I am fascinated with ADHD (otherwise known as Attention Deficit Hyperactivity Disorder). This disorder is confounding because it is EVERYWHERE. You can't walk into a classroom without at least 1 student having it or being suspected of having it. Why is that? What are we missing as parents and educators? Today, I worked in a classroom with a student who displayed a severe case of ADHD. This reminded me of a piece that I wrote a year ago. I decided that I must repost.
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The ADHD Student: What You Must Know
ADHD is a chronic, complicated disorder
Here are a few facts to consider about ADHD, also known as
Attention Deficit Hyperactivity Disorder.
- · ADHD is the most commonly studied and diagnosed psychiatric disorder in children. It is considered a neurobehavioral developmental disorder.
- · ADHD affects approximately 3-7% of all children globally with symptoms typically presenting before the age of 7.
- · Boys are 2 to 4 times more likely than girls to be diagnosed with ADHD.
- · Scientists are not sure exactly what causes ADHD, although many studies suggest that genetics and brain chemistry play a large role. It is thought that ADHD may result from a combination of factors including genetics, brain injuries, nutrition, environmental factors and/or social influences. (NIMH, National Institute of Mental Health).
A diagnosis of ADHD falls into one of three subtypes
To make the disorder even more confounding, ADHD has three
subtypes according to the DSM-IV. A
child who is diagnosed with ADHD will fall into one of the following
categories:
·
ADHD-
Predominantly Inattentive (also known as ADD)
A child with this diagnoses presents
symptoms that are more inattentive in nature. They are easily distracted, forgetful,
have trouble with organizing and completing a task, become bored easily,
struggle to follow directions, have difficulty focusing on one thing, daydream
and/or have trouble completing or turning in homework assignments. Children with this subtype are less likely to
act out or have difficulties getting along with other children. In fact, they tend to be very quiet and are
often overlooked. Parents and teachers may not notice that he or she has ADHD.
·
ADHD- Predominantly
Hyperactive-Impulsive
Students who are diagnosed with this type
of ADHD may display symptoms such as talking nonstop, fidgeting and squirming
in their seats, having difficulty doing quiet tasks, are very impatient, blurt out
inappropriate comments and act without regard for consequences.
·
ADHD-
Combined Hyperactive-Impulsive and Inattentive
These students have the symptoms of
hyperactivity, impulsivity and inattention.
Most children who are diagnosed with ADHD fall into this category.
Diagnosing ADHD is not a simple, single event
ADHD, and other mental illnesses, do not allow for a blood
test to provide a definitive diagnoses.
Instead, diagnosing the disorder is based upon the observations of the
student by parents, teachers and other caregivers.
Questionnaires regarding behaviors in the classroom and at
home help a mental health professional or doctor determine if a child is indeed
suffering from the disorder.
Professionals also look at how long the symptoms have been present and
whether the behaviors are excessive or not age appropriate.
What to do as teachers and parents if we suspect ADHD?
Erin’s son, Matt, started having trouble once he began
Kindergarten. He was
placed on a behavior chart for inattentive behaviors. Every year Erin would get the same email from
his teacher. "Matt has trouble focusing, so we are going to start him on a
behavior chart." Erin became so sick of the smiley face, frown face chart,
as they just didn’t seem to work.
Matt
’s 3rd grade teacher realized that his inattentive behaviors were something
that Matt couldn't help, so she asked if she could have him observed by the
Vice Principal. From there, Erin and
Matt saw his pediatrician who suggested a psychologist for a diagnosis as
well.
Once
Matt was officially diagnosed with ADHD-Inattentive type, Erin and the school
professionals wrote a 504 Plan. Erin
honestly didn’t think it worked well, if at all, because the teacher didn’t follow
it. “She was not a good communicator and
didn't check Matt's backpack like was written in the plan”.
At
home, Erin tried a no sugar diet and found that didn't help either. What does
help is making sure to check Matt’s backpack every night and talking to
him about school, pointing out the positives.
Erin also has Matt repeat back to her directions given at home.
After about 10 months and no success using the 504 Plan,
Erin decided to start Matt on ADHD medicine. Matt began on a low dose and the teacher
reported seeing a difference right away, “much more participation, attention
and interest in math”. Matt takes a low
dose in the morning with the school nurse on the days he is at school. “There has been a real positive change in
Matt since beginning the medicine.”
The treatments for ADHD do not cure the disorder, but
manage it
Because there is no cure for ADHD, current available
treatments focus on reducing the symptoms of ADHD and improving the functioning
of the student. Treatments include:
·
Different types of psychotherapy
·
Behavior therapy
·
Education about the disorder
·
Dietary changes and nutrition
·
Medication
Medication is the most controversial method for
treating ADHD
The most common and controversial method for treating ADHD
is through the use of medication.
Medications can help a child pay attention and complete school
work. But for some students, medications
can cause unwanted side effects.
Amy’s daughter, Brianna was diagnosed with ADHD-Inattentive
type, at the beginning of first grade and was diagnosed with an anxiety
disorder a year later. Brianna’s symptoms were mostly
that she had trouble following directions (especially multi-step directions),
staying organized, following through on things that she would begin, and her
fine motor skills were lacking-very poor handwriting.
After a
positive ADHD diagnoses, Amy decided to start Brianna on an ADHD medicine. “The first medicine we tried was a disaster!
It completely took away Brianna’s appetite.
She was extremely grouchy and mean to the point I didn't even want to
leave her alone in a room with her baby sister.
We
stopped that after just a few days and tried another medicine at a very low
dose. We didn't see it do much of anything so we increased the dose and that
took her appetite away also. The grouchiness wasn't there, but Brianna lost 9
pounds within a few months. The Doctor lowered her dose but we just didn’t see
any overall improvements.
By this
point, it was summer break so we just took her off all meds. I completely changed her diet and I was very
strict about it. No artificial colors, flavors, no preservatives, hardly any
sugar, no dairy, no wheat and no soy. It was HARD to keep her on it. The diet change helped, but not that well and
she still showed signs of anxiety. She worried about everything.”
ADHD can coexist
with other disorders or illnesses
It was not until Brianna was treated for an
anxiety disorder through the use of anti-anxiety medication that many of her
ADHD behaviors began to improve. When
ADHD exists with other disorders, such as a learning disability or anxiety and
depression, it is imperative to treat both conditions for the best possible
outcome.
Is ADHD over
diagnosed?
Are we too
quick to label a student as ADHD just because he can’t sit still or because a
student’s grades are slipping? A recent
study conducted by the CDC (Center for Disease Control) showed that 11% of
school-age children in the United States have received a diagnosis of ADHD.
What
has alarmed many is that in which the rate has climbed. According to the study, the rate has
‘skyrocketed’ 16% since 2007. The rise
was most dramatic among boys, with an estimated 1 in 5 boys of high school age
diagnosed with ADHD.
Like
most mental health disorders, ADHD is not black and white. It is a perplexing condition that can affect
the academic and social lives of affected children, possibly into
adulthood. A few points to consider
about the rising rates of ADHD:
·
Family
doctors, who aren’t always adequately trained in providing the detailed
evaluation that a reliable diagnosis requires, are diagnosing many children with
ADHD when there really may be another condition going on, or in fact, nothing
at all. This problem may lie in the
detail that doctors are required to sort out a very complex condition in a
short amount of time. Just because a
child is showing a few symptoms does not necessarily point to a positive
diagnosis. The symptoms must be present
every day for a long period of time and must lead to an impairment on the child’s
life.
·
A
too quick diagnosis may also mean that children are immediately placed on a
prescription. Instead, non-drug
treatments should be attempted first, such as behavioral therapy. Unfortunately, insurance complications and a lacking
commitment of time, effort, and money from some parents can bypass this
treatment option. Writing and filling a
prescription can be far easier (and cheaper) than getting a child the necessary
mental health professional help and psychosocial treatment the child is
requiring.
20
accommodations to support the ADHD student
Regardless
of the how’s and why’s of ADHD, as teachers it is vital that we support our
students on their academic journey. How
do we support parents and students who are affected by ADHD?
- Learn about which subtype of ADHD the student has been diagnosed with. Get to know the individual student and be mindful of his or her uniqueness.
- Seat the student away from doors and windows that may distract him or her. The student may work best closest to the teacher.
- Allow physical activity breaks (stretching) and incorporate movement activities into a lesson. If possible, allow for outdoor instruction time.
- When possible, provide academic instruction to the ADHD student in the morning. Evidence suggests that on-task behaviors of the ADHD student worsen over the course of a day.
- Write important information down where the student can easily reference it, most likely at their desk.
- Divide large assignments into small segments. Write these segments down. Have the student cross the items off as they are completed.
- Provide frequent breaks for the student to get a drink or walk around the room.
- Allow the ADHD student to run errands for you (take a note to the office) or have them be in charge of sharpening the classroom pencils.
- Provide the student with a stress ball or other object for the student to play with discreetly at their seat, especially when they need a break.
- Write the schedule of the day on the student’s desk and allow him or her to cross off each item as it is completed.
- Recognize and praise aloud all good behaviors. Be specific in what the student is doing correctly.
- Provide an assignment book for the student to keep track of homework and daily work. Encourage this book to be signed by parents so parents know what is going on in the classroom. Communicate with the parent as much as possible.
- Form small groups for the ADHD student to work in so as not to get distracted and lost in a large group.
- Allow the ADHD student to work in a quiet zone within the classroom. This should be a place in the room that is quiet and free from visual stimulation.
- Establish a secret signal with the student to use as a reminder when he or she is off task.
- When giving directions, make eye contact with the student and be as brief as possible.
- Use visuals. Highlight words in colored chalk or bright ink. Underline and circle important things to remember.
- Use auditory cues. Set a timer and encourage the student to work uninterrupted until the timer goes off. Allow the student a break following the work period.
- Provide specific, well-defined rules to the ADHD student. Write these rules down and tape them to the student’s desk. These rules should have clear consequences.
- Most importantly, students need guidance, compassion and understanding from their parents and teachers as they navigate the path of dealing with ADHD. Remember, tt isn’t their fault that they have been diagnosed with ADHD.
