ADD….ADHD….What is it REALLY???
First, let me start on my pet peeve….THERE IS NO SUCH THING AS ADD. Let me repeat, THERE IS NO SUCH THING AS ADD. Ok, so at one time, Attention Deficit Disorder, was the correct name for a constellation of symptoms including hyperactivity, inattentiveness, impulsivity, and other drive teachers nuts behaviors. However, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV TR) , defines those symptoms into three sub categories: Attention-Deficit/Hyperactivity Disorder (ADHD), (1) Predominately Inattentive type, (2) Predominately Hyperactive-Impulsive Type, and (3) Combined type. Doctors, psychologists, and psychiatrists and anyone else diagnosing a child with ADHD should use the DSM-IV TR as the reference when diagnosing ADHD. Therefore, ADD is no longer a relevant term. Ok, stepping off my soapbox now.
ADHD is a term that is thrown around so often that I am quite skeptical that a child has ADHD until I see them in person. And then, only when their behaviors are far beyond that of their peers, AND it occurs in more than one setting. I was very inattentive in my math classes in school. Of course I was. I struggle in math and would frequently tune out when I didn’t understand the material. Didn’t mean I had ADHD, just that math was hard for me. That’s why good clinicians observe the child in several different settings. If that’s not possible, they at least get information from the child’s teacher or someone else other than the parents, usually in the form of rating scales. They also won’t typically diagnose a child with ADHD who is under the age of 6. That is just good practice, if you have ever seen a 5 year old on a sugar high, you know why. The point is that ADHD is not just a kid who has some trouble paying attention (we all do) or who is active (isn’t that a child’s job???), or has trouble making friends (let’s face it, some kids are shy), but a child who is ALWAYS impulsive, inattentive, or hyperactive and consistently has poor relations with other children, may be ADHD. One must look across all the settings to determine that. While ADHD kids may love PE, they probably don’t have great interactions with peers and have more trouble playing correctly with the balls. They may find music class too loud, as many children with ADHD have sensory difficulties too. You may see ADHD symptoms more often in children while in academic classes, due to lack of necessary stimuli.
Ok, so now we’ve gotten that out of the way. How does one
help a child with ADHD be successful in life and school? Well, let’s look at
their weaknesses: inattentive, impulsive, disorganized, hyperactive, poor
social skills, struggle academically due to inability to focus. And their
strengths: quite bright often at a gifted level, fun, want to please/do the
right thing, inventive, can have amazing
focus, with the right activity that provides necessary stimulation, exceptionally
creative, they are fantastic multitaskers, able to carry on multiple activities
at the same time.Given these numerous strengths, how can we best capitalize on them AND help the children with ADHD learn skills to help them manage their weaknesses?
Interventions, for home and school:
1. Rules, posted, positively stated, and simple. “Stay in seat” verus “ No wandering around the room”
2. Clear, short verbal instructions. “Sit down please.” Versus, “Stop walking around the room and park yourself in your seat”
3. Frequent reminders of expectations. Every day review the class rules, some children may need reviewing of rules twice daily or when entering a new environment (transition)
4. Positives, positives, positives, and LOTS of them. Point out what the student is doing right, and they will work to do those things
5. Break assignments, especially long or difficult ones, into smaller pieces. They still have to do the whole thing, but they work only five at a time and then earn a break
6. Give frequent breaks WITH physical activity. Even in High School teachers can have children stand up and stretch or do 5 jumping jacks-it’ll help you and ALL your students concentrate better
7. Give written and verbal directions. And keep them to one to two steps. Children with ADHD can get lost in a lot of words
8. Differentiate instruction. Worksheets are not the end all for children. They learn much better (especially those with ADHD or other learning difficulties) when the material is presented in a way that allows for different learning styles
9. Treat behavioral deficits, the same way you treat academic ones. Teach the child the behavior you want to see.
10.
Provide frequent and immediate reinforcers and
consequences. For some children with
ADHD waiting until the end of the day to get their prize is too hard. They
won’t be able to associate the desired behavior with the reward.
11.
Consider scheduling tough academic tasks for the
morning, by the afternoon , students with ADHD are often worn out after trying
to pay attention, sit still, keep their hands and feet to themselves , all
morning.
12.
Sit children with ADHD away from anything fun
(ie.., rats, aquariums, or other things that move).
13.
Children with ADHD will likely suffer more in
the middle and high school years due to changing classes, more transitions,
more lecture type teaching, less supervision, and higher expectations.
Understand that your students with ADHD will need more prompting, reminding,
and redirection than your other students.
Most importantly remember that children with ADHD, have very little to no control over their behaviors, and they want to do well. And if they don’t do well, they tend to say they are “bad” or attribute their inability to control themselves to something inherently wrong with them. That is so not true, they simply are not able to do well without adult intervention. That’s why it is our job as adults to teach them the behaviors we want to see, praise the mess out of the kids when we see those desired behaviors, remind them of our expectations, verbally and visually, and gently punish them when they exhibit behaviors that must be punished (verbal and physical aggression). Children with ADHD, as all children with “disabilities,” are not broken, they simply function in different ways than other children. We need to recognize and embrace those differences, not punish them.
Cites:
American
Psychiatric Association. (2000). Diagnostic and statistical manual of mental
disorders (4th ed., text rev.). Washington, DC.
Other Cool Resources:
http://myadhdaftablog.blogspot.com/ (Top 5 fictional characters with ADHD)
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002518/ (General Good information)
http://www.mayoclinic.com/health/adhd/DS00275 (General Good information)
http://www.everydayhealth.com/blog/a-doctors-personal-take-on-adhd/the-life-of-an-adhd-childs-mother/ (Blog by a medical doctor who happens to be a mother of a
child with ADHD)
Dr. Sarah Graves, LSSP
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