• Janise

What a General Education Teacher Should Know About Attention Deficit Hyperactivity Disorder (ADHD)



Introduction

What is ADHD, what are the types/characteristics you might observe and how is ADHD diagnosed?

Healthcare providers use the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth edition (DSM-5), to help diagnose ADHD. This diagnostic standard helps ensure that people are appropriately diagnosed and treated for ADHD. The DSM-5 Criteria for ADHD is: People with ADHD show a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with functioning or development:

1. Inattention: Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:

  • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.

  • Often has trouble holding attention on tasks or play activities.

  • Often does not seem to listen when spoken to directly.

  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).

  • Often has trouble organizing tasks and activities.

  • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).

  • Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

  • Is often easily distracted

  • Is often forgetful in daily activities.


2. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:

  • Often fidgets with or taps hands or feet, or squirms in seat.

  • Often leaves seat in situations when remaining seated is expected.

  • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).

  • Often unable to play or take part in leisure activities quietly.

  • Is often “on the go” acting as if “driven by a motor”.

  • Often talks excessively.

  • Often blurts out an answer before a question has been completed.

  • Often has trouble waiting their turn.

  • Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:

  • Several inattentive or hyperactive-impulsive symptoms present before age 12 years.

  • Several symptoms are present in two or more settings, (such as at home, school or work; with friends or relatives; in other activities).

  • There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.

  • The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.

Based on the types of symptoms, three kinds (presentations) of ADHD can occur:

  • Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months

  • Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months

  • Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity, but not inattention, were present for the past six months.

Symptoms can change at any time as well as the presentation. It is important to note that these symptoms indicated in the DSM-V range at different levels from person to person and are both strengths and weaknesses depending on the person.


(American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.)


Research does not support the popularly held views that:

ADHD arises from excessive sugar intake, excessive television viewing, poor child management by parents, or social and environmental factors such as poverty or family chaos. Of course, many things, including these, might aggravate symptoms, especially in certain individuals. 

But the evidence for such individual aggravating circumstances is not strong enough to conclude that they are primary causes of ADHD. ( https://chadd.org/about-adhd/the-science-of-adhd/ - Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) was founded in 1987 in response to the frustration and sense of isolation experienced by parents and their children with ADHD. )


What are the possible causes?

In addition to genetics, scientists believe there are some other possible causes and risk factors including:

  • Brain injury

  • Exposure to environmental (e.g., lead) during pregnancy or at a young age

  • Alcohol and tobacco use during pregnancy

  • Premature delivery

  • Low birth weight





Prevalence in NYC

An estimated 133,091 children used the NYS Public Mental Health System, where 31% of those children had an ADHD diagnosis. It is also important to note that the prevalence rate of ADHD among whites is significantly lower than that among Hispanics or blacks in all gender and age groups.


Cultural factors influence whether and where care is sought and whether practitioners appropriately diagnosis ADHD.


(Siegel CE, Laska EM, Wanderling JA, Hernandez JC, Levenson RB. Prevalence and Diagnosis Rates of Childhood ADHD Among Racial-Ethnic Groups in a Public Mental Health System. Psychiatr Serv. 2016;67(2):199-205. doi:10.1176/appi.ps.201400364.)


What treatments are available: Depends on the individual!

Take an inventory of needs & Know your rights.
https://www2.ed.gov/about/offices/list/ocr/docs/dcl-know-rights-201607-504.pdf

Types of treatment for ADHD include

  • Behavior therapy, including training for parents; and

  • Medications.

(https://www.cdc.gov/ncbddd/adhd/treatment.html)


Children younger than 6 years of age

For young children with ADHD, behavior therapy is an important first step before trying medication because:


o Parent training in behavior management gives skills and strategies to help the child.

o Young children have more side effects from ADHD medications than older children.

o The long-term effects of ADHD medications on young children have not been well-studied.


School-age children and adolescents

For children ages 6 years and older, AAP recommends combining medication treatment with behavior therapy. Several types of behavior therapies are effective, including:


Parent training in behavior management; Behavioral interventions in the classroom; Peer interventions that focus on behavior; and Organizational skills training.


These approaches are often most effective if they are used together, depending on the needs of the individual child and the family.




Teaching Students:

Family, teachers, and the child's care team (Psychologists, ABA therapist etc.) should all be involved in making decisions about a learning plan for children with ADHD. Planning needs to happening for purposeful learning, engagement and accommodations.

Always consider that we need to keep our expectations high and believe in every unique person's capabilities to move mountains

-Famous people with ADHD-

https://www.healthline.com/health/adhd/celebrities


Here are some resources to help:

Help Guide: https://www.helpguide.org/articles/add-adhd/teaching-students-with-adhd-attention-deficit-disorder.htm

Inside the ADHD Mind: https://www.additudemag.com/teaching-strategies-for-students-with-adhd/

VeryWell: https://www.verywellmind.com/help-for-students-with-adhd-20538

o You can look for school-based services by finding the school social worker.

(1:1 Instruction, Specialized classrooms, IEP with teacher, Cue Cards in class, positive/negative reinforcement tactics, ABA or ABI Therapy at Home and more)

Another good source to watch is : ADHD How Schools Could Do Better By Josh Cook

https://www.ted.com/talks/josh_cook_adhd_how_schools_could_do_better

& The Top 5 Ted Talks for Parents of Kids with ADHD. If we understand the parents, we can have a better classroom.

https://huntingtonhelps.com/resources/adhd-blog/top-five-ted-talks-adhd-2019