Attention Deficit Disorder (ADD):
ADD or ADHD (Attention Deficit Hyperactive Disorder) is a neurological-based medical condition diagnosed via a psychological assessment. It may be a stand alone condition, or may co-exist, to a greater or lesser degree, with any one of a number of other disorders (e.g. dyslexia, autism, learning disorder, dyspraxia, conduct disorder, oppositional defiance disorder). ADD/ADHD would seem to be more prevalent among boys than girls. It is most commonly defined by DSM IV –TR (2000) – “A persistent pattern of inattention and/or hyperactivity that is more frequent and severe than typically observed in individuals at a comparable level of development”.
The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (known as DSM-IV-TR) classifies ADHD in three ways, based on the child’s behaviour. The symptoms are split into two core categories of 1.Inattention and 2.Hyperactivity-Impulsivity. A doctor will consider how many symptoms the child has in each category and can diagnose-
• ADHD combined type: this is the most common type, and means the child has six or more symptoms in each category.
• ADHD predominantly inattentive type: this means the child has six or more inattention symptoms but fewer than six hyperactivity-impulsivity symptoms.
• ADHD predominantly hyperactive-impulsive type: this is the least common type and means that the child has six or more hyperactivity-impulsivity symptoms but fewer than six inattention symptoms.
These core characteristics exist in differing degrees of intensity, and DSM-IV-TR also includes consideration of the following in a diagnosis:
• signs must occur often, and be present for at least six months
• some signs must have developed before the age of seven.
• signs must be more severe than expected for the child’s age and intelligence
• signs must have a significant negative impact in at least two settings, for example at home, work, school or play.
• no signs should occur exclusively as part of another disorder.
(Adapted from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (2000), American Psychiatric Association)
1. Signs of Inattention
• Fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities
• Has difficulty sustaining attention in tasks or play activities
• Does not seem to listen when spoken to directly
• Does not follow through on instructions and fails to finish schoolwork, chores or duties in a workplace
• Has difficulties organising tasks and activities
• Avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort (such as school work)
• Looses things necessary for tasks or activities such as toys, school books, pencils, tools)
• Is easily distracted
• Is forgetful in daily activities
2. Signs of Hyperactivity and Impulsivity
• Fidgets with hands or feet or squirms in seat
• Leaves seat in classroom or in other situation in which remaining seated is expected
• Runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, subjective feelings of restlessness)
• Has difficulty playing or engaging in leisure activities quietly
• Is ‘on the go’ or acts as if ‘driven by a motor’
• Talks excessively
• Blurts out answers before questions have been completed
• Has difficulty awaiting a turn
• Interrupts or intrudes on others
(Adapted from Scientific American feature Article (1998) Attention –Deficit Hyperactivity Disorder)
Intervention for the child diagnosed with ADD/ ADHD needs to be multi-disciplinary and multi-modal to bring symptoms under control, and must provide alternative strategies for the child. A combination of some or all of the following may be offered by Psychiatric/ Psychological Services involved in the diagnosis and treatment of children-
1. Medication with routine monitoring
2. Behavioural advice and intervention
3. Educational advice and management
4. Parental and familial advice, support and counselling
5. Dietary advice
Ideally, within a treatment plan, other co-existing difficulties if present should be addressed (e.g. specific learning problems, anxiety or attachment issues and difficulties.)
In the classroom students with ADHD will:
• find it difficult to plan and control their behaviour.
• have a tendency to rush into things
• are disinclined to engage in activities which require prolonged effort
• seem unaware of danger, and oblivious of the consequences of their actions
• find listening to and remembering instructions very difficult
• are easily distracted.
• have great difficulty in organizing themselves and their belongings, or materials required to complete classroom tasks.
• May be disliked by their peers because they cannot sustain play, and are seen as aggressive, impulsive and unable to take responsibility for their actions
Helpful Strategies include:
• Behavioural support and management- directly teach self-regulation skills(e.g. How Does your Engine Run – The Alert Programme), guided self-talk, and relaxation techniques
• Behaviour reinforcement strategies such as a Token Economy system or good behaviour programmes such as Golden Time
• Teach Anger Management techniques as these focus on providing alternative ways for dealing with frustration; use role- play and rehearsing situations which the child finds difficult
• Provide regular, consistent and constructive feedback to the student- reward when possible and immediately praise any good behaviour or accomplishment
• Use concrete materials, and employ ICT to maximise learning
• Any classroom intervention should take into account each child’s likes/strengths /interests to best re-enforce the programme
• Teachers and SNAs operate as a team, and work closely with other professionals involved, and as far as possible keep communication open between home and school.
• Keep class-based tasks short and varied
• Present uncluttered worksheets and text-books- consider using a sheet to cover bulky and confusing text on work pages or reading books, only revealing text when ready to move on to next section of work
• Have all materials, books and tools pre-organised and minimize distraction at the desk and in the classroom
• Ensure you have the child’s attention before giving instruction
• Give clear and brief instructions, broken down into simple steps
• Provide a structured, predictable environment, with routines and timetables- consider using more visual cues to minimise confusion in times of anxiety
• Provide advance warning when something is about to happen, change, or a period of transition is imminent- children with ADHD have great difficulty with change, especially when un-prepared
• Provide and use lists for student to work through when completing tasks or homework
• Use Mind Mapping Techniques (Tony Buzan)
• Above all, interact with the student in a calm manner
As with all such diagnosis, the message seems to be very negative. Here is a list taken from The Attentional Disorders Association of Edmonton:
THIRTY FIVE GOOD THINGS ABOUT HAVING ADHD
1. Lots of energy
2. Willing to try things - take risks
3. Ready to talk, can talk a lot
4. Gets along well with adults
5. Can do several things at one time
6. Smart
7. Need less sleep
8. Good sense of humour
9. Very good at taking care of younger kids
10. Spontaneous
11. See details that other people miss
12. Understand what it's like to be teased or to be in trouble
so are understanding of other kids
13. Can think of different and new ways of doing things
14. Volunteer to help others
15. Happy and enthusiastic
16. Imaginative – creative
17. Articulate - can say things well
18. Sensitive - compassionate
19. Eager to make new friends
20. Great memory
21. Courageous
22. More fun to be with than most kids
23. Charming
24. Warm and loving
25. Care a lot about families
26. Inquisitive
27. Quick to forgive
28. Genuine
29. Never boring
30. Empathetic
31. Perceptive ways to do things
32. Playful
33. Honest
34. Optimistic
35. Interested in new things
Further Resources and References:
http://www.hadd.ie/ - Irish online support group for families and educationalists.
Provides access to a number of free PDF downloads including:
• ADHD and Education: A Resource for Teachers (2005) HADD Family Support Group.
• A Survey of ADHD in Irish Children (2007) HADD Family Support Group - a Nation-wide survey of 150 Irish parents of children diagnosed with ADHD
http://www.adders.org/ - ADHD support group in UK and Ireland
http://www.ncld.org/ The National Centre for learning disabilities website (American site)
http://www.ldonline.org/ - Learning Disabilities on line, specializing in resources and information on ADHD. (American site)
http://www.chadd.org/ - information and resources relating to ADHD (American site)
http://www.sess.ie/ - (Special Education Support Service) - use as a portal to range of sites associated with multiple disabilities including ADHD.
http://www.ncte.ie – National Centre for Technology in Education has information on ICT with a range of disabilities including ADHD
http://www.buzanworld.com – website of Tony Buzan- Mind Mapping examples, and books can be ordered directly from here.
http://www.sensoryintegration.org.uk/ - the Sensory Integration Network, UK and Ireland
Books can be ordered on line from:
http://www.amazon.co.uk/
http://www.otb.ie/ - Outside the Box
http://www.jkp.com/ - Jessica Kingsley Publications
Buzan, T. (2005). The Ultimate Book of Mind Maps, London: Harper Thorsons
Dennison, P. and Dennison, G. (1992). Brain Gym (Orange): Edu-Kinesthetic, Inc. See http://www.braingym.com/
O’Regan, F. (2002). How to Teach and Manage Children with ADHD, Cambridge: LDA
Williams, M. (1996). How Does Your Engine Run? A Learner’s Guide to the Alert Program for Self-Regulation.
Plummer, D. (2008). Anger Management Games for Children. London; Jessica Kingsley Publishers
Cooper, P. and Bilton, K. (1996). Attention Deficit/ Hyperactivity Disorder- A Practical Guide for Teachers. Second Edition. London; David Fulton Publishers
Reif, S.F. (2003).The ADHD Book of Lists: a Practical Guide for Helping Children and Teens with Attention Deficit Disorders. San Francisco; Jossey-Bass
Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (2000), American Psychiatric Association