Characteristics of Attention Deficit Hyperactivity Disorder (AD/HD)

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Characteristics of Attention Deficit
Hyperactivity Disorder (AD/HD)

• Presented by Connie McDonald BrookinsDeveloped
  by Renee B. Leach,
• Consultants
• Upper Cumberland Special Education Cooperative

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Definition of ADHD

• ADHD (attention deficit hyperactivity disorder)
  is a condition characterized by severe problems
  of inattention, hyperactivity, and/or
  impulsivity. (Hallahan and Kauffman, 2003,
  p.513) 

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Prevalence of ADHD

• ADHD is the most common behavioral disorder in
  children in America. (Kollins, Barkley, and
  DuPaul, 2001) 
• It exists in between 3 and 5 percent of
  school-aged children. 
• Boys are more often diagnosed with ADHD than are
  girls, ranging somewhere between a 2.5 1 and 5
  1 ratio.
• This may be because the behaviors associated with
  ADHD are more characteristic and natural in boys
  than they are in girls. 

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• Girls that do have ADHD most likely have the
  inattentive type.  (Boschett, 2002). 
• Less than half of the children who have ADHD use
  special education programs in school.

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Three Types of ADHD as defined under Diagnostic
and Statistical Manual of Mental Disorders (DSM).

• -ADHD Predominately Inattentive Type
• -ADHD Predominately Hyperactive Impulsive Type
• -ADHD Combined Type (Inattentive and Hyperactive
  Impulsive)

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Signs of Hyperactivity -Impulsivity

• Feeling restless, often fidgeting with hands or
  feet, or squirming while seated
• Running, climbing, or leaving  a seat in
  situations where sitting or quiet behavior is
  expected
• Blurting out answers before hearing the whole
  question
• Having difficulty waiting in lines or taking tours

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Signs of Inattention

• Often becomes easily distracted by irrelevant
  sights and sounds
• Often failing to pay attention to details and
  making careless mistakes
• Rarely following instructions carefully and
  completely losing or forgetting things  like
  toys, or pencils, books, and tools needed for a
  task
• Often skipping from one uncompleted activity to
  another

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The Symptoms

• Typically, AD/HD symptoms arise in early
  childhood, unless associated with some type of
  brain injury later in life.
• Some symptoms persist into adulthood and may pose
  life-long challenges.
• Although the official diagnostic criteria state
  that the onset of symptoms must occur before age
  seven, leading researchers in the field of AD/HD
  argue that criterion should be broadened to
  include onset anytime during childhood.

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Criteria for the three primary subtypes are
summarized as follows
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AD/HD predominately inattentive type

• Fails to give close attention to details or makes
  careless mistakes.
• Has difficulty sustaining attention.
• Does not appear to listen.
• Struggles to follow through on instructions.
• Has difficulty with organization.
• Avoids or dislikes tasks requiring sustained
  mental effort.
• Loses things.
• Is easily distracted.
• Is forgetful in daily activities.

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AD/HD predominately hyperactive-impulsive type

• Fidgets with hands or feet or squirms in chair.
• Has difficulty remaining seated.
• Runs about or climbs excessively.
• Difficulty engaging in activities quietly.
• Acts as if driven by a motor.
• Talks excessively.
• Blurts out answers before questions have been
  completed.
• Difficulty waiting or taking turns.
• Interrupts or intrudes upon others.

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AD/HD combined type

• Individual meets both sets of inattention and
  hyperactive/impulsive criteria.

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• Because everyone shows signs of these behaviors
  at one time or another, the guidelines for
  determining whether a person has AD/HD are very
  specific.
• To be diagnosed with AD/HD, individuals must
  exhibit six of the nine characteristics in either
  or both DSM-IV categories listed above.

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• In children and teenagers, the symptoms must be
  more frequent or severe than in other children
  the same age.
• In adults, the symptoms must affect the ability
  to function in daily life and persist from
  childhood. In addition, the behaviors must create
  significant difficulty in at least two areas of
  life, such as home, school, social settings and
  work.
• Symptoms must be present for at least six months.

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The Evaluation

• Determining if a child has AD/HD is a
  multifaceted process.
• Many biological and psychological problems can
  contribute to symptoms similar to those exhibited
  by children with AD/HD.
• For example, anxiety, depression and certain
  types of learning disabilities may cause similar
  symptoms.

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• There is no single test to diagnose AD/HD.
• Consequently, a comprehensive evaluation is
  necessary to establish a diagnosis, rule out
  other causes and determine the presence or
  absence of co-existing conditions.
• Such an evaluation should include a clinical
  assessment of the individuals academic, social
  and emotional functioning and developmental
  level.

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• A careful history should be taken from the
  parents, teachers and when appropriate, the
  child.
• Checklists for rating AD/HD symptoms and ruling
  out other disabilities are often used by
  clinicians.

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• There are several types of professionals who can
  diagnose AD/HD, including school psychologists,
  private psychologists, social workers, nurse
  practitioners, neurologists, psychiatrists and
  other medical doctors.
• Regardless of who does the evaluation, the use of
  the Diagnostic and Statistical Manual IV (DSM-IV)
  criteria is necessary.

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• A medical exam by a physician is important and
  should include a thorough physical examination,
  including hearing and vision tests, to rule out
  other medical problems that may be causing
  symptoms similar to AD/HD.
• Only medical doctors can prescribe medication if
  it is needed.

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• According to a June 1997 AMA study, AD/HD is one
  of the best researched disorders in medicine, and
  the overall data on its validity are far more
  compelling than that for most mental disorders
  and even for many medical conditions.
• Goldman, L.S., Genel, M., Bezman, R, et.al.
  (1998) Diagnosis and treatment of
  attention-deficit/hyperactivity disorder in
  children and adolescents. Journal of the American
  Medical Association.

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• The exact causes of AD/HD remain illusive.
• Currently, most research suggests a
  neurobiological basis.
• Since AD/HD runs in families, inheritance appears
  to be an important factor.
• U. S. Department of Health and Human Services.
  (1999). Mental Health A Report of the Surgeon
  General (Children and Mental Health).

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• Even though a diagnostic test for AD/HD does not
  exist, the 1998 National Institute of Health
  Consensus Statement concludes, there is evidence
  supporting the validity of the disorder.
• National Institute of Health. (1998). Diagnosis
  and treatment of attention deficit hyperactivity
  disorder. Washington, D.C. NIH Consensus
  Statement.

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Multimodal Treatment

• There may be serious consequences for persons
  with AD/HD who do not receive treatment or
  receive inadequate treatment.
• These consequences may include low self-esteem,
  social and academic failure, career
  underachievement and a possible increase in the
  risk of later antisocial and criminal behavior.

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• Treatment plans should be tailored to meet the
  specific needs of each individual and family.
• So treating AD/HD in children often requires
  medical, educational, behavioral, and
  psychological intervention.

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This comprehensive approach to treatment is
called multimodal and often includes

• Parent training
• Behavioral intervention strategies
• An appropriate educational program
• Education regarding AD/HD
• Individual and family counseling
• Medication, when required

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• Research from the landmark NIMH Multimodal
  Treatment Study of AD/HD is very encouraging.
• Children who received medication, alone or in
  combination with behavioral treatment showed
  significant improvement in their behavior and
  academic work plus better relationships with
  their classmates and family.

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• Psychostimulants are the most widely used class
  of medication for the management of AD/HD related
  symptoms.
• Approximately 70 to 80 percent of children with
  AD/HD respond positively to psychostimulant
  medications.

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• Significant academic improvement is shown by
  students who take these medications increased
  attention and concentration, compliance and
  effort on tasks, amount and accuracy of
  schoolwork produced and decreased activity
  levels, impulsivity, negative behaviors in social
  interactions and physical and verbal hostility

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• Other medications that may decrease impulsivity,
  hyperactivity and aggression include some
  antidepressants and antihypertensives.
• However, each family must weigh the pros and cons
  of taking medication.

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• Behavioral interventions are also a major
  component of treatment for children who have
  AD/HD.
• Important strategies include being consistent and
  using positive reinforcement, and teaching
  problem-solving, communication, and self-advocacy
  skills.
• Children, especially teenagers, should be
  actively involved as respected members of the
  school planning and treatment teams.

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• School success may require a variety of classroom
  accommodations and behavioral interventions.
• Most children with AD/HD can be taught in the
  regular classroom with minor adjustments to the
  environment.
• Some children may require special education
  services if an educational need is indicated.
• These services may be provided within the regular
  education classroom or may require a special
  placement outside of the regular classroom that
  meets the childs unique learning needs.

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• Behavioral treatments for AD/HD should be started
  as soon as the child receives a diagnosis.
• There are behavioral interventions that work well
  for preschoolers, elementary-age students, and
  teenagers with AD/HD, and there is consensus that
  starting early is better than starting later.
• Parents, schools, and practitioners should not
  put off beginning effective behavioral treatments
  for children with AD/HD

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What is behavior modification?

• With behavior modification, parents, teachers and
  children learn specific techniques and skills
  from a therapist, or an educator experienced in
  the approach, that will help improve childrens
  behavior.
• Parents and teachers then use the skills in their
  daily interactions with their children with
  AD/HD, resulting in improvement in the childrens
  functioning in the key areas noted above.
• In addition, the children with AD/HD use the
  skills they learn in their interactions with
  other children.

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• Behavior modification is often put in terms of
  ABCs Antecedents (things that set off or happen
  before behaviors), Behaviors (things the child
  does that parents and teachers want to change),
  and Consequences (things that happen after
  behaviors).

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• In behavioral programs, adults learn to change
  antecedents (for example, how they give commands
  to children) and consequences (for example, how
  they react when a child obeys or disobeys a
  command) in order to change the childs behavior
  (that is, the childs response to the command).
• By consistently changing the ways that they
  respond to childrens behaviors, adults teach the
  children new ways of behaving.

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• Parent, teacher and child interventions should be
  carried out at the same time to get the best
  results.
• The following four points should be incorporated
  into all three components of behavior
  modification  
• Start with goals that the child can achieve in
  small steps.
• Be consistent across different times of the
  day, different settings, and different people.
• Implement behavioral interventions over the long
  haul not just for a few months.
• Teaching and learning new skills take time, and
  childrens improvement will be gradual.

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• Parents who want to try a behavioral approach
  with their children should learn what
  distinguishes behavior modification from other
  approaches so they can recognize effective
  behavioral treatment and be confident that what
  the therapist is offering will improve their
  childs functioning.

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How does a behavior modification program begin?

• The first step is identifying a mental health
  professional who can provide behavioral therapy.
• Finding the right professional may be difficult
  for some families, especially for those that are
  economically disadvantaged or socially or
  geographically isolated.

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• The mental health professional begins with a
  complete evaluation of the child's problems in
  daily life, including home, school (both
  behavioral and academic), and social settings.
• Most of this information comes from parents and
  teachers. The therapist also meets with the child
  to get a sense of what the child is like.

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• The evaluation should result in a list of target
  areas for treatment. Target areas often called
  target behaviors are behaviors in which change
  is desired, and if changed, will help improve the
  childs functioning/impairment and long-term
  outcome.

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• Target behaviors can be either negative behaviors
  that need to stop or new skills that need to be
  developed.
• That means that the areas targeted for treatment
  will typically not be the symptoms of AD/HD
  overactivity, inattention and impulsivity but
  rather the specific problems that those symptoms
  may cause in daily life.

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• Common classroom target behaviors include
  completes assigned work with 80 percent
  accuracy and follows classroom rules.
• At home, plays well with siblings (that is, no
  fights) and obeys parent requests or commands
  are common target behaviors.

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• After target behaviors are identified, similar
  behavioral interventions are implemented at home
  and at school.
• Parents and teachers learn and establish programs
  in which the environmental antecedents (the As)
  and consequences (the Cs) are modified to change
  the childs target behaviors (the Bs).
• Treatment response is constantly monitored,
  through observation and measurement, and the
  interventions are modified when they fail to be
  helpful or are no longer needed.

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Parent Training

• Behavioral parent training programs have been
  used for many years and have been found to be
  very effective.
• Although many of the ideas and techniques taught
  in behavioral parent training are common sense
  parenting techniques, most parents need careful
  teaching and support to learn parenting skills
  and use them consistently.

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• It is very difficult for parents to buy a book,
  learn behavior modification, and implement an
  effective program on their own.
• Help from a professional is often necessary.

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• However, with early identification and treatment,
  children and adults can be successful.
• Studies show that children who receive adequate
  treatment for AD/HD have fewer problems with
  school, peers and substance abuse, and show
  improved overall functioning, compared to those
  who do not receive treatment.

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• The topics covered in a typical series of parent
  training sessions include the following
• Establishing house rules and structure
• Learning to praise appropriate behaviors
  (praising good behavior at least five times as
  often as bad behavior is criticized) and ignoring
  mild inappropriate behaviors (choosing your
  battles)
• Using appropriate commands
• Using whenthen contingencies (withdrawing
  rewards or privileges in response to
  inappropriate behavior)
• Planning ahead and working with children in
  public places
• Time out from positive reinforcement (using time
  outs as a consequence for inappropriate behavior)
  
• Daily charts and point/token systems with rewards
  and consequences
• School-home note system for rewarding behavior at
  school and tracking homework

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The Prognosis

• Children with AD/HD are at-risk for potentially
  serious problems academic underachievement,
  school failure, difficulty getting along with
  peers, and problems dealing with authority.
• Furthermore, up to 67 percent of children will
  continue to experience symptoms of AD/HD in
  adulthood.

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Contact Todays Presenter at

• Renee B. Leach
• Technology/Curriculum Consultant
• Upper Cumberland Special Education Cooperative
• 116 North 4th Street
• Williamsburg, KY
• Phone [phone]
• Email rleach_at_whitley.k12.ky.us

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Additional resources

• www.chadd.org
• http//www.help4adhd.org/index.cfm
• http//www.chadd.org/fs/fs2.htm
• http//www.familyeducation.com/article/1,1120,23-1
  6631,00.html
• www.add.org

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For your attention!!!!
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Characteristics of Attention Deficit
Hyperactivity Disorder (AD/HD)

• Renee B. Leach, Consultant
• Upper Cumberland Special Education Cooperative