Of Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is a complex condition with no visible physical characteristics and a huge social and ethical debate around appropriate intervention.  Dr. K. Heikilla describes the condition as a neurological one impacting the brain's attention centres as the brain lacks beta waves that focus attention.

Healthlink BC defines ADHD as follows: Attention deficit hyperactivity disorder (ADHD) is a condition in which a person has trouble paying attention and focusing on tasks, tends to act without thinking, and has trouble sitting still. It may begin in early childhood and can continue into adulthood. Without treatment, ADHD can cause problems at home, school, work, and with relationships. In the past, ADHD was called attention deficit disorder (ADD).










A) Characteristics of ADHD students

1. Limited sustained attention 
2. Reduced impulse control
3. Excessive task-irrelevant activity
4. Deficient rule following
5. Greater than normal task variability during task performance

One very interesting aspect that has been published is the similarity between ADHD "symptoms" and the "traits" of gifted people.  In his book Engaging Minds and his lectures, Dr. Brent Davis frames this as a question of "Are we ritalinizing our geniuses?"  A difficult consideration for any parent.

Here is what we do know medically about ADHD based on research.  The condition is attributed to neurological causes including anatomical, chemical, physiological and pyshcological including reduced brain activity, lesser neurotransmitter activity and dysfunction or differences in the frontal lobes affecting "executive function." Still, much more research is needed on these models.  See CHADD for more.   (image credit: www.scienceblogs.com - The Neuroscience of ADHD)

B) Identifying ADHD
Incidence estimates vary but ADHD is the most common child psychiatric disorder with the Canadian Pedriatric Society states 3-7% amongst school age children.

ADHD has a genetic thread as it often runs in families which can be a helpful reference during diagnosis.

The identification process usually involves referral by a teacher or parent to the school team or school psychologist based on concerns over attention problems.  The teacher will use assessment measures and document behaviour over time in different settings.  Ultimately, a physician or psychiatrist involvement is required as ADHD is not an exceptionality category in the Canadian education system.

The assessments and documentation should help identify the type of ADHD and identify other factors that may exist which can include aggression, LD, Giftedness and Developmental Disabilities.  This process is critical to the right plan and adaptations.

The major strategies for intervention are medication and structural adaptations (covered in the next section).  The medical aspects are briefly touched on here since stimulant and anti-depressant medications are often prescribed including Ritalin, Adderal and Concerta.

So how does a parent decide whether to try medication?   Only after considerable thought and exploration of other interventions.  Significant school and home disruptions by the child's behaviour may indicate a stronger case for medication.  Side effects versus the benefits from addressing the impairment the child faces should be considered.  Will they suffer worse outcomes without the medication?
Other considerations include the child's age, supervision ability, costs, past interventions, the child's concerns and feelings and even competitive sports performance.

If a course of medication is decided upon, then the school team and parents need to monitor the behaviour impacts and any side effects like appetite loss.  Dosages or types of medication may need to be adjusted to find the right mix and substance abuse monitored.   Strong communication lines need to be in place with the physician as results are monitored.  Barkley (1999-2000) reports a 90% success rate for individuals that continue to try different stimulants after one fails.

It is important for parents to educate themselves and for those involved to be aware that the presence of ADHD may not necessarily be proven by positive response to the medication and that some children with ADHD may show no response at all.

C) Classroom adaptations and modifications
The literature related to ADHD generally suggests some of these approaches:

• Proactive classroom management around groups, physical management and behaviour
• Mutual rules development (5-6 maximum) and consistent rules application and consequences
• Positive language, patience, periodic review, positive reinforcement for abiding
• Spending time to develop relationship and teaching to their strengths and interests
• Routines, clear rules and choices during free times, flexible pacing and workload
• Respectful treatment of students
• Teaching cognitive strategies like note-taking, Power Point etc and apply skills to real world
• "Grandma's Law" - A clear reward following a desired behaviour
• Negative reinforcement - removing an aversive stimulus like homework for desired behaviour

As featured in the Parent Resource post, an excellent resource on classroom strategy for boy-centric problems is Barry Macdonald's Mentoring Boys.  Tips include:  consideration of the active learner style of many boys through physical environment, activity centres, novelty, fun, encouraging mistakes and calculated risks, clear goals and enabling boys to take on responsiblity and give input on school tasks.

As well the incorporation of Tactile-Kinesthetic Activities including:  role-play, performances, manipulatives, picture-taking for projects, note-taking strategies, field trips, models and dioramas, artifacts or foods related to theme and means of allowing students to get in touch with their feelings and gut reactions (journals).

More on Gardner's Multiple Intelligences can be viewed here.