WELCOME
Welcome to "Supporting the child with ADHD". At some point, you will encounter the particular social and learning needs of a student with this disorder. This course will provide you with a better understanding of ADHD and strategies for recognizing and working with ADHD students.
This course consists of three modules:
- What is ADHD?
- Identifying and understanding ADHD
- Helping children with ADHD succeed in school
As you work through the course you will:
- increase your knowledge of ADHD increase your knowledge of how ADHD is assessed and diagnosed
- learn a number of techniques and strategies to use with ADHD children in your classroom
At any time you may email us with questions or problems you may be having with the material or site.
PREPARATION
This course requires you to gather data on students in your school. Whenever you gather data about students or colleagues, you should do so on the basis of informal consent. This means that all involved (e.g., students, parents, colleagues and principals) should know you're carrying out research for your own learning, and how this will benefit students. You should make clear what you're researching, how it will be carried out, how any data will be recorded and what use will be made of it. Before you start, it would be a good idea to identify a number of students who have already been identified as having ADHD or who display its characteristics. Several Activities and Tasks require you to observe such students. You should check with the child and all those responsible for him or her that your observations and approach are acceptable to them at this time.
COURSE STRUCTURE
This is an independent study program which means your individual starting date and due date are based on your date of registration. Your instructor will advise you of this due date.
This is an interactive on-line course. Although you will be able to complete some of it just by sitting in front of your screen working through the on-line material, we will regularly ask you to reflect on what you have learned, and put ideas into practice.
- Activities - exercises or reflections for you to carry out in front of your computer screen. Unlike a Task, there is no specific end product, and you'll always be able to complete them on your own.
- Tasks - similar to Activities, but requiring you to put your learning into practice in a specific situation in school.
- Forms - use to collect the information learned.
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Resources -
a) RESOURCE FORMS: Has PDF forms to help you answer questions in the Student Books
b) RESOURCE FURTHER READING: Includes clarifications about the module.
c) REFERENCE LINKS: Has links to websites referred to in the module.
d) DEFINITIONS: Has definitions of terms used in the module.
e) BIBLIOGRAPHY: The bibliography is located at the bottom of this page that includes books you may check out at your local library.
- Student Book-for you to record your reflections and send to your instructor.
STUDENTBOOK
At any time you may email your instructor with questions or problems you may be having with the material or the web site.
How do I get the Student Book to my instructor?
You will need to email it to your instructor. Download and save the document as described below and then you can enter your own text into the Student Book word document. Your instructor will expect a version of your Student Book as you complete each module. These can be saved by you in your files as well as being sent to your course instructor via email as an email attachment.
How do I save and name the Student Book?
You cannot type your answers on this web site. You must download your Student Book template which is a word document, by clicking on the download link below.
For your Student Book, please use a text document or a Microsoft Word document and type your text there. Title the document like this:
- NAME OF CLASS
- NAME OF TEACHER
- YOUR NAME
- DATE
- MODULE1
[NAMEOFCLASS_TEACHERSNAME_YOURNAME_MODULENUMBER.doc ]
like this
6208_DRCLARK_JOHNDOE_MODULE1.docSave the Student Book on your computer and complete the assignments on the document and then email it to your teacher.
INDEX
STUDENTBOOKS Click here to download all Student BooksRESOURCES
BIBLIOGRAPHY
REFERENCE LINKS
DEFINITIONS
Module 1: What is ADHD?
MODULE1A Intended learning outcomes for Module 1
MODULE1B The characteristics of Attention Deficit Hyperactivity Disorder (ADHD)
MODULE1C Activity 1: Examining behaviors
MODULE1D Labeling behavior
MODULE1E The development of ADHD as a label
MODULE1F Diagnostic criteria
MODULE1G Activity 2: How useful is it to label children?
MODULE1H Symptoms of ADHD
MODULE1I Task 1: Observing the characteristics of ADHD
MODULE1J Activity 3: Disruption to classes
MODULE1K Incidence of ADHD
MODULE1L Activity 4: What causes ADHD?
MODULE1M What have you learned? Evaluation of your learning from Module 1
MODULE1N Congratulations
Module 2: Identifying and understanding ADHD.
MODULE2A Intended learning outcomes for Module 2
MODULE2B The development of attention
MODULE2C Choosing students to observe
MODULE2D Task 2: Observing levels of attention
MODULE2E Behavior over a period of time
MODULE2F Activity 5: Matching behaviors
MODULE2G Other conditions that could cause ADHD-like behavior
MODULE2H Activity 6: Other causes of problem behavior
MODULE2I Task 3: Redefining behaviors
MODULE2J There are limits to what you can do
MODULE2K Task 4: Using diagnostic tools
MODULE2L Activity 7: Profile of selected students
MODULE2M Involving others
MODULE2N Diagnosis by a multidisciplinary team
MODULE2O The diagnostic process
MODULE2P What have you learned? Evaluation of your learning from Module 2
MODULE2Q Congratulations
Module 3: Helping children with ADHD succeed in school.
MODULE3A: Intended learning outcomes for Module 3
MODULE3B: Planning for success
MODULE3C: Creating a positive learning environment
MODULE3D: Task 5: Observing ADHD students in the classroom
MODULE3E: Task 6: Strategies to help
MODULE3F: Self-management techniques
MODULE3G: Task 7: Refining your plan
MODULE3H: Leading ADHD students to self-understanding
MODULE3I: Activity 8: Seven things to help pupils understand and manage ADHD
MODULE3J: Task 8 (optional): Treating ADHD: a discussion paper
MODULE3K: What have you learned? Evaluation of your learning from Module 3
MODULE3L: Congratulations
Module 1: What is ADHD?
MODULE1A Intended learning outcomes for Module 1
By the end of this module you should:
- know the characteristics of ADHD
- know in broad terms the suggested causes and effects of ADHD
MODULE1B The characteristics of Attention Deficit Hyperactivity Disorder (ADHD)
There's a good chance that you work with several students who have problems with inattention or hyperactivity. It's important to say at the outset that a student with these problems does not necessarily have an attention deficit disorder.
ADHD is an internationally recognized condition which has a World Health Organization diagnostic criterion known as ICD 10 (International Classification of Diseases No. 10). There is no diagnostic test – an appropriate clinician determines whether a child has ADHD. In the UK for example, only psychiatrists and pediatricians are able to professionally diagnose ADHD.
ADHD isn't characterized by just one set of symptoms or behavioral features. Pupils with ADHD have serious and persistent difficulties in three specific and combined areas:
- inattention
- impulse control
- hyperactivity
Read Resource 1 for a description of these terms.
MODULE1C Activity 1: Examining behaviors
Think about the students you work with. Using the descriptions from Resource 1, think of an example of each of the three behaviors. If you can't think of an example of one of these behaviors, ask colleagues about the students they teach. Record your findings in your Student Book (1).
Then read Resource 2 for some further discussion on the effects of these behaviors.
Labeling behavior is fraught with problems! Once we've chosen to label a child as "x" all sorts of people see that child in a particular way and so a clear understanding of what a particular label means is essential if we are to meet students' individual needs.
MODULE1E The development of ADHD as a label
Descriptions of the kinds of behavioral problems and difficulties we now describe as ADHD were first reported in 1902. During the past century there have been several names to describe the behavior of children and adults affected by the symptoms of ADHD. These different names reflect uncertainty about its underlying causes..
For some more information on this, read Resource 3.
There's some debate in the medical and psychological worlds about which criteria should be used for diagnosing ADHD. Different criteria are used in the USA and the UK for example.
Although it's highly unlikely you'll be involved in diagnosing ADHD, it's important that you know whether the difficulties a child faces could be linked to ADHD. Not least, you may face queries from anxious parents looking for a reason for their child's behavior, so it will be useful to have some facts at your fingertips.
Have a look at the two most used diagnostic criteria: Resource 4: The ICD-10 criteria which is commonly used in the UK, and Resource 5: DSM V criteria, commonly used in the USA
MODULE1G Activity 2: How useful is it to label children?
Read the case studies in Resource 6. In your Student Book (2), reflect on how you might label these students.
BACK TO INDEX
MODULE1H Symptoms of ADHD
We have seen that ADHD has evolved to the point where it now describes two interrelated sets of symptoms:
- inattention
- a combination of hyperactive and impulsive behaviors
Most children are at times inattentive, easily distracted, impulsive and highly active. So seeing this behavior doesn't mean that a child has ADHD. A significant part of the diagnosis is the persistence and pervasiveness of the symptoms.
Sometimes a child is simply not mature enough to meet the demands of the classroom. The younger the child, the less aware they are of time and the less able they are to give priority to future events over more immediate wants. So when considering a diagnosis of ADHD, a child's developmental "age and stage" should be taken into account.
Remember, these behaviors are only indicative of a problem if children display them significantly more than their peers, and if they hinder development and progress
MODULE1I Task 1: Observing the characteristics of ADHD
If you have a student diagnosed as having ADHD in your school, or one who displays the characteristics of ADHD, observe that student closely over the next two weeks. Observe them wherever you can – in class or assembly, and during playtime, break or lunchtime. Look out in particular for differences between the behavior of your chosen student and their peer group.
Print out Resource 7 to help you record your observations. Once you've completed your observations, record your findings in your Student Book (3).
MODULE1J Activity 3: Disruption to classes
Students with ADHD frequently disrupt the classroom. Recent research identified the most frequently occurring student behaviors that lead to disruption in mainstream secondary school classrooms.
Read the list of behaviors in Resource 8.
From what you've learned and observed so far, which behaviors might be characteristic of children with ADHD? Note your thoughts in your Student Book (4)
So how many children have ADHD? The fact is that different definitions and measurements of ADHD result in very different estimates about the incidence of ADHD. To illustrate this, look at the following findings:
- Studies in the USA have found that teachers of first-year students rate as many as 50 percent of boys in their class as having ADHD. This highlights a potential danger of labeling behavior as abnormal when it might simply be within the lower end of the normal range of development.
- Some USA studies estimated that around three to five percent of school age children are affected by ADHD. In the UK, the number is thought to be lower.
- Other studies worldwide have produced estimates that between two and eight percent of all school-age children may suffer from ADHD. Researchers have identified ADHD and its underlying characteristics in every nation and culture they have studied.
Obviously it's difficult to draw any firm conclusions from these numbers. However, as a rough guide, we could tentatively suggest that in any typical class, a teacher might have one or two students suffering to some extent from this condition.
Worldwide studies show a higher incidence of ADHD in boys than girls – approximately 6 boys to 1 girl. However, concern has been expressed that some girls may have undetected or undiagnosed ADHD or ADD.
MODULE1L Activity 4: What causes ADHD?Opinion is divided about what causes ADHD. To help you get an idea of the debate, there's an outline of the main theories in Resource 9.
Then read Resource 10, which briefly explains the biological effects of ADHD on four major brain functions.
Having read the Resource, in your opinion which factors are the most important contributors to ADHD? Base your answers both on what you've read and your own experience of students with ADHD. Note your opinion in your Student Book (5).
BACK TO INDEX
MODULE1M What have you learned? Evaluation of your learning from Module 1
Now you have worked through the Activities and Task in this module, please look again at the intended learning outcomes for Module 1.
By the end of this module you should:
- know the characteristics of ADHD
- know in broad terms the suggested causes and effects of ADHD
In your Student Book (6) make a note of the extent to which you have achieved the intended learning outcomes for Module 1. Then, e-mail your comments to your instructor.
MODULE1N Congratulations
Module 2: Identifying and understanding ADHD.
MODULE2A Intended learning outcomes for Module 2By the end of this module you should:
- know the normal stages of attention development
- be able to use some tools to assess ADHD
- understand the role of a multidisciplinary team in diagnosing ADHD
BACK TO INDEX
MODULE2B The development of attention
It's important to remember that at some point in their development, most children tend to be inattentive, hyperactive, or impulsive, without having ADHD. Preschool children have lots of energy and run everywhere, but this doesn't mean they are hyperactive. Many teenagers go through a phase when they are untidy, disorganized and reject authority. It doesn't mean they will have a lifelong problem controlling their impulses.
Similarly, different levels of attention are expected at different ages and stages. You may work with students who are developmentally younger than their chronological age. This needs to be considered when thinking about a diagnosis of ADHD.
Read Resource 11 for some more information on the development of attention in younger children.
BACK TO INDEX
MODULE2C Choosing students to observe
For the next few Tasks and Activities in this module, you will need to observe some students in action in your school. Ideally, you should choose to observe pupils you know quite well. You should focus on students who currently exhibit some of the behavioral problems we discussed in Module 1. Have a look at Resource 12 for a quick reminder of some typical ADHD behaviors.
MODULE2D Task 2: Observing levels of attention
The majority of children of seven years and above should have good attention, and be able to take in auditory and visual information while performing a task. They should be able to focus their attention on a task and not be distracted by noise or activity around them. Of course, they may choose to be distracted – motivation and interest level play a significant part in paying attention.
If you work with a younger age group you'll be aware of the need to pace information and activities to suit their attention level.
When you're next in school, observe two or three students who show some of the typical ADHD behaviors. Using Resource 13 to record your observations (print off one copy for each student), focus on the students, making a note of what factors increase or reduce their attention to a task.
Once you've done your observations, record your thoughts in your Student Book (7).
MODULE2E Behavior over a period of time
To identify a student with the characteristics of ADHD, you must first be sure that the child has poorer attention than you'd expect for their age group. However, poor attention on its own, or observed at a single isolated moment, doesn't mean that the student has ADHD.
You need to observe a student's level of activity and responses over time – some clinicians suggest six months. The fact that a student is sometimes unusually active or impulsive doesn't necessarily mean they have ADHD. Most people, both adults and children, sometimes blurt out things they didn't mean to say, jump from one task to another, or become disorganized and forgetful.
The difference with ADHD students is the persistence and pervasiveness of these behaviors. For a clinician to diagnose ADHD, they would need to see observations gathered over a period of time and in different settings.
MODULE2F Activity 5: Matching behaviors
Refer back to at least two of the students you selected for the previous task (Task 2). How closely do some of the descriptions we saw in Resource 12 fit those students? Match the behaviors with the students in your Student Book (8).
MODULE2G Other conditions that could cause ADHD-like behavior
You should be starting to get a picture of ADHD and a clearer idea of whether or not it applies to some of the students you work with.
As we've mentioned already, poor attention, hyperactivity and impulsivity do not necessarily mean ADHD.
A number of other conditions and factors can result in these behaviors. So, you need to make sure that if you're observing these behaviors, they're not caused by something else unrelated to ADHD.
Read Resource 14, which contains some other conditions and factors that can cause symptoms of inattention and impulsivity.
BACK TO INDEX
MODULE2H Activity 6: Other causes of problem behavior
Some causes of problem behavior are easier for you to find out about than others. A good place to begin is by thinking about your classroom environment and some of the triggers for behavior that looks like ADHD. Resource 15 describes two situations that are creating problems for two students and their teach
rs. Think about your students. What other potential causes are there for their problem behavior? Are there any particular instances that you feel you have resolved successfully and how did you achieve this result? Note your thoughts in your Student Book (9).
BACK TO INDEX
MODULE2I Task 3: Redefining behaviors
Choose a student who displays the behaviors we've discussed. It could be one you've already observed. Make a list of five possible causes of this behavior, other than ADHD. Note your answers in your Student Book (10). Have another look at the examples in Resource 15 to help you. Don't limit your thinking to "within child" factors – see Resource 16 for some prompts
BACK TO INDEX
MODULE2J There are limits to what you can do
The discovery of a previously undiagnosed medical condition can certainly transform a child's life, but unfortunately there will always be some causes of difficult behaviors which you simply can't treat.
Conditions and relationships in a child's home, for example, are difficult for you to influence. That said, it's often a good idea to meet the child's parents or care taker, as this might shed light on any possible contributory factors in their home.
BACK TO INDEX
MODULE2K Task 4: Using diagnostic tools
There are a number of checklists available which help us to measure the degree of inattention, hyperactivity and impulsivity within a child, and to judge how this compares with the average student.
Resource 17 is a sample checklist for teachers. It's useful because it helps you focus in greater depth on the student's particular areas of difficulty and to select appropriate strategies to help. Print out and work through the teacher's checklist, thinking about one of your students who displays the behaviors characteristic of ADHD. You will probably need to go into school and note your responses soon after seeing the student in question. Keep the checklist somewhere safe as you'll need to return to it later in the course. Then record the behaviors which your chosen student exhibits in your Student Book (11). Note: Module 3 suggests some ideas and strategies for helping ADHD students.
BACK TO INDEX
MODULE2L Activity 7: Profile of selected students
Read back through your Student Book to remind yourself of the profile you've now built up of your selected pupils (from Tasks 2, 3 and 4).
It should include:
- a description of the behaviors you observed
- some ideas for helping inattention
- possible alternative causes of the behaviors
- a completed checklist rating the level of concern about specific behaviors
This profile is helping you to build a picture about whether or not your students are likely to have the underlying characteristics of ADHD. Make notes in your Student Book (12) of any areas in which you feel you should do further observations, or areas you'd like to investigate further, perhaps with other staff or other third party professionals.
BACK TO INDEX
MODULE2M Involving others
Remember that it's not your job to diagnose a child with ADHD. If you're concerned about particular students, you can get help and advice from a support agency outside your school.
A number of agencies may become involved in making a diagnosis of ADHD. You may be familiar with these agencies through their involvement with other pupils in your school. Resource 18 has some examples of the type of people who can get involved.
In the UK, educational psychologists visit schools regularly and are likely to be involved at an earlier stage than other agencies. Referral to an educational psychologist usually takes place after school staff and parents have worked together on strategies to address a child's problems.
The psychologist will want to see your observations of the student, to hear about what you have tried already and to see your records of the outcomes. They may ask you to complete other observation schedules or checklists, and work with you on other strategies.
A review date will be set and at that stage a decision may be made to involve other agencies.
In the UK, a code of practice sets out the process by which students' special educational needs should be identified and addressed. Every school has a special needs coordinator who is responsible for overseeing this process.
Parents of children who display the characteristics of ADHD may have referred their child for specialist help. Perhaps they have approached you or you may have approached them. Either way, it's essential to include and involve parents in all aspects of the child's academic, emotional and social development.
MODULE2N Diagnosis by a multidisciplinary team
In some cases a child's problem behaviors are identified at routine preschool developmental checks. In many cases, however, the teacher is the first to notice that a child is unusually inattentive, impulsive or hyperactive. An assessment process is necessary to provide evidence for these initial feelings.
When other specialists become involved in diagnosis, their first task is to rule out other possible reasons for the child's behavior. They check school records and find out whether school or home environments are stressful. They usually want to observe the child in class and in other settings.
They may give the child tests to see if they have a learning difficulty and whether these difficulties are in all or only certain parts of the school curriculum.
A doctor might look for problems such as emotional disorders, undetectable (petite mal) seizures and poor vision or hearing. A doctor may also look for allergies or nutrition problems like chronic "caffeine highs" that might make the child overly active.
Teachers will also be asked to complete a rating scale about the student's behavior in school and parents to complete a scale about their child's behavior at home and in other situations. Parents will also be encouraged to gather information from other people who know their child well, such as friends and extended family.
MODULE2O The diagnostic process
At the end of the process of assessment, the specialist team compare the information they've gathered with the symptoms and diagnostic criteria (depending which country they are in).
They check:
- which ADHD-like behaviors listed in the criteria the child exhibits how often and in what situations how long the child has been behaving in these ways
- how old the child was when the problems started
- whether the behaviors seriously interfere with the child's friendships, school activities or home life
- whether the child has any other related problems The answers help identify
- whether the child's hyperactivity, impulsivity and inattention are significant and long-standing.
If so, the child may need to be referred for an ADHD diagnosis. Parents and teachers frequently find it helpful to have a diagnosis of ADHD because it helps them understand and support the child more effectively.
It can also help the child understand their own difficulties. It's just another milestone along the road of helping the pupil to succeed in school and in other social situations. For parents, a successful diagnosis can be a relief, as it helps refute any blame they may have faced for their child's behavior.
BACK TO INDEX
MODULE2P What have you learned? Evaluation of your learning from Module 2
Now you have worked through the Activities and Tasks in this module, look again at the intended learning outcomes for Module 2.
By the end of this module you should:
- know the normal stages of attention development
- be able to use some tools to assess ADHD
- understand the role of a multidisciplinary team in diagnosing ADHD
In your Student Book (13) make a note of the extent to which you have achieved the learning intentions for Module 2. Then, e-mail your comments to your instructor.
MODULE 3: Helping children with ADHD succeed in school
MODULE3A Intended learning outcomes for Module 3
By the end of this module you should:
- have learned some classroom strategies to help students with ADHD
- to succeed know how to provide individual help for students
- know some techniques to help students manage their symptoms of ADHD
This module examines ways of helping students with ADHD to be more successful in classrooms and in the school environment in general.
Many of the ideas and strategies are based on general principles of good teaching and behavior management. Some will be relevant outside the school, too, and can be shared with parents and other care takers of children with ADHD.
Over the course of this module, we'll look at the following stages of planning for success with ADHD students:
- creating a positive learning environment
- individual strategies
- helping the student towards self-understanding and self-management
MODULE3C Creating a positive learning environment
Some parts of school life present more of a challenge for ADHD students than their classmates. Typically, this is when they feel vulnerable, whether with classroom conventions, academic work, or social and behavioral norms.
Students with ADHD are used to "failing" and consequently tend to have low self-esteem. If they're put into vulnerable situations where there is a high chance of failure, they're likely to withdraw. Their behavior may appear uncooperative, when in fact, they're trying to protect themselves.
At other times they don't understand the "rules of the game". They're either unsure about what they're meant to do and how they should be doing it, or they've misunderstood and may appear to be deliberately defiant or disruptive.
MODULE3D Task 5: Observing ADHD students in the classroom
Over a period of about ten days, observe students during everyday classroom routines and activities. Make a note of the particular circumstances that create problems for ADHD pupils (or students who exhibit ADHD-like symptoms). When are these students most vulnerable? How does it show? Look for situations that create problems for the student, not situations where the student creates problems.
Print out Resource 19 to note your observations.
Once you've done your observation, choose one of your ADHD students (or one who exhibits symptoms of ADHD) to be the focus of your planning. Ensure that you have the permission of your principal and the student's parents before starting this Task. You can continue the course while you're completing this Task.
MODULE3E Task 6: Strategies to help
Print out and read Resource 20: Classroom strategies and Resource 21: An individual strategy.
Using ideas from the two Resource, plus any of your own, make a plan of action to help address the problematic behaviors of your student. Focus on specific changes you need to make and strategies you need to introduce. You will probably need to carry out further classroom observations to complete this task.
Outline your plan in your Student Book (14), and then put it into practice over the next few weeks. You'll be returning to this page of your Student Book later in the module to adapt and refine your plans.
MODULE3F Self-management techniques
Students with ADHD often need to learn techniques for monitoring and controlling their own attention and behavior.
Read Resource 22. It gives two examples of different strategies for helping students manage their own behavior.
When using an individual plan, it's important to explain it to pupils in language they understand so they know you are trying to help them rather than "punish" them. For example, a teacher may say: "When I need you to get a piece of work finished I will ask you to come and sit at this special work station because we know that sitting here helps you to concentrate. Sometimes I will ask other students to move to a special work station too."
MODULE3G Task 7: Refining your plan
Review the strategies you currently use to help individual students to succeed. Many of these will probably be helpful to a number of your students, not just those with ADHD. To get more ideas, ask your colleagues about the strategies they use.
You may now have some additional ideas to add to the plan you made in Student Book (14). Use the checklist provided in Resource 23 to check that you have covered everything
MODULE3H Leading ADHD students to self-understanding
It's important to help ADHD students understand their problems and what can help them. Asking if they know other people who are similar to them helps them to see that they are not alone. Frequently, students will describe other members of their family who do the same kinds of things.
It's also helpful to get students to reframe their behaviors in positive terms. Instead of regarding all aspects of their behavior as a problem, encourage them to think about times when that behavior is useful. For example, having ADHD means that you are good at noticing things – when might this be an advantage?
Students with ADHD usually have difficulty making and keeping friends because they are so unpredictable. Getting them to think about what makes a good friend is a way of helping them think about what they need to do to be a good friend.
Have resources available to help students learn strategies for managing some of their own difficulties. For example, charts for self-completion to help them manage their time, organize tasks, plan and put things into sequence.
Provide some lists of suggestions to help students to calm themselves down, know when to take "time out: and concentrate when they need to. Resource 24 contains a list of ideas that can help older students start taking responsibility for themselves.
In your Student Book (15), note down a minimum of seven new things you will do to help your students understand and manage their ADHD. You should now have a detailed plan of how you are going to help your current and future ADHD students. Good luck!
MODULE3I Activity 8: Seven things to help pupils understand and manage ADHD
In your Student Book (15), note down a minimum of seven new things you will do to help your students understand and manage their ADHD.
You should now have a detailed plan of how you are going to help your current and future ADHD students.
Good luck!
MODULE3J Task 8 (optional): Treating ADHD: a discussion paper
This optional Task provides you with some extra information on the various issues around treating ADHD – an area of much debate. If you'd like to know more, read Resource 25.
MODULE3KWhat have you learned? Evaluation of your learning from Module 3
Now you have worked through the Activities and Tasks in this module, please look again at the intended learning outcomes for Module 3.
By the end of this module you should:
- have learned some classroom strategies to help students with ADHD to succeed
- know how to provide individual help for pupils
- know some techniques to help students manage their symptoms of ADHD
In your Student Book (16) make a note of the extent to which you have achieved the learning intentions for Module 3. Then, e-mail your comments to your instructor.
BACK TO INDEX
RESOURCES
These are linked in your outline to take you to further reading and any data forms you might need to help you answer questions
Resource 1: Understanding ADHD Inattention
Children with inattention problems:
- fail to pay close attention to detail and can make careless mistakes in school work
- are easily distracted from tasks and do not appear to listen when spoken to
- find it difficult to understand social rules or follow instructions and subsequently
- often fail to carry out what's expected of them often fail in simple activities, making them reluctant to take part again
Impulse control
Children with impulse control problems:
respond to events in their environment without pausing first and reflecting on how they should respond
- act first and think later
- often interrupt others
- blurt out answers before questions
- have been finished have difficulty in waiting their turn
Hyperactivity Children with hyperactivity:
- are unable to sit calmly and still for very long, especially in classrooms and during mealtimes
- may fidget with their hands and feet and squirm in their seats
- may frequently climb and run around
- seem to have endless energy
Resource 2: Combined inattention, impulsivity and hyperactivity
It's easy to see how these three behaviors are interrelated. If a child has a combination of being inattentive, impulsive and hyperactive then you can understand how difficult it must be for him or her to learn within the normal classroom setting. Poor concentration, acting without thinking, and being unable to keep still are not a good combination!
These children need a different approach. Classroom strategies which address these types of behaviors will also benefit the rest of the class, as many of them will quite normally have some of the underlying characteristics of ADHD themselves.
ADHD appears in early infancy and its effects extend through adulthood. The symptoms can have a negative effect on a child's experience of life at home, at school and in the community and society. ADHD creates problems for pupils in coping both with the learning and behavioral requirements of school. If they're not effectively helped to deal with their problems, students with ADHD are at greater risk of difficulties at work, socially and in relationships. According to some research, they may also have problems with solvent and alcohol misuse and may be more likely to become involved in crime (Kewley, 2003).
It's important then, not just from an educational standpoint but also from a future life perspective, that we do all we can to help students with ADHD to reach their full academic potential.
Resource 3: ADHD as a label
At various times, the cause of ADHD has been thought to be neurological, hereditary or genetic – in other words, some kind of "brain problem" was assumed to be the cause. As a result, research began to focus on identifying the source of the problem within the brain and on discovering medical treatments using drugs.
But no hard evidence was found and attempts to identify the precise location of the behavior within the brain have failed (at the time of writing this course). The term "minimal brain damage" – later "minimal brain dysfunction" (MBD) – came to be used to describe children who were hyperactive and unusually inattentive or impulsive.
In the early 1960's, the term "hyperkinetic syndrome" or "hyperactive syndrome" began to be used when hyperactivity was a significant feature of a child's behavior. Where the main problem was poor attention, the term "attention deficit disorder" (ADD) was used.
As children differed in the degrees of poor attention or over-activity that they exhibited, the label of attention deficit disorder with or without hyperactivity came into common use.
The term ADHD became common because the combined symptoms of ADD plus hyperactivity were more frequently brought to the attention of teachers and other professionals. Quietly non-attentive students without hyperactive behaviors are more likely to be overlooked as having a particular learning disorder than those who are also hyperactive.
Within the last two decades the term ADHD – attention deficit hyperactivity disorder – has become the agreed "label".
Resource 4:
Click here to download this resource PDF
Resource 5:
Click here to download this resource PDF
Resource 6: Case studies of labeling behavior
Ben
Ben, aged 10, has more energy than most boys of his age. But then, he's always been extremely active. As a three year old, he was a human tornado, dashing around and disrupting everything in his path. At home, he darted from one activity to the next, leaving a trail of toys behind him. He was reckless and impulsive, often getting into scrapes and not learning from his mistakes, like the time he fell off the same section of a cliff path twice on a family holiday. He ignored warnings about danger from his parents and telling him off had no effect. In the playground, he seemed no more active than the other boys but he was frequently in trouble because of his tendency to overreact. He would, for example, hit playmates for bumping into him. His parents didn't know what to do. Ben's doting grandparents reassured them, "Boys will be boys. Don't worry, he'll grow out of it." But he hasn't yet.
Kelly
At age 15, Kelly still struggles to pay attention and act appropriately. But this has always been hard for her. She often thinks about some of the embarrassing things she has said to people. Like her comment to her aunt, "Your hair dye looks terrible!" She was particularly upset because she really likes her aunt and could see that she had upset her. She just seems to blurt things out before she can stop herself. Throughout elementary school Kelly was quiet and cooperative but often seemed to be daydreaming. She is bright, yet didn't manage to get her work done no matter how hard she tried. In secondary school she frequently gets low grades in tests and exams. Even though she knows most of the answers, she can't seem to keep her mind on the tests. Her parents respond by taking away privileges and scolding, "You're just lazy. You could do better if you only tried." One day, after Kelly had got another set of disappointing results, the teacher found her sobbing, "What's wrong with me?"
Resource 7:
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Resource 8:
Elton Report into discipline in England and Wales – common behaviors
- talking out of turn (e.g., by making remarks, calling out, distracting others by chatting)
- calculated idleness or work avoidance (e.g., delaying start to work set, not having essential books or equipment)
- hindering other students (e.g., by distracting them from work, interfering with equipment or materials)
- making unnecessary (non-verbal) noise (e.g., by scraping chairs, banging objects, moving clumsily) persistently infringing class (or school) rules (e.g., on dress, student behavior)
- getting out of seat without permission
- verbal abuse towards other students (e.g., offensive or insulting remarks)
- cheeky or impertinent remarks or responses
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Resource 10: Effects of neurotransmitter problems in ADHD on four major brain functions
Working memory
Working memory is the capacity to hold information in consciousness over a short period of time. By holding an event in mind it can be processed from short-term into long-term memory. In children with ADHD, where there is a difficulty in inhibiting a response, events are not kept in short-term memory and an "off the cuff" response may be given. People with ADHD tend not to bring previous experiences into their current framework of thinking and are less likely to learn from their mistakes.
Inhibiting behavior
Inhibiting behavior is the ability to delay one's emotional response to a situation, to analyze it and decide on the most appropriate way forward.
Self-directed speech
Students with ADHD do not use self-directed speech as effectively as those without. By not inhibiting their initial reaction, they are less reflective and more impulsive. Difficulties with self-directed speech can cause problems with rule-governed behavior and consideration of all possible solutions to a problem.
Sequencing and verbal fluency
Problems with sequencing and verbal fluency may cause difficulties in communication with others and produce disjointed ideas and behavior patterns. It may also affect the coherence of writing and organization. (Kewley, 1999)
Resource 11: The development of attention
Normal attention span develops in several stages:
Level 1 (0-1 year): Characterized by extreme distractibility. The child's attention flits from one object, person or event to another. Any new event immediately distracts them.
Level 2 (1-2 years): The child can concentrate on a concrete task of their own choosing but will not tolerate any intervention by an adult, whether verbal or visual. The child may appear obstinate or "willful", but they must ignore extraneous stimuli in order to concentrate on what they're doing. Their thinking is "single channeled".
Level 3 (2-3 years): The child's attention is still single channeled and they cannot attend to auditory and visual stimuli from different sources. They cannot listen to an adult's directions while playing, but can shift their whole attention to the speaker and back to the activity with the adult's help.
Level 4 (3-4 years): The child must still alternate their her full attention – visual and auditory – between the speaker and the task, but now does this spontaneously, without help. Level 5 (4-5 years): The child's attention is now two-channeled – they understand verbal instructions related to the task without interrupting an activity to look at the speaker. Their concentration span may still be short but they can be taught in a group.
Level 6 (5-6 years): Auditory, visual and manipulatory channels are fully integrated and attention is well established and sustained. (Reynell, 1977)
Resource 12: Typical ADHD behaviours
- ADHD students are unable to sit still, plan ahead, finish tasks, or be fully aware of what's going on around them.
- They are easily bored, easily distracted by unimportant sights and sounds and frequently jump from one thought or activity to another.
- They are often so wrapped up in their own agenda that they don't notice when someone speaks to them. They seem to exist in a whirlwind of disorganized or frenzied activity.
- On some days and in some situations they seem fine, often leading others to the mistaken conclusion that they can control these behaviors if they choose to. This can be a source of great frustration for adults who work with them. Their frequent failure to achieve goals is frustrating and damaging for their self-esteem.
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Resource 14: Other conditions
- Depression or anxiety can produce disruptive, uncooperative or unresponsive behavior. For example, a formerly cooperative child who becomes quarrelsome and easily distracted after a parent becomes seriously ill, is dealing with an emotional problem, not ADHD.
- Living with family members who are physically abusive, or addicted to drugs or alcohol, creates a climate of fear and uncertainty and reduces a child's ability to pay attention in school. These children are showing the effects of environmental problems not ADHD.
- Petit mal seizures will cause attention lapses.
- A chronic middle ear infection and consequent poor hearing can make a child seem distracted and uncooperative.
- In some children, ADHD-like behaviors may be a child's response to a defeating classroom situation.
- A generally chaotic classroom environment with poor management will reduce children's capacity to attend to information and remain on task.
- A child may have a learning disability and not be developmentally ready for the set work.
- Or maybe the work is too hard or too easy, leaving the child frustrated or bored. Other conditions such as conduct disorder, oppositional defiant disorder, dyslexia, dyspraxia, Asperger's Syndrome, and speech and language difficulties need to be considered
Resource 15: Paul and Jodie
For months, Paul shouted answers out in class, then became disruptive when the teacher ignored him. He certainly seemed hyperactive and impulsive. Finally, after observing Paul in other situations, his teacher realized he just wanted approval for knowing the right answer. She began to seek opportunities to ask him for answers before he could shout out, and then to praise him. Gradually, Paul became calmer and more cooperative and behaved appropriately in class. His teacher noticed, however, that he was still behaving impulsively with adults in other situations. She shared her strategy with them and Paul began to succeed in other areas of the school day.
Jodie always seemed to be noisy and disruptive when the class needed to settle down to work. Focusing on this problem, her teacher realized that this behavior actually occurred during reading tasks. She carried out an assessment of Jodie's reading skills and found that her reading book and general level of reading tasks were too difficult for her. Jodie was placed in a group where the books and tasks were easier and where she could successfully participate in the lesson. Her disruptive behavior stopped
Resource 16: Within child and environmental factors
"Within child" factors include:
- hearing
- eyesight
- general health
- learning skills
- learning style
- early experience
Environmental factors include:
- classroom situation – e.g., proximity to distractions
- relationships with others – e.g., falling out with friends
- home environment – e.g., family members with drug or alcohol problems
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Resource 18: Other agencies involved
At a later stage in the diagnostic process it may be necessary to work with a specialist service to assess a child. The people who can be involved in this include:
- educational
- psychologists
- community
- pediatricians
- clinical
- psychologists
- child psychiatrists
- specialist behavior
- support teachers
- health visitors
- social workers
- therapeutic counselors
Resource 19
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Resource 20
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Resource 21: An individual strategy
Diary keeping Students with ADHD frequently arrive home without a clear idea, or a clear note, of what they should be doing for homework or taking to school the following day. This creates a great deal of stress and anxiety for all and is very de-motivating for students. One way of managing this is to develop a routine of using a daily diary or notebook, linked to an individual education plan (IEP). A diary system not only helps pupils to succeed at being prepared for tasks and activities, it also helps with everyday communications such as sending messages home about a pupil's successes. With heavy demands within a school day or teaching period it often feels like one task too many for teachers to spend time checking that pupils have accurately recorded homework or notes for other activities. However, in the long term this pays off through not having to spend time unraveling problems or chasing up assignments. Asking a student to re-read their notes and explain the task to you is a good strategy. Sign the diary when you receive homework and get parents to sign to indicate that they have read the diary. In terms of relationships and emotional well-being, it helps the student to feel supported, confident about asking for help and much more positive about school.
Resource 22: James and Monique
James' teacher has taught him several alternative strategies for when he loses track of what he's supposed to do. He can look for instructions on the blackboard, raise his hand, wait to see if he remembers or quietly ask another child. The process of finding alternatives to interrupting the teacher has made him more self-sufficient and cooperative. And because he now interrupts less, he is beginning to get more praise than reprimands.
In Monique's class, the teacher frequently stops to ask students to notice whether they are paying attention to the lesson or if they are thinking about something else. The students record their answer on a chart. As they become more consciously aware of their attention, they begin to see progress and feel good about staying focused. The process helped make Monique aware of when she was drifting off, so she could return her attention to the lesson faster. As a result, she became more productive and the quality of her work improved.
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Resource 24: Ideas for older students
- When necessary, ask the teacher to repeat instructions rather than guess.
- Break large assignments or job tasks into small, simple tasks.
- Set a deadline for each task and reward yourself as you complete each one.
- Each day, make a list of what you need to do. Plan the best order for doing each task.
- Then make a schedule for doing them. Use a calendar or daily planner to keep yourself on track.
- Work in a quiet area.
- Do one thing at a time. Give yourself short breaks.
- Write things you need to remember in a notebook with dividers.
- Write different kinds of information in different sections.
- Keep the book with you all of the time.
- Post notes to yourself to help remind you of things you need to do.
- Tape notes on your locker, in your school bag or wherever you're likely to need the reminder Create a routine.
- Get yourself ready for school at the same time, in the same way, every day.
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REFERENCE LINKS
Name:National Society for the Prevention of Cruelty to Children (NSPCC)
Description:This site provides help and advice to teachers and others faced with issues of child abuse.
URL: http://www.nspcc.org.uk
Name:Kidscape
Description:A site for parents, teachers and children that deals with various issues.
URL: https://www.kidscape.org.uk
Name: NAEYC for Families
Description: This site is affiliatied with the National Association for the Education of Young Children
URL: https://families.naeyc.org
BIBLIOGRAPHY
Sites the source of resources and information
Author: Canter, L and Canter, M
Title: Assertive Discipline: Positive Behavior Management for Today's Classroom (2002)
Publisher: Canter Lee & Associates
ISBN: 1572710357
Author: Cooper, P and Ideus, K
Title: A Practical Guide for Teachers (2002)
Publisher: David Fulton
ISBN: 1853467316
Author: Cooper, P and O'Regan, F
Title: Educating Children with AD/HD (2001)
Publisher: Routledge Falmer Press
ISBN: 0415213878
Author: Green, C and Chee, K
Title: Understanding ADHD (1997)
Publisher: Vermilion
ISBN: 0868247456
Author: Kewley, GD
Title: ADHD Recognition, Resolution and Reality (2002)
Publisher: Australia
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