test-taking skills and strategies; and allow student tobe tested orally.+ Use clear, readable and uncluttered test forms. Use test format that the student is mostcomfortable with. Allow ample space for student response. Consider having lined answerspaces for essay or short answer tests.

10. Confusion from non-verbal cues(misreads body language, etc.)

+ Directly teach (tell the student) what non-verbal cues mean. Model and have studentpractice reading cues in a safe setting.

11. Confusion from written material(difficulty finding main idea from aparagraph; attributes greater importance tominor details)

+ Provide student with copy of reading material with main ideas underlined orhighlighted.+ Provide an outline of important points from reading material.+ Teach outlining, main-idea / details concepts.+ Provide tape of text / chapter.

12. Confusion from written material(difficulty finding main idea from aparagraph; attributes greater importance tominor details)

+ Provide student with a copy of presentation notes.+ Allow peers to share carbon-copy notes from presentation (have student compare ownnotes with a copy of peer’s notes).+ Provide framed outlines of presentations (introducing visual and auditory cues toimportant information).+ Encourage use of tape recorder.+ Teach and emphasize key words (the following..., the most important point...,etc.).

13. Difficulty sustaining attention to tasks orother activities (easily distracted byextraneous stimuli)

+ Reward attention. Break up activities into small units. Reward for timelyaccomplishment.+ Use physical proximity and touch. Use earphones and/or study carrels, quiet place, orpreferential seating.

14. Frequent messiness or sloppiness. + Teach organizational skills. Be sure student has daily, weekly and/or monthlyassignment sheets; list of materials needed daily; and consistent format for papers. Havea consistent way for students to turn in and receive back papers; reduce distractions.+ Give reward points for notebook checks and proper paper format.+ Provide clear copies of worksheets and handouts and consistent format for worksheets.+ Establish a daily routine, provide models for what you want the student to do.+ Arrange for a peer who will help him with organization.+ Assist student to keep materials in a specific place (e.g. pencils and pens in pouch).+ Be willing to repeat expectations.

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+ Assist student to keep materials in a specific place (e.g. pencils and pens in pouch).+ Be willing to repeat expectations.

15. Poor handwriting (often mixing cursivewith manuscript and capitals with low-caseletters)

+ Allow for a scribe and grade for content, not handwriting. Allow for use of computeror typewriter.+ Consider alternative methods for student response (e.g. tape recorder, oral reports,etc.).+ Don’t penalize student for mixing cursive and manuscript (accept any method ofproduction).+ Use pencil with rubber grip.

16. Difficulty with fluency in handwritinge.g. good letter/word production but veryslow and laborious.

+ Allow for shorter assignments (quality vs. quantity).+ Allow alternate method of production (computer, scribe, oral presentation, etc.).+ Use pencil with rubber grip.

17. Poorly developed study skills + Teach study skills specific to the subject area - organization (e.g. assignment calendar),textbook reading, note taking (finding main idea / detail, mapping, outlining), skimming,summarizing).

18. Poor self-monitoring (careless errors in spelling,arithmetic, reading)

+ Teach specific methods of self-monitoring (e.g. stop-look-listen).+ Have student proof-read finished work when it is cold.

19. Low fluency or production of written material(takes hours on a 10 minute assignment)

+ Allow for alternative method for completing assignment (oral presentation, taped report, visualpresentation, graphs, maps, pictures, etc. with reduced written requirements).+ Allow for alternative method of writing (e.g. typewriter, computer, cursive or printing, or a scribe.

20. Apparent Inattention (underachievement,daydreaming, not there)

+ Get student’s attention before giving directions (tell student how to pay attention, look at me while I talk,watch my eyes while I speak). Ask student to repeat directions.+ Attempt to actively involve student in lesson (e.g. cooperative learning).

21. Difficulty participating in class without beinginterruptive; difficulty working quietly

+ Seat student in close proximity to the teacher.+ Reward appropriate behavior (catch student being good).+ Use study carrel if appropriate.

22. Inappropriate seeking of attention (clownsaround, exhibits loud excessive or exaggeratedmovement as attention-seeking behavior, interrupts,butts into other children’s activities, needles others)

+ Show student (model) how to gain other’s attention appropriately.+ Catch the student when appropriate and reinforce.

23. Frequent excessive talking + Teach student hand signals and use to tell student when and when not to talk.+ Make sure student is called when it is appropriate and reinforce listening.

24. Difficulty making transitions (from activity toactivity or class to class); takes an excessive amountof time to find pencil, gives up, refuses to leaveprevious task; appears agitated during change.

+ Program child for transitions. Give advance warning of when a transition is going to take place (now weare completing the worksheet, next we will ...) and the expectation for the transition (and you will need...)+ Specifically say and display lists of materials needed until a routine is possible. List steps necessary tocomplete each assignment.+ Have specific locations for all materials (pencil pouches, tabs in notebooks, etc.).+ Arrange for an organized helper (peer).

25. Difficulty remaining seated or in a particularposition when required to

+ Give student frequent opportunities to get up and move around. Allow space for movement.

26. Frequent fidgeting with hands, feet or objects,squirming in seat.

+ Break tasks down to small increments and give frequent positive reinforcement for accomplishments(this type of behavior is often due to frustration).+ Allow alternative movement when possible.

27. Inappropriate responses in class often blurtedout; answers given to questions before they have beencompleted.

+ Seat student in close proximity to teacher so that visual and physical monitoring of student behavior canbe done by the teacher.+ State behavior that you do want (tell the student how you expect him to behave).

28. Agitation under pressure and competition(athletic or academic)

+ Stress effort and enjoyment for self, rather than competition with others.+ Minimize timed activities; structure class for team effort and cooperation.

29. Inappropriate behaviors in a team or large groupsport or athletic activity (difficulty waiting turn ingames or group situations)

+ Give the student a responsible job (e.g. team captain, care and distribution of the balls, score keeping,etc.); consider leadership role.+ Have student in close proximity of teacher.

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30. Frequent involvement in physically dangerousactivities without considering possible consequences

+ Anticipate dangerous situations and plan for in advance.+ Stress Stop-Look-Listen.+ Pair with responsible peer (rotate responsible students so that they don’t wear out!).

31. Poor adult interactions. Defies authority. Sucksup. Hangs on.

+ Provide positive attention.+ Talk with student individually about the inappropriate behavior (what you are doing is..., a better way ofgetting what you need or want is...).

32. Frequent self-putdowns, poor personal care andposture, negative comments about self and others,low self-esteem

+ Structure for success.+ Train student for self-monitoring, reinforce improvements, teach self-questioning strategies (What am Idoing? How is that going to affect others?)+ Allow opportunities for the student to show his strength.+ Give positive recognition.

33. Difficulty using unstructured time - recess,hallways, lunchroom, locker room, library, assembly

+ Provide student with a definite purpose during unstructured activities (The purpose of going to thelibrary is to check out the purpose of...is...).+ Encourage group games and participation (organized school clubs and activities).

34. Losing things necessary for task or activities atschool or at home (e.g. pencils, books, assignmentsbefore, during and after completion of a given task)

+ Help students organize. Frequently monitor notebook and dividers, pencil pouch, locker, book bag,desks. A place for everything and everything in its place.+ Provide positive reinforcement for good organization. Provide student with a list of needed materials andlocations.

35. Poor use of time (sitting, starting off into space,doodling, not working on task at hand)

+ Teach reminder cues (a gentle touch on the shoulder, hand signal, etc.).+ Tell the student your expectations of what paying attention looks like. (You look like you are payingattention when...)+ Give the student a time limit for a small unit of work with positive reinforcement for accuratecompletion.+ Use a contract, timer, etc. for self-monitoring.

Environment• Reduce clutter in the environment.• Seat the student in the front of the room unless that is a high traffic area.• Do not have the student's seat near colorful displays, windows, or commonly used

equipment.• Seat student away from high-traffic and noisy areas.• Seat the student at an individual desk rather than a table.• Eliminate unnecessary distractions.• Closed classroom architecture (4 walls and a door) helps minimize distractions.• Decrease auditory and visual distractions during difficult or new tasks.• Put brightly colored poster board under the student's work to help him/her focus.• Allow student to get into a comfortable position while he/she is learning.

Setting Up Your Classroom for ADD ADHD Attention Deficit Disorder Students...• Right from day one, make clear rules and post them, with logical consequences and with

rewards.• Privacy boards can work well, but should never embarrass a student.• It is usually better to use rows for seating arrangement and to try to avoid tables with

groups of students. Often the groups are too distracting for the ADHD student. In theideal setting, provide tables for specific group projects, and traditional rows forindependent work. Of course, we are rarely in an ideal setting.

• Every once in a while, try arranging desks in a horseshoe shape to allow for appropriatediscussion while permitting independent work.

• Your ADD ADHD student's desk should be near the teacher (for prompting andredirection), away from other challenging students, and not touching others' desks.However, if you notice that your attention deficit student looks around a lot to see wherenoises are coming from, because he is very auditory distractible, he may benefit from

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being seated near the rear of the classroom. Experiment with seat location in the front ofthe classroom (near the board) and instructional area if your student is more visuallydistracted.

• Have all of the distractible ADD ADHD students seated nearest to place in the classwhere you will give directions or lectures. At least as close as possible without beingpunitive.

• To minimize distractions, seat the ADD ADHD student away from both the hallway andwindows.

• Use desk dividers and/or study carrels carefully. Make sure they are used as a "study areaoption" rather than as a punishment.

• Your attention deficit student will do better when he is able to anticipate times requiringincreased concentration. Make a copy of the day's schedule and post it for your students.

• If your ADD ADHD student tends to lose focus, and his activity-level increases duringthe day, schedule the most demanding attentional tasks in the morning.

• Use the ADD ADHD student's worksheet as an example.• Provide comfortable lighting and room temperature.• It has become somewhat fashionable to play classical music, or baroque music, quietly in

the background while students are working. This may, in fact, actually work.• Provide a quiet, carpeted space in the room as a special study section for independent

reading.• Many students often bring their own distractions (toys) from home. Try to make a

classroom rule about appropriate time/place to share them with classmates and limit theirappearance in the classroom and on the desks.

Using Worksheets and Other Tips• Stress accuracy instead of quantity of work. This is really what you want as a teacher

anyway.• The ADD ADHD student may be easily overwhelmed and discouraged. Reduce the

quantity of work on a page. Instead of giving 30 problems on a page, give only 10 or 15.Then the ADD ADHD student won't be overwhelmed, and successes will build up hisself-esteem.

• Your ADD ADHD student may tend to want to be "the first one done" on assignments.Set reasonable accuracy goals with him and collect the entire group's work at once toreduce time pressures.

• Use large type.• Keep page format simple. Include no extraneous pictures or visual destructors that are

unrelated to the problems to be solved.• Provide only one or two activities per page.• Have white space on each page.• Use dark black print. (Avoid handwritten worksheets or tests.)• Use off-white or buff-colored paper rather than white if the room's lighting creates a glare

on white paper.• Write clear, simple directions.• Underline key direction words or vocabulary or have the students underline these words

as you read directions with them.• Draw borders around parts of the page you want to emphasize.• Divide the page into sections and use a system to cover sections not currently being used.• If possible, use different colors on worksheets or tests for emphasis, particularly on those

involving rote, potentially boring work.• Have the students use colored pens or pencils.

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• Give frequent short quizzes and avoid long tests.• Provide practice tests.• Provide alternative environments with fewer distractions for test taking.• Shorten assignments. If the attention deficit student can demonstrate adequate concept

mastery in 10 or 20 questions, don't require 30-40 problems.

Organize the ADD ADHD student's environment.• Use dividers and folders in his desk so he can easily find things.• Teach him how to organize himself better.• Help the student with Attention Deficit Disorder to organize his written work or numbers.• Allow the ADD ADHD student to move a pencil or his finger across the page while

reading. If he's writing, allow him to use one or two fingers for spacing between words.• During math, graph paper may be very helpful to organize his numbers and columns.• Break longer assignments into a series of smaller "sprints" for the ADD ADHD student to

complete one after another. Your Attention Deficit student will feel less "overwhelmed"and he will complete the total project in far less time.

• Consider having the ADD ADHD student complete every second or third problem,instead of answering each one. Require him to show mastery of concepts.

• Emphasize practice and assignment completion on the word processor to lower thefrustration many ADD ADHD students feel with written work.

• Model an organized classroom and model the strategies you use to cope withdisorganization.

• Establish a daily classroom routine and schedule.• Show that you value organization by following 5 minutes each day for the students to

organize their desks, folders, etc.• Use individual assignment charts or pads that can go home with the student to be signed

daily by parents if necessary.• Develop a clear system for keeping track of completed and uncompleted work such as

having individual hanging files in which each student can place completed work and aspecial folder for uncompleted work.

• Develop a color coding method for your room in which each subject is associated with acertain color that is the that subjects textbook cover and on the folder or workbook forthat subject.

• Write schedule and timelines on the board each day.• Provide due dates for assignments each day.• Tape a checklist to the ADD ADHD student's desk or put one in each subject

folder/notebook that outlines the steps in following directions or checking to be sure anassignment is complete.

• THE BLACK HOLE OF HOMEWORK exists in your ADD ADHD student's desk orbackpack. We have seen attention deficit students struggle for hours with homework,only to not turn it in and then lose it in their desks or backpacks. Please check to makesure that they are actually turning in the work. It is strange but true. They have probablydone the homework, but just are not paying attention when you ask them to turn it in.

• Provide study guides or outlines of the content you want the student to learn, or let thestudent build her/his own study guide with worksheets that have been positivelycorrected.

• Be clear about when student movement is permitted and when it is discouraged, such asduring independent work times.

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• Your ADD ADHD student should be encouraged to utilize assignment sheets, brokendown by day and subject. He or his teachers can record assignments at the completion ofeach task.

• An organizing time at the end of each day can be helpful to gather the necessary materialsfor the assignments and develop a plan of action for completion. This will greatly aid thedevelopment of the "executive processes".

• Some Attention Deficit ADD ADHD students now take a small dose of theirmedication when they come home from school to aid in studying/homeworkcompletion. Check with the doctor about the time period of maximum medicationeffectiveness to help set-up a sensible homework schedule.

• One of the simplest interventions for ADD ADHD students is to have an extra set oftextbooks at home to minimize the problem of not having the necessary homeworkmaterials.

• Your ADD ADHD student should have a regularly scheduled time for cleaning up hisdesk at least once a week. However he may need some help from teachers, volunteers, orhis parents.

Increasing Your ADHD Students' Time On-Task• Promote time on-task with attention deficit students, never time off-task. Reward the

behaviors that you want the ADD ADHD student to do, not the one's that you don't wanthim to do.

• Most students with attention deficit disorder have difficulty with sustaining attention ontasks over time. Students with ADD ADHD problems may need different levels ofstimulation to keep them focused.

• Break work up into smaller segments and sprints, and allow your ADD ADHD studentfrequent breaks to move around inside and outside the classroom. This may vary from adaily outside walk, doing errands around the building, to classroom stretching exercises.

• Schedule the most demanding attentional tasks in the morning.• Your ADD ADHD student may get overwhelmed with large assignments. His attention

may wander after guided practice on similar tasks. Adjust the assignment down to smallerintervals. Give the assignment one sheet at a time. Assign every third problem, ratherthan every one, for completion to reflect mastery level. Cut apart single worksheets intostrips. Tailor guided practice to occur during those time periods. Schedule breaks afterthis optimum attention time period and then return to the assignment.

• Seat work is often extremely difficult for students with attention deficit disorder. This canbecome compounded when the teacher is instructing another small group. Check on yourADD ADHD student as much as possible or have him check-in with the teacher.

Dealing with Impulsive Behaviors• ADD ADHD students tend to act without thinking first. Behaviorally, this shows itself in

a lack of understanding of cause and effect. Attention Deficit students do things withoutthinking about the consequences of their actions. They say things without consideringhow others will respond.

• Research also suggests that attention deficit students can often verbalize the rules inplace for behavior but have difficulty internalizing them and translating them intothoughtful behavior. Difficulties in delaying gratification also add to the impulsivity.

• Some clinicians believe that this lack of self-control (poor regulation and inhibitionof behavior), rather than their ability to pay attention, is the main problem withADD.

• How can you help these ADD ADHD students with their self-control?

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• By having attention deficit students think "out loud" when they are problem-solving, theteacher will gain insights into their reasoning style and the process will slow them downbefore they respond impulsively. Or ask the ADD ADHD student your question, but askhim not to answer for 15 or 20 seconds, long enough to think about it first and not justrespond impulsively.

• Quite often, attention deficit students will continue to have difficulty with certain types ofinteractions on a regular basis; difficulty in taking turns, over-interpreting others' remarksas hostile, personalizing others' actions excessively, and misreading social cues. With thehelp of your ADHD ADD student, his teacher, and his trusted peers, problems thathappen over and over again can be identified.

• Role-play the problems, and possible solutions, ahead of time. Use his friends to help inthe role-playing. Have your ADD ADHD student practice these responses during theschool day and have him and others give you feedback on their success.

• Teach your attention deficit students to "Stop and Think" before talking. This will helphim to learn to slow down before talking. Encourage thoughtful responding and decreaseimpulsivity by waiting 10 to 15 seconds to receive responses during whole groupinstruction.

• Keep the classroom behavior rules simple and clear. Define and review classroom ruleseach day.

• Implement a classroom behavior management system. Actively reward the behaviors thatyou want the students to do. Focus on the positive.

• Set hourly, daily, weekly, or monthly goals depending on the reinforcement needs of theADD ADHD student. Provide frequent feedback on the attention deficit student'sprogress toward these goals.

• Provide a changing array of backup rewards or privileges so that ADD ADHD studentsdo not "burn out" on a particular system.

• Avoid giving the whole class negative consequences based on the ADD ADHD student'sbehavior. The Attention Deficit student, as well as the whole class, can benefit fromimplementation of social skills curriculum for the entire class.

• Modeling and requiring the students to use a systematic method of talking throughclassroom conflicts and problems can be particularly valuable for the ADD ADHDstudent.

• Praise specific behaviors. For example, "I like how you wrote down all your assignmentscorrectly," rather than, "Good boy!"

• Frequently move about the room, manage by "walking around." When you catch yourADD ADHD student working on-task, reward him with a simple wink or smile. "I likethe way that you are working hard" goes a long way with Attention Deficit students.

• With students who can be quite volatile and may initially refuse negative consequences(such as refusing to go to time-out), set a kitchen timer for a brief period (1-2 minutes)after refusal has occurred. Explain to the student that the student can use the two minutesto decide if she/he will go to time out on her/his own or if more serious consequencemust be imposed. Several experienced teachers insist this method has successfullyreduced the extent to which they have had to physically enforce certain negativeconsequences with students and seems to de-escalate the situation.

Improving Social Skills• Provide a safe environment for the student with ADD ADHD. Make sure the student

knows you are there to help him. Treat him with respect. Never belittle him in front of hispeers. Both he and the other students know that he stands out, and if the teacher belittles

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the student, then the rest of the students will see that as permission from the teacher tobelittle the student as well. Students can be cruel.

• Students with attention deficit disorder can experience many difficulties in the socialarea, especially with peer relationships. They tend to have trouble picking up social cues,they act impulsively, have limited self-awareness of their effect on others, displaydelayed role-taking ability, and over-personalize other's actions as being criticism, andtend not to recognize positive feedback.

• ADD ADHD students tend to play better with younger or older students when their rolesare clearly defined.

• These attention deficit students tend to repeat self-defeating social behavior patterns andnot learn from experience.

• Conversationally, they may ramble and say embarrassing things to peers.• Areas and time-periods with less structure and less supervision, such as the playground

and class parties, can be a problem. Students with good social awareness and who like tobe helpful can be paired with the ADD ADHD student to help. This pairing can take theform of being a "study buddy", doing activities/projects, or playing on the playground.

• Cross-age tutoring with older or younger students can also have social benefits. Mostsuccessful pairing is done with adequate preparation of the paired student, planningmeetings with the pair to set expectations, and with parental permission. Pairingexpectations and time-commitments should be fairly limited in scope to increase theopportunity for success and lessen the constraints on the paired students.

• Students with attention deficit disorder tend to do well in the cooperative groupinstructional format. Small student groupings of three to five members, in which thestudents "sink or swim" together to complete assignments/projects, encourage students toshare organizational ideas and responsibilities, and gives an ideal setting for processinginterpersonal skills on a regular basis.

• Small "play groups" of two to four students can help your ADD ADHD student todevelop more effective social skills. These groups are most effective if sociallycompetent peers are willingly included in the group. The group should be focused onactivities that stress interaction and cooperation.

• Your ADD ADHD student would benefit most when the target social skills are identifiedand practiced with them prior to the activity and processed after the activity. Role-playahead of time.

• Many Attention Deficit students lack friends to be with outside of the school-setting. Itcan be beneficial to strategize with your ADD ADHD student and his parent ondeveloping a "friendship plan" for the home setting. Sometimes the goal of establishingone special friendship is ambitious and sufficient. This could include steps of identifyingfriend possibilities that might be available/accepting, practice in making arrangementsusing the phone, planning an activity or sleep-over that is structured/predictable, and tipson how to maintain friendships over time.

• A subtle way for your ADD ADHD student to learn social skills is through the use ofguided observation of his peers on the playground. Accompany them on to theplayground and point out the way other students initiate activities, cooperate in a game,respond to rejection, deal with being alone, etc.

• For many attention deficit hyperactivity disorder students, thirty minutes on theplayground is beyond their capability to maintain peer relationships successfully. Ifnecessary, break-up the recess into ten minutes of activity, a ten minute check-in with theplayground supervisor, then another ten minute activity period.

• Restricting the area available for your ADD ADHD student during recess can increasethe contact with adult supervision and lessen the complexity of social decision-making.

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This can be done privately with your attention deficit student prior to recess. Many ADDADHD students welcome this manner of simplifying their social interactions during thisperiod of low structure.

• It is helpful to meet with your ADD ADHD student prior to his lunchroom/playgroundperiod to review his plan for recess activity and with whom he will sit during lunch. Havehim ask peers in advance of the recess block to do a certain activity with him. Process theactivity with your attention deficit student after recess and make suggestions for thefollowing day.

Increasing Compliance in the Classroom• Listen to the student. They want to be heard too.• Treat him with respect.• Give him a break once in a while. Know the difference between big things and little

things, and don't confront him on each little thing. It is hard for these students to controlthemselves all of the time.

• Help the student find his areas of strength so that he can build his self-esteem.• It is important to pair verbal praise with a reward. This will facilitate "weaning" from a

concrete reward structure to an internalized system.• A simple nod, wink, smile, or touch on the shoulder can be very powerful.• Instead of confronting your student continually on activities/behaviors that are

inappropriate, point out the alternative choices that are available. This will make theexpectations clearer to him and avoid the negativity inherent in what he would perceiveas criticism.

• Some students respond to a prearranged cuing system with the teacher. In this system, theteacher gives a visual signal (touching the ear) or verbal phrase ("Remember, I'm lookingfor good listeners") when a targeted inappropriate behavior occurs. The cue can remindyour student to correct behavior without direct confrontation or loss of self-esteem. It caninvolve the classroom teacher or any support personnel available to the student.

• Encouraging your student to monitor his own behavior has many benefits. It can providean opportunity for discussion when your student and the teacher agree/disagree on theratings. It also prompts movement toward your student's internal frame of reference inevaluating his behavior.

Improving Consistency of Performance• Computers are great for immediate feedback to the Attention Deficit Disorder student.

They provide 1 on 1 work, and they are highly stimulating. Use them with ADD ADHDstudents whenever possible.

• ADD ADHD students often have trouble with change, as you may see when asking anAttention Deficit student to move from one activity to another. Establish routines andnotify the student well ahead of time if there are to be changes in the daily routine. Thiswill help the student to focus better.

• Report any significant changes in behavior or school performance of ADD ADHDstudents to parents, school administrators, or school psychologist. There may bemedication issues, or other issues, that the parents or physicians need to be aware of.

• Your ADD ADHD student may need a place to unwind and reduce stress during theschool day. Often times this can be simply providing a place for sitting alone, using thecomputer, taking a short walk, drawing, or modeling with clay. After ten to fifteenminutes, your attention deficit student will likely be able to access the energy needed toattend to the classroom.

• Know the difference between big things and little things.

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• ADD ADHD Students using medication to treat attentional problems will have theiroptimal attention effects for Methylphenidate (Ritalin) 45 minutes to 2 2 hours aftertaking the medication. Other medications differ, and it is best to check with the physicianabout the time of maximum medication effects. If possible, try to schedule the mostattention-demanding tasks for the ADD ADHD student during this medication window.Work with parents to coordinate this.

• An individualized plan that emphasizes stimulating reinforcers on a consistent basis has agood chance of success. Consequences and reinforcement should be as immediate aspossible. Changing the reward periodically is usually necessary.

• If your ADD ADHD students believe that you are on their side, and that you really wantthem to be successful, then your behavioral plans will probably succeed. If they believethat you are out to get them, then they will view your behavioral plans as punitive andmanipulative. Same plan, different interpretation and results. You must be on the ADDADHD student's side. You must convince the student with attention deficit disorder thatyou what him to succeed.

• Rewards and verbal praise on a continual basis will change the attentional problem themost effectively. One suggested system is the "point system". Feedback that is delayed orvariable is problematic in that your student may have difficulty in correlating delay andgratification. Your student may begin to make faulty behavioral connections in thesesituations.

• ADD ADHD students respond well to rewards that they experience as highly-stimulating.Computer games, artistic media, and action-based play (sports or other physical activity),building sets, and activities outside of the school setting, can be effective.

• Ask your attention deficit student what he would like to earn. Your ADD ADHD studentis the best source of identifying the reward.

• Rewards should be changed frequently to maintain their "novelty power".• It is important in any behavioral system that your ADD ADHD student finds early

success to "buy in" to the program.• One of the characteristics of attention deficit hyperactivity disorder is the variability of

work performance across settings, tasks, and over time. In other words, ADD ADHDstudents have good days and bad days, good hours and bad hours. Rather than take highperformance on some tasks as an indicator that low performance on other tasks is due tolow motivation and willfulness, it is important to understand this as the nature ofattentional problems. Your ADD ADHD student will do better on tasks he findsinherently interesting and stimulating. He will tend to do worse on tasks that requiredsustained attention and are boring.

• If you bore your ADD ADHD students, they will perform poorly. When they performpoorly, you might quietly ask yourself if your lesson was boring.

• Your ADD ADHD student may have difficulty with tasks that require complex problem-solving strategies. There is continued difficulty with the "executive processes" (strategiesthat are used to organize and monitor thinking and action). Your ADD ADHD studentmay not learn from his mistakes, and may just keep guessing until he gets the rightanswer. Help your attention deficit student to develop problem solving strategies.

• Although your ADD ADHD student may seem to be verbally expressive (he may talk alot), he may still be poor in putting down his ideas in written form. Sometimes it is a longjourney from the brain, down the sleeve, to the hand, and finally to the pencil and paper.The mouth is a lot closer to the brain. Help the attention deficit disorder student with hiswriting skills.

• My ADD wife is verbally expressive. However, it can take her an hour to write a simplethank you note. This has always been the case for her, and as a result, school was very

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frustrating for her. Show great wisdom with your ADD ADHD students when it comes towriting assignments. Teach necessary skills, and encourage the attention deficit students.

• In assignments that require research reports and creative writing, have the student dictatethe words to someone rather than writing it down. The ADD ADHD student can thencopy the words using the word processor. This technique will yield greater output ontasks requiring expressive written language skills by removing the written component.

• Assignments that require extensive fine motor skills are difficult.• Give seat work one sheet at a time, if possible. This will prevent your ADD ADHD

student from feeling overwhelmed. This is also a helpful technique in testing him.• Identifying your attention deficit student's goals with his involvement is effective. Goals

should begin by being simple and easy to understand. Two to three goals are enough.• The criteria for success (or earning points) should be simple and clear. Successful goal

attainment early in the process is critical. Ask your ADD ADHD student to generatepossible goal areas or have him choose from a menu that the teacher has created. Thelarger the role that he has in identifying the goals, the greater investment he will have inreaching them.

• Have someone actively monitoring your ADD ADHD student during tests, especiallymultiple-choice, fill in the "bubble" tests. He can get off-track and fill in the wrong placesor become so frustrated that he might answer at random to simply complete the test.

• Emphasize that part of the work routine is to "check your work". Attention Deficitstudents tend to complete work and turn it in without checking it over. Give the ADDADHD student some instruction in how to check his work and practice it with him.

Dealing with Impulsive Behaviors Older students• Give your ADD ADHD students a break once in a while.• Quite often, ADD ADHD students will make the same mistakes over and over again,

both socially and with school work. Students with attention deficit disorder often haveproblems with taking turns, over-interpreting others' remarks as hostile, personalizingothers' actions excessively, and misreading social cues.

• A major consideration in forming an effective behavioral plan is assessing what isworkable for the classroom teacher on a regular basis. Some plans that require extensivecharting do not succeed because the teacher can not follow through effectively within thecontext of the daily classroom demands. Keeping the plan simple and flexible is the keyto success.

• Have someone actively monitoring your ADD ADHD student during tests, especiallymultiple-choice, fill in the "bubble" tests. He can get off track and fill in the wrong placesor become so frustrated that he might answer at random to simply complete the test.

• Emphasize that part of the work routine is to "check your work". Students with ADDADHD tend to complete work and turn it in without checking it over. Give the attentiondeficit student some instruction in how to check his work and practice it with him.

• In assignments that require research reports and creative writing, have the ADD ADHDstudent dictate the words to someone rather than writing it down. The attention deficitstudent can then copy the words using the word processor. This technique will yieldgreater output on tasks requiring expressive written language skills by removing thewritten component.

Presenting Your Lesson to ADHD Students• Provide an outline with the key concepts or vocabulary prior to lesson presentation. The

students can follow along and see the main concepts and terms as you present the lesson.

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• ADHD teens are easily bored, even by you. Try to increase the pace of lessonpresentation. Resist the temptation to get sidetracked.

• Get excited about your lesson! And communicate your excitement to your students!• Include a variety of learning activities during each lesson. Use multi-sensory

presentations, but screen audio-visual aids to be sure that distractions are kept to aminimum. For example, be sure interesting pictures and or sounds relate directly to thematerial to be learned.

• Many teachers are now using PowerPoint presentations or Astound presentations for theirstudents with great effect.

• Provide self-correcting materials for immediate feedback to the ADD ADHD student.• Use computer assisted instruction, both in terms of the student at a computer, and also in

terms of presenting information via PowerPoint presentations.• Use cooperative learning activities, particularly those that assign each teen in a group a

specific role or piece of information that must be shared with the group.• Pair students to check work.• Provide peer tutoring to help ADD ADHD student's review concepts. Let ADD ADHD

students share recently learned concepts with struggling peers. Use peer tutoringwhenever possible. Use older students to help your attention deficit students, and perhapsallowing him to tutor a younger student.

• The more exciting a subject is to an ADD ADHD students, the better he will perform inyour class.

• Improving Social Skills in Attention Deficit Disorder ADD ADHD Students• Students with attention deficit disorder experience many difficulties in the social area,

especially with peer relationships.• ADD ADHD students tend to experience great difficulty picking up other's social cues,

and often act impulsively.• Attention deficit students are often unaware of their effect on others.• They are likely to over-personalize other's actions as being criticism.• They tend not to recognize or respond well to positive feedback. In fact, ADHD may be

directly related to a deficit in recognizing rewards.• Students with ADD ADHD tend to get into the most trouble during times with little

structure or little supervision.• ideas and responsibilities, and gives an ideal setting for processing interpersonal skills on

a regular basis.

Sources

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Arcia, E., & Conners, C.K. (1998). Gender differences in ADHD?. Journal of Developmentaland Behavioral Pediatrics, 19, 77–83.

Biederman, J. (1998). Attention–deficit/hyperactivity disorder: a life–span perspective.Journal of Clinical Psychiatry, 59(Suppl. 7), 4–16.

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Biederman, J., Faraone, S.V., Mick, E., Williamson, S., Wilens, T.E., Spencer, T.J., Weber,W., Jetton, J., Kraus, I., Pert, J., & Zallen, B. (1999). Clinical correlates of ADHD infemales: Findings from a large group of girls ascertained from pediatric and psychiatricreferral sources. Journal of the American Academy of Child and Adolescent Psychiatry, 38,966–975.

Biederman, J., Faraone, S.V., Spencer, T., Wilens, T., Mick, E., & Lapey, K.S. (1994).Gender differences in a sample of adults with attention deficit hyperactivity disorder.Psychiatry Research, 53, 13–29.

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