I. Definition
II. Diagnostic
Criteria
SUBTYPES BASED ON DIAGNOSTIC
CRITERIA
III. Associated Features
OTHER BEHAVIORS IN INDIVIDUALS
WITH ADHD
IV. Age at onset, Course,
Prevalence GENDER NOTE
V. Adults, and ADHD - ADD
VI. Causes of
Attention Disorders
VII. Genetics -
Predisposing
Factors - Brain Pathology
VIII. ADD Treatments
and Therapy
IX. BEST
EDUCATIONAL
APPROACH & ELS™
CH.A.D.D. LIST OF SUGGESTIONS FOR TEACHING ADHD CHILDREN
I. DEFINITION
The main 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. (DSM-IV, 1994)
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II. DIAGNOSTIC CRITERIA for ADHD
NOTE:
The proper use of these criteria requires specialized clinical training
that provides both a body of knowledge and clinical skills.
Following are the diagnostic criteria Attention-Deficit/Hyperactivity
Disorder according to the American Psychiatric Association (DSM-IV,
1994):
Six (or more) of the following symptoms of inattention have persisted
for at least 6 months to a degree that is maladaptive and inconsistent
with the developmental level:
Inattention
- Often fails to give close attention to details or makes careless
mistakes in schoolwork, work, or other activities.
- Often has difficulty sustaining attention in 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 (not
due to oppositional behavior or failure to understand instructions).
- Often has difficulty organizing tasks and activities.
- Often avoids, dislikes, or is reluctant to engage in
tasks that require sustained mental effort (such as schoolwork or
homework).
- Often loses things necessary for tasks or activities
e.g., toys, school assignments, pencils, books, or tools.
- Is often easily distracted by extraneous stimuli.
- Is often forgetful in daily activities.
Six (or more) of the following symptoms of hyperactivity --
impulsivity have persisted for at least 6 months to a degree that is
maladaptive and inconsistent with developmental level:
Hyperactivity
- Often fidgets with hands or feet or
squirms in seat.
- Often leaves seat in
classroom or in other situations in which remaining in seat is
expected.
- Often runs about or
climbs excessively in situations in which it is inappropriate
(in adolescents or adults, may be limited to subjective feelings
of restlessness).
- Often has difficulty
playing or engaging in leisure activities quietly.
- Is often "on the go" or often acts as if
"driven by a motor."
- Often talks excessively.
- Impulsivity
- Often blurts out answers before questions
have been completed.
- Often has difficulty
awaiting turn.
- Often interrupts or
intrudes on others (e.g., interrupts conversations or games).
Some hyperactive-impulsive or inattentive symptoms
that caused impairment were present before age 7 years.
Some impairment from the symptoms is present in two or more
settings (e.g., at school [or work] and at home).
There must be clear evidence of clinically significant
impairment in social, academic, or occupational functioning.
The symptoms do not occur exclusively during the course of a
Pervasive Developmental Disorder, Schizophrenia, or other Psychotic
Disorder and are not better accounted for by another mental disorder
(e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a
Personality Disorder).
SUBTYPES BASED ON DIAGNOSTIC CRITERIA (DSM-IV, 1994)
Attention-Deficit/Hyperactivity Disorder, Combined Type. This
subtype should be used if six (or more) symptoms of inattention and
six (or more) symptoms of hyperactivity-impulsivity have persisted
for at least 6 months. Most children and adolescents with the
disorder have the Combined Type. It is not known whether the same if
true of adults with the disorder.
Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive
Type. This subtype should be used if six (or more) symptoms of
inattention (but fewer than six symptoms of hyperactivity-impulsivity)
have persisted for at least 6 months.
Attention-Deficit/Hyperactivity Disorder, Predominantly
Hyperactive-Impulsive Type. This subtype should be used if six (or more)
symptoms of hyperactivity-impulsivity (but fewer than six symptoms of
inattention) have persisted for at least 6 months. Inattention may often
still be a significant clinical feature in such cases.
If ADHD is left unidentified or untreated, a child is at great risk
for:
- impaired learning ability
- decreased self-esteem
- social problems
- family difficulties
- potential long-term effects
("Attention Deficit Disorder: an educator’s guide," 1993)
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III. ASSOCIATED FEATURES - OTHER
BEHAVIORS IN INDIVIDUALS WITH ADHD
- non-compliance
- attention-getting behavior
- immaturity
- school problems
- emotional difficulties
- poor peer relationships
- family interaction problems
- low frustration tolerance
- temper outbursts
- bossiness
- stubbornness
- excessive and frequent insistence that
requests be met
- mood lability
- demoralization
- dysphoria (a state of
dissatisfaction and restlessness)
- rejection by peers
- poor self-esteem
- family relationships
characterized by resentment and antagonism
- ADHD & LEARNING PROBLEMS
Only 20% to 40% of ADHD diagnosed children also have learning
problems. Frequently, they are one or more of the following (validity of
ADHD Syndrome, AADD23):
- Auditory perception and processing problems.
- Visual perception and visual
processing problems
- Auditory and visual memory
problems (both short- and long-term)
- Sequencing problems
- Fine-motor problems
- Visual-motor integration delays
- Poor eye-hand coordination and
dysgraphia
- Dyslexia and reading disorders
- Written language problems
- Spelling disorders
- Math disorders
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IV. AGE AT ONSET, COURSE, PREVALENCE
AGE AT ONSET:
In approx. half of all cases, onset of the disorder is before age 4
(DSM-IV, 1994).
Frequently, the disorder is not recognized until the child enters
school (DSM-IV 1994).
COURSE:
In the majority of cases, symptoms of the disorder last throughout
childhood and is relatively stable throughout adolescence (DSM-IV,
1994).
Studies have indicated that the following features predict a poor
course: coexisting Conduct Disorder, low IQ, and severe mental disorder
in the parents (DSM-III-R, 1987).
PREVALENCE:
May occur in as many as 3% to 5% of school-age children (DSM-IV,
1994).
About 70% of ADHD children continue to have behavioral problems in
adolescence ("Attention deficit disorders--not just for children,"
1993).
GENDER NOTE:
In clinical samples of the American Psychiatric Association, ADHD is
from six to nine times more common in males than females. In community
samples, multiple signs of the disorder occur only three times more
often in males than is females (DSM-III-R, 1987).
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V. ADULTS AND ADHD
(Attention deficit disorders--not just for children," 1993)
ADHD is a "hidden disorder" (the symptoms of ADHD are often obscured
by problems with relationships, staying organized, and holding a steady
job) in adults. Adults are often first diagnosed with ADHD because of
problems with substance abuse or impulse control.
Following are some characteristics of adults with ADHD:
- distractibility
- disorganization
- forgetfulness
- procrastination
- chronic lateness
- chronic boredom
- anxiety
- depression
- low self-esteem
- mood swings
- employment problems
- restlessness
- substance abuse or addiction
- relationship problems
about two-thirds of children with ADHD continue to have
behavioral problems in adolescence
about one-third to one-half of these adolescents continue to have
symptoms of ADHD in their adult years
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VI. CAUSES OF ATTENTION DISORDERS
5 MAJOR CATEGORIES
(Validity of ADHD Syndrome, AADD23)
Constitutional or innate biological factors: these relate
particularly to temperament and heredity;
Organic factors: these include all physiological injury to the central
nervous system and/or brain;
Diet, nutrition, allergies, and food intolerance;
Environmental toxins: including lead, formaldehyde, and chemical
pesticides, among others; and,
Secondary to other medical problems
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VII. GENETICS/PREDISPOSING
FACTORS/BRAIN PATHOLOGY
GENETICS
More prevalent among first-degree biologic relatives of people with
the disorder than in the general population (DSM-III-R, 1987).
ADHD OFTEN COINCIDES WITH: (DSM-IV, 1994)
Tourette’s Disorder (a disorder involving tics--sudden involuntary
muscle spasms)
Child abuse or neglect
Multiple foster home placement
Usually lower IQ
Neurotoxin exposure (lead, etc.)
Infection (e.g., encephalitis)
Drug exposure in utero
Low birth weight
Mental retardation
OTHER PREDISPOSING FACTORS
Some ADHD symptoms result from infection or trauma after birth (this
is more difficult to treat than inherited ADHD because it usually
involves some brain damage) (Validity of ADHD Syndrome, AADD23).
Drugs and/or alcohol can cause sever ADHD symptoms and learning
problems (fetal alcohol syndrome).
BRAIN PATHOLOGY
Research strongly suggests that the majority of attention disorders
result from a deficiency or imbalance of neurotransmitters (specifically
norepinephrine and dopamine) or brain chemicals. These chemicals affect
the frontal and central brain structures important for alertness and
attention, and the premotor cortex responsible for motor inhibition and
impulse control. (Validity of ADHD Syndrome, AADD23).
In 1990, the New England Journal of Medicine reported that "the rate
at which the brain uses glucose, its main energy source, was shown to be
lower in persons with ADHD, especially in the portion of the brain that
is responsible for attention, handwriting, motor control, and planning."
Reticular Activating System--Mel Levine’s theory
Brain Wave Abnormalities--EEG info.
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VIII. POSSIBLE TREATMENTS for ADHD
Drug Therapy. Ritalin is the most common stimulant used to calm the
hyperactive symptoms of ADHD (low doses control the brief attention span
symptom). Motor over activity can only be controlled with higher doses
of Ritalin, but with this, the optimum conditions for learning are
sacrificed (Rosenhan, et. al., 1989).
Behavior Management. This method uses operant conditioning techniques,
which means that it focuses on straightforward use of attention and
tangible reinforcers of behavior which are systematically applied. For
example, one research group gave an incredibly overactive little boy a
penny for every ten seconds that he sat still. While the first session
only lasted about five minutes, by the eighth session, his hyperactivity
had virtually ceased (Rosenhan, et. al., 1989).
IX. BEST EDUCATIONAL APPROACH & ELS™ Top
CH.A.D.D. LIST OF SUGGESTIONS FOR TEACHING ADHD CHILDREN
("Attention Deficit Disorder: and educator’s guide," 1993)
Predictability. With ELS™, especially if using a sequence, the
student knows exactly which exercise consecutively follows.
Structure. This is built into ELS™: the lesson word construction and
progression, mastery cycles, levels broken into cyclic lessons, and
sequences that automatically proceed from one task to the next, are just
a few of the structural means by which ELS™ reaches students.
Shorter work periods. ELS™ is different from most learning systems in
that there is a time when the student gets out of his or her chair and
reads to the teacher, or checks written work, or gets a worksheet
graded--all of these are opportunities for the ADHD student to have a
quick break and then get back to work.
Small student-teacher ratio. CEI always recommends a small student-
teacher ratio for students with learning differences.
Individualized instruction. ELS™ was designed to cater to the needs of
one individual. Each exercise provides the teacher an opportunity to
change specific features of the task to best suit the student. The
prescribed sequences were also designed with the specialized needs of
the students in mind.
Motivating and interesting curriculum. The best way to describe ELS™
in its entirety is "motivating" and "interesting" to the students. Just
ask them!
Use of positive reinforcement. ELS™ always provides feedback to any
answer, right or wrong. Positive reinforcement )like the friendly voice,
or points for trying to answer a question) in ELS™ is an essential
element of a child gaining self-confidence in scholastic areas.
About E.L.I. & How It Works
There Is Hope for ANY Learning Disability!
About E.L.I. & How It Works
WORKS CITED
American Psychiatric Association. (1994). Diagnostic and statistical
manual of mental disorders (4th ed.). Washington, DC: Author.
American Psychiatric Association. (1987). Diagnostic and statistical
manual of mental disorders (3rd ed. rev.). Washington, DC: Author.
Attention Deficit Disorder: an educator’s guide. (1993) CH.A.D.D.
Facts, 5, 1-4.
Attention Deficit Disorders--not just for children. (1993) CH.A.D.D.
Facts, 7, 1-3.
Clayborn, M., Long, T., & Whitt, S. (1990). [Overview of ADD--title
unknown]. 1-39.
Medical management of attention deficit disorders. (1993). CH.A.D.D.
Facts, 3, 1-4.
Parenting a child with Attention Deficit Disorder. (1993). CH.A.D.D.
Facts, 2, 1-2.
Parker, Harvey C., Ph.D. (1992). ADD fact sheet. Children with
attention deficit disorders, 1-2
Rosenhan, D.L., & Seligman, M.E. P. (1989). Abnormal Psychology. New
York: W.W. Norton and Company.
The disability named ADD: an overview of attention deficit disorders.
(1993). CH.A.D.D. Facts, 1, 1-2.
Validity of ADHD syndrome. [No further documentation information
available--AADD23 in CEI library], 14-36.
