Chapter 11 ADHD

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Chapter 11ADHD
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Attention-Deficit/Hyperactivity Disorder

• The essential feature of ADHD is a persistent
  pattern of inattention and/or hyperactivity-impuls
  ivity (DSM-IV)
• Problems paying attention and controlling their
  impulses and behavior.
• Andy never stops moving
• Mike is withdrawn and disorganized
• He has difficulties planning ahead and often
  does not complete his assignments
• Controversial diagnosis
• Some believe there is no such disability, the
  behaviors are merely a product of environmental
  experiences such as poor parenting or poor
  teaching
• ADHD is recognized by the courts, US Dpt of
  Education, etc.

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Inattentive symptoms

• Failure to give close attention to details, prone
  to careless mistakes
• Difficulty completing tasks
• Appears that mind is elsewhere
• Shifts from one activity to another
• Difficulty organizing activities
• Avoid activities that require sustained effort
• Disorganized work habits
• Distracted by irrelevant stimuli
• Forgetful of daily activities

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Hyperactive/Impulsive symptoms

• Tendency to fidget and squirm when seated
• Not remain seated when needed
• Excessive running or climbing when inappropriate
• Difficulty playing quietly
• Often on the go
• Talks excessively
• Difficulty delaying responses answers before
  question is completed
• Difficulty waiting ones turn
• Frequently interrupting others

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Academic and Social Characteristics

• Typically do not achieve their academic potential
• Greater risk of grade retention and school drop
  out
• Student may be good at math, but makes careless
  mistakes
• Student may be bad at math do to a learning
  disability in addition to ADHD
• Difficult peer relationships
• Great tendency to display bullying behaviors
• Aggression or withdrawn (more impulsive or
  inattentive type, respectively)
• Half of students have another disability

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Identification

• Symptoms must be present for at least 6 months
• Some of the symptoms must be displayed before the
  age of 7 (controversial)
• Behavior caused by a temporary situation (e.g.,
  divorce) not diagnosed
• Symptoms need to be exhibited at multiple
  settings.
• Impact social, academic and occupational areas.
• Inconsistent with developmental level.
• Usually seen by doctor first
• Interviews, scales, checklists, direct
  observation (Talking out, Out of seat, Attention
  problems, Disruption, etc.

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ADHD

• Children with ADHD can be served under the other
  health impairments category
• Not considered a separate disability under IDEA
  04, may fall under other health impairments
• May also qualify under LD or ED because of
  co-morbidity
• Or are allowed accommodations under section 504
  of rehabilitation Act (allow for instructional
  accommodations for students who do not qualify
  for special ed, but still need help)
• They usually attend general ed classes, requiring
  support.

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Prevalence

• Estimates of prevalence of ADHD range from 3 to
  5 of all school-age children (APA, 2000)
• About two students in a 30-35 student class will
  have ADHD
• Disorder will not be outgrown. 70 of children
  continue with the disorder into adolescence, and
  50 into adulthood.
• Lots of children go undiagnosed.

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Causes

• Why is finding the cause important?
• Myths about ADHD
• Poor diet
• Food additives
• Too much sugar
• Too much TV
• Fluorescent lights
• Although poor teaching and/or parenting may
  contribute to the increase of problem behavior,
  it does not cause them

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Causes

• Although most research has focused on brain and
  genetic causes there are some evidence for
  possible nongenetic causes such as
• Premature birth
• Maternal smoking
• Alcohol use
• Exposure to lead
• Brain anatomy and function (lag in development)
• Although no perfect correlation between these
  differences and ADHD
• Genetic Causes
• Result of multiple interacting genes
• Child of an adult with ADHD has 25 of having it.

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Drug Therapy

• Two treatment approaches that are widely used
  with children with ADHD are drug therapy and
  behavioral intervention
• Psychostimulants such as Ritalin, Dexedrine,
  Cylert, or Adderall, or nonstimulants such as
  Strattera
• Increases the concentration of neurotransmitters,
  improving memory, cognition and attention.
• Improvement in behavior and ability to learn.
  Although controversial
• Academic problems need to be dealt with.
• May be dependent on the medication

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Behavioral Treatment

• Direct Instruction (presentation, guided
  practice, demonstration of mastery)
• Clear and explicit
• Repeat and highlight concepts many times
• High levels of accuracy before moving to another
  activiy
• Precision Teaching
• Method of evaluating instruction
• Direct, continuous, and precise measurements of
  student performance fluency
• Functional-based treatments
• FBA
• Behavior intervention programs should be embedded
  in teaching activities
• Similar strategies used with students with EBD
  and ASD such as reinforcement, token systems,
  contracting, etc.

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Other Strategies

• Peer tutoring
• Immediate, frequent feedback following students
  pace
• Peers can also be behavior modifiers, providing
  differential reinforcement
• Computer-Assisted Instruction (CAI)
• Use of computers to introduce new materials with
  graphics, words, and sounds
• Attention maintained technology
• Response cost, token systems, self monitoring
  (support ABA strategies)

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Ervin et al.

• Background
• Use of FBA for intervention selection
• Antecedent manipulations for decreasing problem
  behavior (task duration)
• Purpose
• Test school-based assessment model to select
  interventions for ADHD
• Teacher involvement and acceptability
• Participants
• Setting
• Dependent Measures

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Ervin et al.

• Hypothesis development
• Informant and structured FBA
• Joey Paper and pencil task evoked off task
• Carl Lack of attention evoked off task behavior
• Hypothesis testing
• Reversal design typical conditions alternated
  with potential interventions
• Joey use of computer escape extinction, or
  brainstorm with peer
• Carl Self-evaluation of peer attention seeking
  behavior reinforcement or extinction