Adhd booklet

Aspire Don’t ever give up Have faith in every child’s potential Differentiate instruction

MARIA ZAFIROPOULOU English Language Teacher November 2013

Don’t ever give up because every student can learn

It is better to build children than to repair adults

Praise children for what they do; don’t punish them for what they don’t do

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To all those people who believe in me and make my life brighter day by day

ISBN : 978-960-93-5697-8

©Maria Zafiropoulou 2013 Μαρία Ζαφειροπούλου 2013

First published in 2013 by Maria Zafiropoulou, Agioi Anargiroi, Greece

Πρώτη Έκδοση το 2013 από τη Μαρία Ζαφειροπούλου, ΆγιοιΑνάργυροι, Ελλάδα -3-

Contents

Page

Chapter 1 1.1 What is ADHD? 1.2 Key symptoms 1.3 Brain imaging studies 1.4 No cure – More effective treatments 1.5 Watch out!

5 5 5 6 6

Chapter 2 2.1 Symptoms of ADHD in children 2.2 Two main categories – Three subtypes

7 7

Chapter 3 3.1 Teaching children with ADHD

10

3.3

10 10

3.2

Steps for successful instruction of children with ADHD Recommended techniques and practices

Conclusion

20

Internet resources

21

Bibliography

22

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Chapter 1 1.1.

What is ADHD? Attention Deficit Hyperactivity Disorder (ADHD) is one of the most

common childhood brain disorders which, however, can continue through adolescence and adulthood. Unlike Learning Disabilities (LD) which are associated with deficiencies in processing data, ADHD manifests itself as an inability to focus and retain attention. It should be noted that the condition is diagnosed in more boys than girls, that is four to nine times more often, as most research suggests (Bender, 1997; Hallowell, 1994; Rief, 1997).

1.2.

Key symptoms

The key symptoms of the disorder include difficulty staying focused, paying attention and controlling behavior, as well as hyperactivity.

Although it is normal for all children to display inattention, hyperactivity or impulsivity sometimes, for children with ADHD these behaviors are displayed with much higher frequency and severity. All these symptoms can make it difficult for a child with ADHD to succeed in school, get along with not only peers but also adults, or finish assigned tasks. It is obvious, therefore, that this disorder can interfere with the child’s academic performance, on the one hand, and his/her social functioning, on the other.

1.3.

Brain imaging studies

According to brain imaging studies, in children with ADHD the brain matures in a normal pattern but is delayed on average by about 3 years and this delay is most pronounced in regions of the brain that are involved in thinking, paying attention and planning. More recent studies have -5-

revealed that the cortex, that is the outermost layer of the brain, shows delayed maturation overall and the same applies to a brain structure responsible for proper communication between the two halves of the brain. These delays and abnormalities can help explain how the disorder may develop.

1.4

No cure – More effective treatments There is currently no cure for the disorder; nevertheless, treatments

can relieve symptoms of ADHD so that most people can be successful in school and lead productive lives. More effective treatments and interventions as well as new tools like brain imaging, that researchers have at their disposal, make it easier to understand ADHD and find more ways to treat and prevent it.

1.5 Watch out!

ADHD can be mistaken for other problems because children with symptoms of the disorder tend to be quiet, unwilling to act out and they may appear to be working silently when they are actually not paying attention to what they seem to be involved in. In addition, they may not have difficulty getting along with other children despite the fact that children with symptoms of hyperactivity or impulsivity tend to have problems functioning in social settings. It is, therefore, possible for parents and teachers to miss the fact that children with symptoms of inattention have ADHD as they usually attribute the disorder to disciplinary factors.

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Chapter 2 2.1 Symptoms of ADHD in children For a child to be diagnosed with the disorder, he/she must have symptoms present before the age of seven for 6 or more months to a degree that is inconsistent with his/her developmental stage. The symptoms must be displayed in at least two settings, namely school and home, impairing the child’s academic and social status. It is worth noticing that the behaviors associated with this particular disorder change as children grow older ranging, for example, from gross motor over-activity at preschool stage to withdrawal and impulsivity when reaching adolescence.

2.2 Two main categories – Three subtypes Individuals with ADHD exhibit combinations of behaviors that fall in two main categories (*not all of these symptoms appear in all situations):

inattention and hyperactivity-impulsiveness.

Symptoms of inattention : 

Easily

distracted,

missing

details,

forgetting

things

and

unexpectedly switching activities 

Having difficulty retaining attention on one thing



Getting easily bored with a task unless they are involved in an enjoyable activity



Having trouble focusing on new information



Finding it difficult to organize, complete or turn in homework and losing things that are necessary to complete a task or activity



Appearing to daydream and not listening when spoken to -7-



Becoming easily confused and moving slowly



Struggling to process information quickly and accurately and having difficulty following instructions

Symptoms of hyperactivity : 

Fidgeting with hands or feet and/or squirming in their seats



Talking nonstop



Constantly in motion, dashing around touching or playing with anything and everything in sight



Difficulty remaining seated or still during dinner, school and story time



Difficulty working on tasks or activities quietly

Symptoms of impulsiveness: 

Being very impatient



Blurting out inappropriate comments and answers to unfinished questions



Showing their emotions without restraint thus, acting without regard for consequences



Difficulty waiting for a turn in tasks, games and, in general, group situations



Difficulty listening to others and often interrupting conversations or activities

The DSM-IV (Diagnostic Statistical Manual of Mental Disorders) defines three subtypes of the disorder: 1. Predominantly Inattentive Type 2. Predominantly Hyperactive-Impulsive Type 3. Combined Type -8-

(American Psychiatric Association [APA] as cited in Barkley, 1997) It is worth pointing out that, although many children have only ADHD, for some others the disorders might come with additional academic or behavioral diagnoses. It has been documented that a quarter to one third of children with ADHD also have learning disabilities (Forness & Kavale, 2001; Robelia, 1997; Schiller, 1996). Likewise, studies show a much greater rate of coexisting psychiatric disorders for children with ADHD that is, Oppositional Defiant Disorder, Conduct Disorder, Anxiety and Depression, Bipolar Disorder and Tourette Syndrome.

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Chapter 3 3.1

Teaching children with ADHD Bearing in mind that a child’s academic success is, to a large extent,

dependent on his/her ability to attend to tasks and teacher and classroom expectations with minimal distraction which, in turn, enables him/her to master new information, complete tasks and take part in classroom activities (Forness & Kavale, 2001), it is of vital importance to select and implement appropriate instructional strategies and practices.

In doing so, we should always pay attention to and try to understand the characteristics of each and every child, including disabilities or diagnoses, and use this knowledge to evaluate effective and successful strategies and practices from which students without ADHD can benefit.

3.2

Steps for successful instruction of children with ADHD The success in educating children with ADHD lies in 1) identifying

their needs from the very beginning (that is, clarifying how, when and why they display the core symptoms of the disorder), 2) moving on to selecting appropriate academic instruction, behavioral interventions and classroom accommodations and 3) integrating an individualized educational program with activities assigned to all the students in the class.

3.3

Recommended techniques and practices It should be noted that many of the techniques described below have

added value as they enhance the learning of children in the classroom who do not have ADHD and they can prove useful not only for children at elementary level but for older students as well. The techniques and strategies suggested fall into three major categories: i) academic - 10 -

instruction, ii) behavior intervening techniques and iii) classroom management.

i)

Academic instruction The principles that can help children with ADHD in a classroom

setting should be applied when introducing, conducting and concluding each lesson.

Introducing the lesson To facilitate the process of learning for students with ADHD the teacher should:  Prepare the class for the lesson to follow by outlining the various activities planned  Review relevant information from previous lessons and problems that have probably come up before moving on to the current lesson  Explain to students what they are expected to learn during the lesson  Be clear and accurate about how students are expected to behave during the lesson (e.g. talk quietly to their classmate, raise hands to ask for help, etc.)  Identify the materials that they will need during the lesson (e.g. crayons, scissors, English book, etc.)  Provide students with additional resources which can help them master the new information  Be as simple as possible when giving instructions or scheduling as it is much easier for ADHD students to comprehend and respond to expectations stated simply

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Conducting the lesson To plan a productive lesson for ADHD children the teacher should always keep in mind that transitions are particularly difficult for them; therefore, preparing them to move from one lesson to the other will help them respond and stay on task. In order to conduct an effective lesson, the teacher should:  Stick to structure and consistency and avoid change; in other words, provide ADHD students with minimal rules and choices so that they can be clear as to what is expected of them and the consequences for not meeting the expectations that have been set  Give ADHD students discreet cues to stay on task and warnings in private, without bringing attention to their differences  Make use of audiovisual aids (e.g. overhead projector) when presenting a lesson  Ask individual students to describe or demonstrate how they mastered the lesson  Allow students sufficient time to work out the answers to questions (15’’) and then call on another student or give the answer, or even give children the opportunity to show what they know with follow-up questions  Help students learn how to correct their own mistakes by reminding them of difficult rules and easy to make errors  Provide individual students or the whole class with follow-up instructions (either oral or written) or learning buddies to make sure students focus and keep working in their assignment  Make sure the noise level in the classroom is appropriate and remind students of the rules that have been set at the beginning of the lesson, if necessary - 12 -

 Simplify assigned tasks by breaking them down into smaller and less complex ones  Help the child with ADHD focus attention on the directions for a particular worksheet by highlighting key words before the beginning of the lesson or while the directions are being read  Avoid, as much as possible, timed tests as ADHD students may not be able to perform according to what they know or, allow them with extra time to make sure they will do their best to demonstrate their knowledge, uninhibited by ‘test anxiety’  Teach them cooperative learning, that is have them work together and share ideas and knowledge with their group

Concluding the lesson To make sure an effective lesson is appropriately concluded the teacher should:  Let students know that the lesson is about to end (make the announcement 5’ to 10’ before the end of the lesson) and inform them about the remaining time, especially if involved in groupwork or pair-work  Review what the students have learned during the lesson so as to plan the one to follow  Check the completed assignments of as many students as possible  Prepare students for the next lesson by giving them some information in advance

A key point that should not be missed by teachers is that ADHD students employ different techniques of learning and processing information, which do not always comply with the traditional - 13 -

practices. Therefore, the lesson should be planned in such a way that extra assistance is provided when needed and the child has ample opportunities to review and move on to mastering a lesson the entire class was presented with. For more individualized strategies that can be applied to different academic subjects, teachers can consult Teaching Children With Attention Deficit Hyperactivity Disorder: Instructional

Strategies

and

Practices,

2006

by

the

U.S.

Department of Education (pp. 9-14).

As previously mentioned, many ADHD students have difficulty focusing attention on set assignments and tend to get easily distracted; therefore, it can prove really effective to help them improve their organization of homework or classroom assignments.

Below is a list of some very useful practices: 

Select a teacher that will act as the student’s advisor and as the liaison between school and home. This teacher should be responsible for meeting with the student on a regular basis to plan for the coming week but also deal with problems from the past week



Encourage the child to keep a notebook and record of assignments



Use folders of different colors to help the child organize material for different subjects



Designate a homework partner to help the student with the assignment notebook



Ask the child to clean out his/her desk, bag and other places where material is stored



Use a variety of visual aids like banners, charts, lists, etc. to remind the student of what is being learned

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

Help the child with time allocation by showing him/her how to use a clock or wristwatch, teaching him/her to read and use a calendar for assignments and create a daily activity schedule for the child’s desk



Give the child opportunities to break down an assignment into smaller chunks

Another area children with ADHD might need help with is learning how to study on their own to achieve academic success. There are a number of strategies that can contribute to acquiring the study skills that are necessary for ADHD students:  ADHD students should be instructed how to adapt worksheets to make them more manageable  It can prove really effective to teach ADHD children to use diagrams and take notes so as to organize key concepts in several academic subjects  A checklist of mistakes that the child frequently makes when given a written task could help the child learn to proofread his/her work  Another list of items that the child might need to complete an assignment (e.g. books, pencils, etc.) should be provided  ADHD students should be taught how to prepare their workspace, keeping it clear from books or other material that they don’t need to complete an assignment  The teacher should keep a record of how well students with ADHD complete assignments so as to be able to deal with any problems that might arise

ii)

Behavior intervening techniques

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As previously noted, ADHD children appear to behave in ways that resemble those of younger children and tend to act immaturely and impulsively while, at the same time, they exhibit hyperactivity. It is, therefore, important to help all students behave in accordance with the classroom setting, promoting conduct that will enhance their learning. The techniques employed towards that direction should, by no means, be treated as an opportunity for punishment; on the contrary, the teacher should take advantage of every opportunity available to provide verbal reinforcement,

praise

incentives

and

support.

Regarding

verbal

reinforcement, the teacher should: 

Praise a student when he/she begins and completes an assignment or exhibits a desired behavior, using very simple phrases



Provide ADHD children with verbal prompts which should be simple, explicit and sincere, focusing on the parts of the student’s behavior that were desirable



Express approval immediately after monitoring appropriate behavior, to maximize the chances of the student repeating this particular behavior



Use a variety of comments, since repetition might make praise lose its value



Make sure all the teachers are consistent with desired behavior so that ADHD students don’t get confused as to what behavior is desirable

Some additional techniques that can prove effective when used in conjunction with verbal praise are the following: I.

Ignore undesirable behavior to the extent that it doesn’t interfere with the learning of others or disrupt the classroom - 16 -

II.

Remove items in the classroom that might distract the ADHD students but, always, after giving students the choice of putting them away themselves

III.

Allow children with ADHD the manipulation of objects that can be used quietly, on the one hand, and can provide these children with sensory input, while they are attending the lesson

IV.

Assign the ADHD students with little rewards (for example, ask them to go and get some chalk, etc.) when you feel that they need to “escape” for a moment so that they will come back settled and ready to focus on the lesson

V.

Encourage them to perform a less desirable behavior before a preferred one

VI.

Help them avoid frustration when faced with a particular assignment

by

providing

them

with

additional

material

or

information VII.

Make parents your “allies” by involving them in planning for the children’s success at all levels, not just academic, keep regular contact with them and get them to collaborate in keeping track of the student’s progress

VIII.

Instruct and train all students how to manage disputes with their classmates

As far as behavioral cues are concerned, they should remind students of expectations that have been set with regard to their learning and classroom behavior. More precisely, the teacher should: Establish a set of visual signals to help the child remember to stay on task

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Ensure physical proximity to the child when talking to him/her so that he/she will focus and pay attention to what the teacher is saying Use body language that is, hand gestures to communicate with ADHD students in private “Sign� a behavioral contract after identifying academic and behavioral expectations for the ADHD student and ensure that the child understands that it is important to live up to these expectations and try to change inappropriate behavior

Establish a set of tangible rewards, namely stickers, badges, etc. to increase the possibilities of the child working for them by involving him/her in the process of selecting the rewards Employ a token economy system (www.classdojo.com

is a very

useful classroom tool) to motivate both individual students and the whole class to work towards achieving set goals (Barkley, 1990) Employ a written rating scale of performance criteria (including desirable and inappropriate behavior) on which teacher and student rate behavior during an activity separately and compare ratings after completing the activity (*teacher involvement should be gradually removed and the students should eventually take full responsibility for self-monitoring)

iii)

Classroom management

Last but not least, ADHD students can benefit from classroom arrangements that help them focus and stay on task while, at the same time, they eliminate distractions. Consequently, the teacher can make the following seating interventions in the classroom environment: - 18 -

 Seat the child near his/her desk and at the front of the classroom so as to be able to monitor the child’s behavior and ensure that he/she stays on task  Identify a student role model and allow him/her to seat with the ADHD student so that they can work cooperatively and exchange information  Try to keep a particular area of the room available and free from distraction to be used for quiet study or when taking a test Finally, to accommodate the special needs of ADHD students, teachers could: a) Teach children to use a pointer so as to visually track words on a page or a bookmark to follow along while students are reading aloud b) Make a note of the starting and finishing time of the lesson and use a timer to indicate to children the time that remains c) Turn the classroom lights on and off to settle the class down when the noise level gets too high d) Use a musical instrument or a CD player to play different types of music and associate each type with a particular kind of activity e) Make sure the furniture that the ADHD child uses is the right size, otherwise, he/she will be inclined to squirm and fidget

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CONCLUSION Children with ADHD can reach their full potential and succeed academically provided they have their parents’ and teachers’ support and, more importantly, understanding. As mentioned earlier, the success in educating ADHD children involves three steps: starting with identifying the how, where and why the disorder manifests itself, moving on to a careful

selection

of

appropriate

academic

instruction,

behavior

intervening techniques and classroom management and, finishing off with the implementation of an individualized educational program which, nevertheless, applies to all the students and can prove really beneficial. A principle that should always be taken into account is that the earlier and more effective the intervention, the better the outcome.

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Internet Resources http://www.webmd.com/add-adhd/childhood-adhd/news/20110206/kidswith-adhd-often-have-other-problems The ADHD Health Center for children provides information on ADHD symptoms and makes references to comorbidity issues. http://psychcentral.com/lib/problems-related-to-adhd This website provides a quick ADHD fact sheet and information on symptoms, causes, treatment, future directions. http://www.helpguide.org/mental/adhd_add_teaching_strategies.htm This website focuses on ADHD at school and gives tips to help students succeed in school. http://www.teachernet.gov.uk The government standard for UK teachers and professions. It gives general information on teaching.

schools-related

http://www.addinschool.com/ This website provides you with hundreds interventions for students with ADHD.

of

school

classroom

http://www.teachervision.fen.com/ Teachervision is dedicated to helping teachers save time. It provides classroom-ready lesson plans, printables, and resources, as well as information on ADHD and management issues. http://www.tes.co.uk/ResourceDetail.aspx?storyCode=6051467 This website is the teacher’s reference page on ADHD and Autism Spectrum Disorders.

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Bibliography Barkley, R.A. (1990). Attention deficit hyperactivity disorder: A

handbook for diagnosis and treatment. New York: Guilford.

Barkley, R.A. (1997). Behavioral inhibition, sustained attention, and executive

functions:

Constructing

a

unifying

theory

of

ADHD.

Psychological Bulletin, 121 (1), 65-94.

Bender, W. (1997). Understanding ADHD: A practical guide for teachers

and parents. Upper Saddle River, NJ: Merrill/Prentice Hall.

Forness, S.R., & Kavale, K. A. (2001). ADHD and a return to the medical model of special education. Education and Treatment of Children, 24 (3), 224-247.

Hallowell, E. (1994). Driven to distraction: Recognizing and coping with

attention deficit disorder from childhood through adulthood. Tappan, NJ: Simon & Schuster.

Rief, S.F. (1997). The ADD/ADHD checklist: An easy reference for

parents and teachers. Reston, VA: Council for Exceptional Children.

Robelia, B. (1997). Tips for working with ADHD students of all ages.

Journal of Experimental Education, 20(1), 51-53.

Schiller, E. (1996). Educating children with attention deficit disorder.

Our Children, 22(2), 32-33.

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U.S. Department of Education, (2006). Teaching Children With Attention

Deficit Hyperactivity Disorder: Instructional Strategies and Practices

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