ADHD

Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder is a disorder that includes a persistent pattern of inattention and/or hyperactivity-impulsivity in a person. There are three subtypes of ADHD including: ADHD Predominantly Inattentive Type, ADHD Predominantly Hyperactive-Impulsive Type, and ADHD Combined Type.It is important to know that ADHD is a neurological disability and people with this disorder have underdeveloped frontal lobes in the brain. This region of the brain that is underdeveloped is responsible for planning, impulse control, attention, reasoning, and working memory.

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most talked about yet misunderstood disabilities in the schools. It is estimated that 3-5% of children truly have one form of ADHD, yet some schools have a much greater percentage with an ADHD diagnosis.

Some students identified with ADHD have been misidentified. There are several reasons that a student may be identified ADHD, but do not actually have this disorder. It is often the first response a teacher might have to a student who misbehaves. A lack of discipline can exasperate behaviors that look like ADHD. A slow learner might not be paying attention due to content over his or her head. A gifted student may be inattentive, because the material is too easy and the student may already understand a concept and not want to listen to the teacher explain it again. It is difficult to differentiate these other factors between ADHD.  Someone who is anxious or depressed can also look inattentive.  Several things should be ruled out before a diagnosis is made.

Is it ADHD?


ADHD: Predominantly Inattentive Type
(Sometimes referred to as ADD)

For a diagnosis of ADHD, Inattentive Type, the following criteria met be met:

  1. Student must have 6 or more of the following criteria to a significant degree for at least 6 months (possible examples with each).
      • Student does not give close attention to details and frequently makes careless mistakes.
        • Grades suffer due to not watching the signs in math.
        • Student regularly completes the wrong assignment.
      • Student struggles with maintaining attention in tasks or play activities.
        • Child needs reminded it is her turn in the game almost every turn.
        • Child starts playing with something and suddenly abandons the first activity to begin something new.
      • Often, student does not seem to listen when spoken to directly.
        • Child may have a blank look on his face or fidgeting with something while directions are being given.
        • When asked a question, he routinely says “what?”
      • The student will often not follow through on instructions or fails to finish schoolwork, chores, or duties. (This is not due to oppositional behavior or failure to understand directions).
        • Child starts an assignment, gets distracted, and forgets to finish.
        • Half of the dishes have been washed.
      • Student often loses things necessary for tasks or activities.
        • Student often needs to borrow pencil or paper from other students.
        • Child leaves the book needed to complete a homework assignment at school.
      • Student has difficulty with organization of tasks and activities.
        • Time management may be a concern.
        • Student rarely knows exactly when assignments are due or what exactly needs to be done.
      • Student is easily distracted by stimuli in the environment.
        • Child does not listen to teacher when she is near a noisy fan.
        • Pictures on the wall may pull his attention away from the teacher.
    • Student is often forgetful in daily activities.
      • Child accidentally leaves homework at home on a regular basis.
      • The student’s backpack is missing and she does not know if she left it at school, the bus, or her friend’s house.
  2. The symptoms that cause impairment must have been present before age 7.
  3. The impairment must be seen in 2 or more settings (ex. home and school).
  4. There must be clear evidence of clinically significant impairment in social academic or occupational functioning.


ADHD: Predominantly Hyperactive-Impulsive Type
  1. For a diagnosis of ADHD, Hyperactive-Impulsive Type, the student must have 6 or more of the following criteria to a significant degree for at least 6 months:
      • Student often fidgets with hands or feet or tends to squirm in seat.
        • Student sits on feet and changes positions frequently while seated.
        • Student often has a paperclip or some random item in his hand.
      • Student often leaves seat in which remaining seated is expected.
        • Student walks to the other side of the classroom to tell a student something.
        • Student sharpens pencil frequently.
      • Student often runs about or climbs excessively in situations in which it is inappropriate.
        • Parents have difficulty keeping child from running through aisles while shopping.
        • People comment about the child being “hyper.”
      • Student often has difficulty playing or engaging in leisure activities quietly.
        • Even board games are not a quiet activity for the child.
        • Child tells stories during movies.
      • Student is often “on the go” or often acts as if “driven by a motor.”
        • Child plays constantly and goes from one activity to another.
        • Child does not engage in down time frequently.
      • Student often talks excessively.
        • One story reminds her of another story and then another . . .
        • Other people often don’t have a chance to respond before the subject has been switched.
      • Student often blurts out answers before questions have been completed.
        • Student does not raise her hand in class.
        • Student answers a wrong question.
      • Student often has difficulty awaiting turn.
        • Student will play before his turn in a game.
        • Child talks out of turn.
    • Student often interrupts or intrudes on others.
      • Child butts into conversations when adults are talking.
      • Child interrupts parents on the phone.
  2. The symptoms that cause impairment must have been present before age 7.
  3. The impairment must be seen in 2 or more settings (ex. home and school).
  4. There must be clear evidence of clinically significant impairment in social academic or occupational functioning.


ADHD: Combined Type

For a diagnosis of ADHD, Combined Type, the student must have met criteria for both types of ADHD for at least 6 months.


Tools used to help diagnose ADHD

A psychologist, psychiatrist, or medical doctor can diagnose ADHD. A psychologist or psychiatrist can easily rule out other learning problems, where a medical doctor can rule out other medical conditions. Communication between professionals and a thorough evaluation is essential.

  • Review of available information.
      • Educational Data – look for grades, discipline records, attendance (It is important to look for teacher comments or other records that indicate a consistent pattern of problems from the early grades that have continued.)
      • Educational testing data – cognitive and academic assessments are important to rule out a learning disability or other learning problems.
      • Medical records to ensure the problems are not related to another medical disorder.
  • Diagnostic Tools (See SPED testingfor more complete information)
      • Clinical Interview – A professional will discuss the symptoms with the parent or the student and ask questions related to the DSM-IV criteria.
      • Rating Scales – A rating scale will often be provided to parents, teachers, and the students to obtain information from multiple sources. The scales may be specific to ADHD or be a global rating scale that can focus on a wide range of problems. These scales are useful because they help to quantify the degree of the problem by comparing the student’s symptoms to other children of the same age and gender.
      • Observation – Watching the child in her natural environment can help a professional see if she is displaying characteristics associated with ADHD. This usually occurs in the classroom, but it is good to see a child across settings and in less structured events such as recess or lunch.
    • Continuous Performance Assessment – This a test given to a student that is designed to be boring. They watch a screen and push a button when they see a dot. It measures attention over periods of time and impulse control.


Treatment

ADHD is a neurological disorder, but with proper treatments and parenting techniques the symptoms can be more manageable.

Treatment is usually the most successful when multiple treatments are utilized across different settings. These Include:

  • Structured classroom management
  • Educating parents with a focus on appropriate discipline and limit-setting
  • Tutoring
  • Behavioral therapy for the child
  • Stimulant medication – Concerta, Ritalin, Adderall, Dexedrine (used to stimulate the frontal lobes in the brain to make them work more efficiently)


Online Resources
    • www.4-adhd.com – Resources for Parents of Children and Teens with ADHD / ADD.


References

American Psychological Association (2000) Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition (Text Revision) – American Psychiatric Publishing


 

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