ADHD In the classroom: Strategies for success

ADHD In the classroom: Strategies for success

ADHD IN THE CLASSROOM: STRATEGIES FOR SUCCESS MEGAN BOLCH, PHD LICENSED PSYCHOLOGIST, PEDIATRIC CARE SPECIALISTS, P.A. GOALS OF PRESENTATION

Provide an overview of ADHD Symptomatology Subtypes Causes Treatment Highlight educational strategies that can allow children with ADHD to utilize their strengths and allow for a successful and inclusive

academic environment WHAT IS ADHD? Common Behavioral condition 11% of school-aged children (Visser, 2014) Found universally Symptoms continue into adulthood in more than 75% of cases (Brown, 2013) Characterized by developmentally inappropriate levels of inattention,

hyperactivity, and impulsivity Symptoms must be present before the age of 12 (DSM-V) ADD vs. ADHD COMORBIDITY More than 2/3 of children with ADHD have at least one other co-existing condition (CHADD) Most common:

ODD/Conduct Anxiety Depression Tic Disorders Learning Disabilities Sleep Issues (up to 85% of children with ADHD; (Howard, Campbell, and Allan, 2012) ADHD: SUBTYPES

Predominately inattentive Predominately hyperactive/impulsive Combined presentation Children should have 6 or more of symptoms to meet criteria (17 or older, 5 symptoms) ADHD IN A NUTSHELL

ADHD: INATTENTIVE TYPE (30-40%) Fails to give close attention to details or makes careless mistakes Difficulty sustaining attention Does not seem to listen when spoken to directly Does not follow thru on instructions Difficulty organizing tasks or activities Avoids or dislikes tasks that require sustained mental effort Often loses things

Easily distracted Forgetful in daily activities ADHD: HYPERACTIVE-IMPULSIVE TYPE (10%) Often fidgets or squirms Difficulty remaining seated Runs about or climbs in situations; Restlessness in adults Difficulty engaging in activities quietly

Often on the go or acts as if driven by a motor Talks excessively Blurts out before questions have been completed Difficulty waiting or taking turns Often interrupts or intrudes upon others ADHD-COMBINED TYPE (50-60%) Criteria met for both inattentive and hyperactive-impulsive symptoms

Consider it a disorder of executive functioning (EFHD); its not just attention 1. ANALYZE a task 2. PLAN how to attack the task 3. ORGANIZE the steps 4. DEVELOP timelines to complete the task 5. ADJUST if needed 6. COMPLETE the task in a timely manner

WHAT IS THE CAUSE? ADHD: CAUSES Strong genetic link (Heritability of .75) The MOST genetically determined psychological trait (Height=.91) Brain-based disorder (prefrontal cortex and basal ganglia) Multiple interacting genes (Cortese, 2012)

Delayed brain maturation (smaller brain structures) Some nongenetic links include: Prematurity Maternal alcohol and tobacco use High levels of lead exposure DELAYED BRAIN GROWTH IN ADHD (2-3 YEARS)

ADHD IS NOT CAUSED BY: Sugar Too much TV Family stress (but ADHD can contribute to it!) Trauma Parenting style (certain types may make it worse)

UNDER OR OVERDIAGNOSED? The answer is probably both! Greater bias with hyperactive young boys Missing inattentive girls 7 minutes with a pediatrician is not enough! Highlight need for comprehensive testing with multiple informants (teachers, parents, child depending on their age, etc) and testing tools

Ruling out alternative causes for behavior ADHD TREATMENT Comprehensive approach Parent and child education about ADHD Behavioral management strategies/behavioral therapy Medication (if necessary) Educational strategies

Even if Catholic schools exempt from IDEA, ADA, and portions of Section 504, request a plan of reasonable accommodations ADHD: CLASSROOM STRATEGIES FOR SUCCESS Megan Bolch, PhD BASICS OF BEHAVIORAL MANAGEMENT

Focus on immediate, short-term feedback and rewards Touch more, talk less! You will gain more with carrots than sticks! Goal is to reinforce prosocial behaviors 5 times more than disciplining inappropriate behaviors (Avoid too many corrective comments) Personalize the rewards and the consequences to the child

BASICS OF BEHAVIORAL MANAGEMENT Describe the desired behavior or what you want to see (e.g., Sit criss cross applesauce, Take out your book and pencil, etc). Rule of thumb to remember: Behavior + Attention = More Behavior Best teaching tool is simple: Describe and Praise!

PROVIDE STRUCTURE GENERAL ADHD ACCOMMODATIONS Preferential seating near the teacher or front of the class Pair them with a good role model or buddy Extended time for tests or alternate setting with fewer distractions Directions one at a time Agenda coach to ensure that they have necessary items and review the planner/homework

folder and sign off on it Breaking down assignments into smaller parts Modifications in work, if necessary Additional checks for accuracy on completed work (CHECK: Complete?, Have name?, Errors?, Can it be read?, OK to turn in?) VISUALS, VISUALS, AND MORE VISUALS Post classroom rules and expectations- must be oral and visual!

Simple post-it notes for expected behaviors or to provide reminders can go a long way STOP Sign for young kids (Barkley, 2008) (red zone = lecture, yellow= desk work, green= free time) STAR (STOP, THINK, ACT and REVIEW) for any age Use timers or visuals for transitions (example: blocks or other trinkets that show how long is left before a transition occurs)

CLOCKS OR A TIMER MAY NOT WORK. DAILY REPORT CARD Can utilize both a Daily Home and Daily School Report Card Allows for communication with the parents Target the major behaviors that the child is having most difficulty with and frame it positively (Examples: Keeping hands to him or herself, working quietly, accepting feedback)

Consider parents ONLY rewarding for a good day (unless major offense) May use a token or ticket system DAILY REPORT CARD DAILY REPORT CARD

DAILY BEHAVIOR REPORT CARD ALLOW FOR SELF-MONITORING Children with ADHD lack awareness into some of their behaviors Provide modeling and practice at awareness by self-monitoring Let them be a part of their plan and even rate themselves! BE CREATIVE WITH REWARDS AND CHANGE

THEM OFTEN! Teachers helper Play teacher Eat lunch outside Messenger to the office

Lunch with teacher Grade papers Line leader Use computer

Student of the Day Take a note to the office Prize box Choose a game

Special note home Extra recess time MANAGING IMPULSIVE OR HYPERACTIVE BEHAVIORS Secret Signal for blurting

Let them stand or move! Give them a jobthey may like to be the runner or messenger Provide opportunities for restlessness and fidgety behavior Brain breaks Exercise balls or alternate seating Dont take away recess! Allow a space in the classroom to calm.for everyone!

STAR (STOP, THINK, ACT AND REVIEW) TEACH THEM TO COPE IN THE CLASSROOM Integrate deep breathing into brain breaks or counselor lessons Use a visual like stuffed animal to teach belly breathing Consider mindfulness or meditation as a calming tool

Use technology (Stop, Think and Breathe app, Headspace app) Model your own ability to cope TACKLE THE HARDEST TASKS EARLY! Poor vigilance over time Prioritize tasks- Hard, Easy, and Middle Tackle the hardest task first!

Can reinforce then with a easier task after BEHAVIORAL MOMENTUM Ask the child to complete several high probability behaviors first and then request a lower probability behavior to be completed

OTHER TIPS Use participatory teaching methods (Let the child be actively involved in teaching some lessons) or peer tutoring Touch when praising, reprimanding or instructing Have them repeat instructions back to you Children with ADHD require more forms of external motivation; cues, prompts, rewards or consequences Noisemaking may be a sign of their brain working or self-stimulation;

telling them to be quiet isnt always the answer USE THEIR GIFTS AND STRENGTHS HELP THEM FIND THEIR NICHE! Help cultivate their strengths and allow the opportunity to use these in action Art

Computers Sports Music Share stories of celebrities or other successful individuals who have ADHD USE THEIR GIFTS AND STRENGTHS

BOOKS/WEBSITES/RESOURCES TO CHECK OUT American Academy for Pediatrics (AAP) Clinical practice guidelines CHADD website and local support group (ADHDKC.org) NICHQ ADHD Toolkit ADAPT Teacher Planbook (Parker, 1992) Russell Barkley (articles and books); Taking Charge of ADHD

ADHD: A CASE STUDY 9 year old, 4th grade Caucasian girl presenting in office who lives with supportive parents and attends Catholic school in suburban setting History of distractibility/poor focus and poor ability to regulate her emotions with frequent outbursts as well as impulsivity (e.g., blurting, poor social boundaries) Avoidance issues and frustration with homework with comments such as I cant do this; Homework can take up to 3 hours to get through

Tested for Learning Disabilities at the age of 7 due to reading and general processing difficulties Testing noted some dyslexic tendencies but diagnosed with ADHD, Inattentive Type Tried on several medications for ADHD but not tolerated side effects Recent bullying episodes that have culminated in parents considering transfer to public school ADHD: A CASE STUDY What classroom strategies might help this child find more success? How can we help her feel like she belongs in this school

environment? What other ways can her parents support her needs at home? Is there anything we should pay attention to that might be an important (but overlooked) factor? INCLUSION OR BELONGING Swintons view: The problem we have as a society is a real emphasis- and a quite right emphasis- on inclusion. I think at one level thats fine. However, inclusion is

simply not enough. To include people in society is just to have them there. There is a big difference between inclusion and belonging. To belong, you have to be missed. Theres something really, really important about that. People need to long for you, to want you to be there. When youre not there, they should go looking for you. In order to integrate people with disabilities, you simply have to create a space where they can be there. Make sure you have large-print music, ramps, etc. These are important. Belonging should be the goal of all communities. Particularly religious communities. And its not just for people of disabilities.its for all of us.

INCLUSION WORKS!

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