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Attention Deficit Disorder - ADD with hyperactivity

ADHD with aggression

[IDEA 97 places ADD and ADHD in the over-all category of Health Impairment]

ADD and ADHD create uncomfortable conditions for parents and teachers. It can also be frustration for youngsters. Many students have a hard time focusing on school work. Indeed, each of us has times when we get distracted or fail to pay attention to things, and later realize that we did not fully experience or remember or attend to all the was occurring. With ADD, it happens more of the time. Some ADD youngsters cannot watch TV - not even a commercial, before losing concentration or focus. Like LD (learning disabilities), ADD and ADHD cover a multitude of related, interrelated and unrelated acts, sort of a laundry basket of acts and failures to act.

For the past decade, I have asked students at the college level to define ADD. This "street" list is a typical example of responses. Next to it, I put the list I generated through 20 years of working with the students or children who are at the extreme in the continuum. Continuum is an important concept. Think of yourself at WalMart. How much of the street list would apply to you? Nearly all of us have times when some of these statements apply. Most of us can get control, or move out of these extremely stimulating situations and seek calm settings or settle ourselves. The ADD and ADHD youth often lacks the desire or ability, the insight or understanding of what it is doing to others and relationship, fails to recognize or embrace the consequences of actions and does not self modulate.

"Street" list of ADD"
My common sense definition
Unfocused Ego development seems stalled at seeing self and meeting personal agenda, seldom gets subtle clues about others' needs or wishes
Moving a lot Often does not sleep through the night - wakeful periods
Not able to sit still Quiets self through self stimulation and busy body behaviors
Easily distracted Messy and disorganized coupled with odd ways of organizing - including some odd or bizarre compulsive reactions and perseveration
Doesn't finish tasks Passive and intentional power struggles common, almost willful
Doesn't mind Frequently calmed by stimulants - Ritalin, coffee, tea
Doesn't follow through Doesn't see consequences, so doesn't understand need to follow through
Impulsive Personal needs are foremost and crowd out social needs
Angry or irritable Many youngsters move on to have personality disorders
Over do things Substance abuse - perhaps self medicating - is quite common
Picks and fiddles Often have a lot of anger and difficulty managing anger
Often involved in fights May be openly combative with parents or siblings and tends not to care for pets constructively

 

National Viewpoint on Defining ADD

Definitions
Attention Deficit Disorder (ADD) and Attention Deficit/Hyperactivity Disorder (ADHD): are diagnoses applied to children and adults who consistently display certain characteristic behaviors over a period of time. The most common behaviors fall into three categories: inattention, hyperactivity, impulsivity. People who are inattentive have a hard time keeping their mind on any one thing and may get bored with a task after only a few minutes. People who are hyperactive always seem to be in motion. They can't sit still and may feel constantly restless. People who are overly impulsive seem unable to curb their immediate reactions or think before they act. For more information on ADD and ADHD please visit ADD and ADHD in our LD In-depth section. National Institutes of Health

The essential feature of Attention-Deficit/Hyperactivity Disorder is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development.

Some hyperactive-impulsive or inattentive symptoms that cause impairment must have been present before age 7 years, although many individuals are diagnosed after the symptoms have been present for a number of years.

Some impairment from the symptoms but be present in at least two settings (e.g., at home and at school or work)

There must be clear evidence of interference with developmentally appropriate social, academic or occupational functioning.

The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia or other Psychotic Disorder and is not better accounted for by another mental disorder (e.g., a Mood Disorder, Anxiety Disorder, Dissociate Disorder, or Personality Disorder). - APA (1994). DSM-IV

Guiding Principles for the Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder

presented by The National Attention Deficit Disorder Association

Over the past two decades there has been an explosion of diagnosis, treatment and research regarding Attention Deficit Hyperactivity Disorder (ADHD). As clinicians and researchers have gained more experience working with ADHD, it has become clearer that its impact on life is far greater than we had ever appreciated.

ADHD not only can interfere with learning and behavior control in childhood, but, as a critical neurobehavioral condition, it can profoundly compromise functioning in multiple areas throughout the life span. Research and clinical experience suggest that ADHD difficulties can lead to significant educational, occupational, and family dysfunction and can be a significant contributor to a variety of health, social, and economic problems.

ADHD is a common disorder. The Diagnostic and Statistical Manual of the American Psychiatric Association, Fourth Edition (DSM-IV) estimates that ADHD is found in 3%-5% of school-age children. A recent review of thirteen community studies of the prevalence of ADHD indicated that between 1.7% and 16% of children have ADHD, depending upon the populations and the diagnostic methods.

1 As more and more is written and broadcast about ADHD, increasing numbers of adults and parents wonder whether ADHD might be underlying the problems they or their children are experiencing. As a national organization whose role is to educate and advocate for the needs of individuals with ADHD, we talk with thousands of individuals each month who are seeking help regarding the diagnosis and treatment of ADHD. From these conversations we know that most first turn to their family physician, pediatrician, or a mental health professional for help. We also know that the care they receive varies greatly, ranging from a brief office visit that ends with a prescription for medication to a thorough evaluation cooperatively conducted by members of several different disciplines. We are concerned that paradoxically, ADHD is both over diagnosed and under diagnosed; ADHD is both over treated and under treated.

National ADDA believes that one of the most critical steps in properly addressing the significant impact that ADHD has on contemporary society is to establish a standard of care for its diagnosis and treatment. While gaps exist in our knowledge about the precise cause of ADHD and controversy abounds about aspects of its diagnosis and treatment, research and clinical experience over the past few decades have been sufficient to begin to identify certain principles regarding the evaluation and treatment of ADHD. The National ADDA Guiding Principles for the diagnosis and treatment of ADHD represent an attempt to enhance the overall health care of individuals and their families who are affected by ADHD.

These Guiding Principles seek to define the essential elements of diagnosis and treatment that are necessary for realizing a high quality of care. The Guiding Principles should not be viewed as a diagnostic tool or a therapeutic cookbook. Rather, they represent an organizational framework to guide consumers in navigating the health care maze and to focus on our understanding of the essential ingredients of diagnosis and treatment. In addition, we hope that these Guiding Principles will positively impact the activities of health care providers, educators, and clinicians, as well as, the policy making decisions of health insurance companies, governmental agencies, educational administrators and corporate executives whose actions can have a profound impact on the lives of individuals with ADHD.

These Guiding Principles represent a synthesis of lay and professional literature, the experiences of clinicians and conversations with thousands of patients and families. This is National ADDAís working philosophy regarding some critical components of high quality assessment and treatment. As a consumer advocacy organization, National ADDAís goal is that these Guiding Principles serve as a step towards identifying the essential components of assessment and treatment of ADHD. We hope that they will improve the quality of life for everyone affected by ADHD.

1. Evaluate and treat the whole person. A comprehensive diagnostic protocol for ADHD provides a description of the whole person. That is, it should seek to identify how a personís ADHD symptoms interact and contribute to his or her physical and mental functioning, as well as his or her personality. Each person is unique, with unique strengths and weaknesses. Making a diagnosis based solely on "plugging" attentional symptoms into a diagnostic checklist, for example, is inadequate. After considering the complete person, the role of ADHD, if present, can be placed in its proper context. The success of treatment is dependent upon understanding and managing ADHD within the context of an understanding of the whole person.

2. ADHD should be suspected but not presumed. ADHD is a common problem and may be suspected as a contributing factor whenever a child or an adult experiences problems in learning, self-control, addiction, independent functioning, social interaction, or health maintenance. ADHD symptoms present across a wide spectrum- from extremely mild to extremely severe. The appropriate diagnosis of ADHD can help clarify the presence of other physical, learning, and emotional disorders, or may be present in combination with any number of these. The professional will need to identify and address potentially coexisting conditions. These may include: Depressive and Bipolar disorders Anxiety Disorders Chemical and Behavioral Addictions- Drugs, alcohol, disordered eating, gambling, sexual addictions, etc. Oppositional Defiant and Conduct Disorders Learning Disorders, including receptive and expressive language problems, reading and written language Psychotic Disorders and Pervasive Developmental Disorders Obsessive/Compulsive Disorders Personality Disorders Tic Disorders Hypo and Hyperthyroidism Sleep Disturbances Chromosomal anomalies and other Developmental Syndromes Brain Trauma

3. ADHD may present across the life span. ADHD is the result of biological differences in the parts of the brain associated with paying attention, impulse control, and activity level. While ADHD is biologically-based and usually present from birth, symptoms may not become problematic until the individual begins to struggle trying to meet lifeís expectations. As a result, ADHD can present clinically anywhere along the life span and in any life domain. Even though the symptoms of ADHD may not impair an individual until later in life, some of these symptoms must be present since childhood to make a positive diagnosis. Thus, an early history of ADHD symptoms is essential in making a diagnosis of ADHD in an adult. The evaluator should look for evidence of a childhood onset of ADHD symptoms through third party interviews, transcripts, report cards, teacher comments, medical records, past psycho educational testing, and other archival data. ADHD often negatively affects a personís educational achievements. Lack of school success can contribute to a myriad of economic, social and life adjustment problems throughout a personís life. Educational functioning should be reviewed carefully. In children, adolescents, or adult students, a review of educational functioning should include administration of intelligence and achievement tests. However, it should be noted that success in the educational arena is not by itself a reason to rule out the diagnosis of ADHD.

4. A comprehensive assessment is necessary for an accurate diagnosis. ADHD is complex and impacts all aspects of a personís life. It can coexist and/or mimic a variety of health, emotional, learning, cognitive, and language problems. An appropriate, comprehensive evaluation for ADHD includes a medical, educational, and behavioral history, evidence of normal vision and hearing, recognition of systemic illness and a developmental survey. The diagnosis of ADHD should never be made based exclusively on rating scales, questionnaires, or tests. The evaluation should be designed to answer three basic questions:

(1) Are a sufficient number of ADHD symptoms occurring, pervasively and causing impairment, at the present time in the personís life;

(2) Have these symptoms been present since childhood;

(3) Is there any alternative explanation for the presence of these ADHD symptoms?

5. The evaluation and treatment of ADHD should be conducted by a qualified professional. A qualified professional may be from any one of the following disciplines and would have the appropriate license to practice this discipline: psychiatrist, pediatrician, internist, family physician, other qualified physician, psychologist, social worker, professional counselor, and psychiatric nurse. A qualified professional not only has a license to practice but has training and experience in the differential diagnosis and treatment of ADHD and the full range of psychiatric disorders.

6. Response to medication should not be used as the basis to diagnose ADHD. There are a number of reasons why an individualís response to a stimulant or other medication is not a valid indication of the presence of ADHD. First, stimulant medications doesnít just work for people with ADHD; individuals with other disorders and without any disorders may respond positively to them. Second, failure to respond to medication may be because the dose was incorrect or the personís body is not responsive to that drug, rather than because the person does not have the diagnosis of ADHD. Third, a positive response to medication may the result of a placebo effect rather than a true indication of the presence of ADHD. Fourth, the use of medication as a diagnostic tool may lead the physician to prematurely conclude the diagnostic process without considering disorders that coexist with ADHD and jointly interfere with the individualís functioning.

7. Diagnosis should be based primarily upon the DSM-IV ADHD criteria. In order to promote standardization, the diagnosis of ADHD should be based upon the prevailing professional criteria for the diagnosis of mental conditions. At the present time, the prevailing criteria are the Diagnostic and Statistical Manual of the American Psychiatric Association, Fourth Edition, known as DSM-IV. A number of professionals have justifiably criticized the DSM-IV ADHD criteria, noting several problems. In particular, they are not adjusted for age, making them too stringent in their published form for diagnosis of adults, e.g. adults will be under diagnosed. Minor adjustments have been suggested in the professional literature, but nonetheless, it is strongly recommended that diagnosis be based primarily upon these criteria.

8. Diagnosis and treatment of ADHD should involve others familiar with the person undergoing the evaluation. Proper diagnosis and treatment of ADHD should involve others such as parents, spouses, teachers, and when appropriate, employers. These individuals can corroborate and provide information and can be enormously helpful in the diagnostic and treatment process. When guided to better understand and accept ADHD, they can also become positive supports for the person with ADHD.

9. Treatment should often involve more than one discipline working cooperatively. Since there is currently no way to cure ADHD, the goal of treatment is to enhance the individualís ability to cope with it. Coping successfully with ADHD often requires a combination of treatments provided by specialists from different disciplines. The physician prescribes stimulant or other types of medication. The mental health professional and/or the coach provides supportive counseling for the individual with ADHD and the family, teaches the individual compensatory strategies for home and school/workplace, and provides training in behavior management. The educator helps to remediate school-based problems, and often provides feedback to the parents and the physician about the effectiveness of medication. Members of different disciplines should communicate with each other to coordinate their efforts to help the individual cope with ADHD. Generally, medication should not be started until a comprehensive evaluation has been completed and the need for other forms of treatment has been evaluated. Coordinated treatment by physicians, mental health professionals, educators, coaches, and other health care professionals will maximize the individualís opportunities for treatment success.

10. Practitioners should become familiar with current research and diagnostic tools. It is the responsibility of each professional involved in the evaluation and management of ADHD to continually integrate the most up to date understanding of ADHD into his/her repertoire of clinical skills. The improved understanding of the cause, diagnosis, and treatment of ADHD which comes from a review of the current literature will improve the quality of care. National ADDA urges all professionals to become familiar with updated diagnostic tools and treatment methods, as well as standards for a comprehensive assessment. National ADDA is committed to facilitating the process of keeping professionals abreast of the latest developments in the field of ADHD through its conferences and publications.

Notes Goldman, L.S., Genel, M., Bezman, R.J., and Slanetz, P.J. (1998). Council report of diagnosis and treatment of Attention -Deficit Hyperactivity Disorder in children and adolescents. Journal of the American Medical Association, 279, 1100-1107.

(c) 1998 National Attention Deficit Disorder Association. This document may be reproduced for personal nonprofit use, otherwise expressed permission from National ADDA is required.

Questions and inquiries should be directed to: National Attention Deficit Disorder Association P.O. Box 1303 Northbrook, IL 60065-1303 E-MAIL: mail@add.org WEBSITE: www.add.org

LDA of Canada Checklist

This check list is designed to alert the classroom teacher to the possible presence of ADD among one or more of his/her students. It is on the web at The Learning Disabilities Association of Canada site and was developed by Foothills Academy in Calgary.

ATTENTIONAL DISABILITIES
 
Hyperactivity:  
1. Acts impulsively: eg. acts first, thinks later Yes No
2. Is moving constantly Yes No
3. Behavior is inconsistent from day to day Yes No
4. Is disruptive in class Yes No
5. Has a short attention span Yes No
Disinhibition  
1. Attention seems to wander Yes No
2. Daydreams Yes No
3. Comments are off topic Yes No
4. Starts assignments without having listened to directions Yes No
Distractibility:  
1. Is easily distracted by sights and sounds around him/her Yes No
2. Can't discriminate between what is important and what isn't Yes No
Perseveration:  
1. Persists in an activity or a train of thought to an obsessive level Yes No
Organization: Yes No
1. Is rarely prepared for class Yes No
2. Loses assignments and personal belongings Yes No
3. Has a messy locker and/or desk Yes No
4. Notes are disorganized Yes No
5. Is often late or forgetful Yes No
Social Perception:  
1. Dislikes school, complains frequently Yes No
2. Seldom takes responsibility for his own actions: eg. blames others Yes No
3. Loses his temper easily Yes No
4. Insensitive to the feelings of others Yes No
5. Has few friends Yes No
6. Is withdrawn Yes No
7. Does not participate in group activities Yes No
8. Does not like change Yes No

Give yourself 25 points for developing a personal definition off ADD and ADDHD

My definition of ADD
My definition of ADHD
   

 

Information about ADD/ADHD

Subject
Personal notes

Research about medication and ADD

Strategies for parents and teachers

Bibliography for ADD

 

 

 

Tips and Strategies

Educational Interventions
Personal Web Sites

Reading, writing, 'rithmetic and ADHD

Assistive technology devices to support learning

ADD helps and assists

Site of Amen Clinic - checklist

Give yourself 15 points for each great site with educational interventions you find. - up to 100 points. Feel free to post them in WebCT.

 

Meeting Student Needs and Promoting Communication and Personal Growth

Many teachers believe that a classroom needs to be a quiet place. For the student who is impulse driven or hyperactive, being still may be a lot like asking someone who is visually impaired to squint harder until they see. ADD is real and it is important to support the student in efforts to learn self control rather than to impose control on them. .

Ms. Roberts stated that the test of a marriage may be the depth of the tooth marks from biting the tongue. It sounds funny in a way, but the truly successful teacher learns self control - to control her or his own impulses rather than giving way to anger and frustration when working with the ADD student.

. It is crucial to stay out of anger issues with students who are ADD/ADHD. One can build a great relationship with youngsters if the approach is adult to adult rather than parent or teacher (boss) to child. As the relationship strengthens, the student will be much more likely to do the difficult work of learning self control if a bond has been established - and if there is hope for pleasing and being appreciated for self.

This chart gives an example of a positive and supportive way to approach this.

Student action

Needs

Creative solution
Student does not seem to be able to stay still during discussions or lessons in class.

Student - to be soothed - Safety - or in some situations, control

 

Provide areas in the class where the student may move around without distracting others. Consider alternative teaching processes when other students are being asked to stay still.

Consistency and safety issues - solid structure that is agreed upon with student self monitoring is a crucial part of a workable plan.

Student refuses to work on an assignment

Student - fluency

 

Refusal may be one way to save face. "I won't" may mean, "I can't." It may also be an "automatic" response, much as "no" is to the two-year-old. Promote self management, self control and offer options and choices when getting the student to work.
Student raises hand and talks off the subject during instructional question and answer time Student - may have be easily distracted, have problems with impulse control, need for attention, need for control, lack of social awareness, or think and process slowly enough that by the time the thoughts are framed, the class has gone on. Work to determine the reason for inappropriate responses. The student may not realize that when s/he is not talking, thinking and being is still occurring, may not pick up social context, may have issues with impulse control, may not be hearing, or organizing the content or context. This is actually a wonderful symptom that can alert the teacher to the need to focus on supporting a child's learning needs.
     
     
     

 

Fill in the next three cell rows, using the ideas you gain from experience, from materials in the text and in your web searches. Identify a likely student behavior that may hamper learning and then go through the process of defining needs, then finding a solution that allows everyone to get needs met [25 points have been allotted for this activity].

Finding out about a student's individual learning style can support your work with students who are having trouble staying focused, getting started or completing assignments.

List materials and methods you might use to support students with ADD/ADHD.

 

 

Activity List

1. Adhering to the recommendations of Section 504 may be the most useful treatment plan for helping youth who are ADD. What would that look like? [50 pts].

2. Surf TV for a week and look for portrayals of ADD/ADHD [50 points each]. Review the characterization for another 25 points per character.

4. Learn about behavior assessments or functional analysis and why it might be helpful in working with students who have ADD. Try to find an opportunity to work one on one for an hour with someone who has ADD. You will probably find people in your family, dorm or class. If you are at a college, there may be opportunities to work with peers as a tutor. [50 points].

5. Identify three commonly held fallacies about ADD and then provide three fact based beliefs about this category and aligned issues. [15 points]

6. Review the diagnostic and treatment guidelines included here or in other places in your work. Critique them and discuss which you feel are appropriate, which may not? [25 points]. For an interesting look at ADD, surf the web looking for material on people who are "gifted and ADD or ADHD." [25 points].

7. What impact does disease have on ADD/ADHD? [Examples - measles, viruses]. Discuss in detail for 50 points. What effect do substances have on cognitive abilities? [Examples, crack, alcohol, thalidomide]. Discuss in detail for 50 points. What about the theories of food allergies, sugar, caffeine? Again, discuss in detail for 50 points.

8. Competition, grading on the curve and time tests can decrease the ADD student's ability to perform. Cooperative Learning may or may not be a good answer for students. What could you do to help these youngsters succeed while other students are involved in these activities? Feel free to explore these ideas and write a 500 - 1000 word essay discussing findings. [50 points].

9. There are clusters of symptoms that are included in the broad diagnosis of ADD. Choose one of the categories and find at least 10 articles or discussions about the characteristics of the condition. Feel free to use materials off the web, as well. Then write a paper of 500-100 words, discussing the challenges these young people have and provide a set of methods or materials that might address strengths and diminish barriers to education. [100 points each]

10. Remember to feel free to develop your own personal response to the material. Allot yourself approximately 25 points per hour for your work.

 

Book List

Hallowell, Edward M., MD and Ratey, John, MD(1994). Driven to Distraction: Recognizing and Coping with ADD, from Childhood through Adulthood. New York: Pantheon Books, Hallowell and Ratey cover a broad range of issues pertaining to ADD/ADHD in both children and adults.

Silver, L. (1993). Dr. Larry Silver's Advice to Parents on Attention Deficit Hyperactivity Disorder. Washington, DC: American Psychiatric Press, Inc., 1993. A guide for parents that includes information about diagnosis and treatment of ADHD.


You should now:

Go back to Characteristics

E-mail J'Anne Ellsworth at Janne.Ellsworth@nau.edu

Course developed by J'Anne Ellsworth


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