Microsoft PowerPoint - ATTENTION DEFICIT HYPERACTIVITY DISOR.pdf
- 1. ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) DR. LEONARDO B. DORADO, Ph.D
- 2. Facts about ADHD • Approximately 5 to 9 percent of school - age children in the United States have attention deceit disorders. • Data from a 2006 study in the Philippines • Data from a 2006 study in the Philippines indicate a four-percent (4%) incidence (that’s more than three million!) assuming at that time the population was at 84 million (Philippine Daily Inquirer, Posted November 19, 2008).
- 3. • Every classroom teacher most likely has at least one or two students with ADHD in his or her classroom each year, and these educators need to understand the nature of the disorder, as well as the most effective strategies for reaching and teaching these students. reaching and teaching these students. • It is often not easy to live with or teach a child who has ADHD. The better we understand this disorder, the more tolerant, empathetic, and empowered we all will be to help.
- 4. What causes ADHD? • Research also reveals that there are several things happening in the brain of the ADHD child which cause the disorder. • The primary problem, however is that certain parts of the central nervous system are under- stimulated, while others may be over-stimulated. stimulated, while others may be over-stimulated. Tests show that some hyperactive kids have an uneven flow of blood in the brain - with some parts getting too much blood flow, and other centers not getting as much. Medications and other forms of treatment can be used to address these problems.
- 5. • They believe that some people with ADHD do not have enough chemicals called neurotransmitters in their brain. These chemicals help the brain brain. These chemicals help the brain control behavior (Manila Bulletin Publishing Corp., 2010).
- 6. WHAT IS THE AD/HD? • AD/HD stands for Attention Deficit/Hyperactivity Disorder. • This is the current and official term that is used when referring to this disorder, and it is the umbrella term for the three types of AD/HD: 1. the Predominantly Inattentive type (AD/HD – I); 2. the Predominantly Hyperactive and Impulsive type (AD/HD - HI); 3. and the Combined type (AD/HD - C).
- 7. • Most people diagnosed with ADHD have the combined type of the disorder with significant symptoms in inattention, impulsivity, and hyperactivity. hyperactivity.
- 8. RISK FACTORS ASSOCIATED WITH ADHD • More serious accidents, hospitalizations, and significantly higher medical costs • More school failure and dropout • More delinquency and altercations with the law • More engagement in antisocial activities • More teen pregnancy and sexually transmitted diseases • More teen pregnancy and sexually transmitted diseases • Earlier experimentation with and higher use of alcohol, tobacco, • and illicit drugs • More trouble socially and emotionally • More rejection, ridicule, and punishment • More underachievement and underperformance at school or work
- 9. Prevalence of ADHD • Estimates of the prevalence in school - age children range from 3 percent to 12 percent. Most sources agree that somewhere between 5 and 9 percent of children are affected. • Approximately 2 to 4 percent of adults are believed to have ADHD. • The worldwide prevalence of ADHD in children is • The worldwide prevalence of ADHD in children is estimated at approximately 5 percent. The U.S. prevalence rate falls somewhere in the middle range of other reporting countries. • Although this disorder can have serious negative outcomes affecting millions of people when untreated, it is estimated that at least half of the children with ADHD are not receiving treatment, and far more adults remain unidentified and untreated.
- 10. More Statistics Associated with ADHD • Between 50 and 75 percent of individuals with ADHD have at least one other disorder or coexisting condition such as anxiety, depression, oppositional defiant disorder, depression, oppositional defiant disorder, learning disabilities, or speech and language impairments.
- 11. • Barkley (2000), a leading researcher in the field, cites these statistics: • Almost 35 percent of children with ADHD quit school before completion. • Up to 58 percent have failed at least one grade in school. • At least three times as many teens with ADHD as those without ADHD have failed a grade, been suspended, or been expelled from school. been expelled from school. • For at least half of the children with ADHD, social relationships are seriously impaired. • Within their first two years of independent driving, adolescents with a diagnosis of ADHD have nearly four times as many auto accidents and three times as many citations for speeding as young drivers without ADHD (Barkley & Murphy, 1996).
- 12. BEHAVIORAL CHARACTERISTICS OF ADHD • Easily distracted by extraneous stimuli (for example, sights, sounds, movement in the environment) • Does not seem to listen when spoken to directly • Difficulty remembering and following directions • Difficulty sustaining attention in tasks and play activities • Difficulty sustaining level of alertness to tasks that are tedious, • Difficulty sustaining level of alertness to tasks that are tedious, perceived as boring, or not of one’s choosing • Forgetful in daily activities • Does not follow through on instructions and fails to finish school-work, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions) • Tunes out; may appear “spacey “ • Daydreams (thoughts are elsewhere)
- 13. Predominantly Inattentive Type of ADHD • This type of ADHD is what many prefer to call ADD because those diagnosed with it do not have the hyperactive symptoms. They may show some, but not a significant amount of symptoms in the hyperactive - impulsivity category. • These children and teens often slip through the cracks and are not as easily identified or understood. Since they do not exhibit the disruptive behaviors that command not exhibit the disruptive behaviors that command attention, it is easy to overlook these students and misinterpret their behaviors and symptoms as Not trying or being lazy. • Most people display any of the following behaviors at times and in different situations to a certain degree. Those who truly have an attention deficit disorder have a history of frequently exhibiting many of these behaviors far above the normal range developmentally.
- 14. • They are pervasive symptoms, exhibited in different settings and environments, and they cause impairment in functioning at school, at home, and in other settings. • Many children with ADHD and significant • Many children with ADHD and significant difficulties with inattention are often able to be focused and sustain attention for long periods of time when they play video games or are engaged in other high - interest, stimulating, and rapidly changing activities.
- 15. CHARACTERISTICS AND SYMPTOMS OF INATTENTION • Appears confused • Easily overwhelmed • Difficulty initiating or getting started on tasks • Does not complete work, resulting in many incomplete assignments assignments • Avoids, dislikes, or is reluctant to engage in tasks requiring sustained mental effort such as schoolwork or homework • Difficulty working independently; needs a high degree of refocusing attention to task • Gets bored easily • Sluggish or lethargic (may fall asleep easily in class)
- 16. • Fails to pay attention to details and makes many careless mistakes (for example, with math computation, spelling, and written mechanics such as capitalization and punctuation) • Poor study skills • Inconsistent performance; one day is able to • Inconsistent performance; one day is able to perform a task and the next day cannot; the student is “consistently inconsistent “ • Loses things necessary for tasks or activities (for example, toys, school assignments, pencils, books, or tools)
- 17. ACADEMIC DIFFICULTIES RELATED TO INATTENTION • Reading 1. Loses his or her place when reading 2. Cannot stay focused on what he or she is reading (especially if the text is difficult, lengthy, boring, or not of his or her choice reading material), resulting in missing words, details, and spotty comprehension • Writing • Writing 1. Off topic as a result of losing train of thought 2. Poor spelling, use of capitalization and punctuation, and other mechanics and a poor ability to edit written work as a result of inattention to these details • Math 1. Numerous computational errors because of inattention to operational signs (plus, minus, multiplication, division), decimal points, and so forth 2. Poor problem solving due to inability to sustain the focus to complete all steps of the problem with accuracy
- 18. Predominantly Hyperactive - Impulsive Type of ADHD • Individuals with this type of ADHD have a signifi cant number of hyperactive - impulsive symptoms; they may have some but not a signifi cant number of inattentive symptoms considered developmentallyinappropriate. developmentallyinappropriate. • This type of ADHD is most commonly diagnosed in early childhood, and many of those receiving this diagnosis will be reclassified as having the combined type of ADHD when they get older and the inattentive symptoms become developmentally significant.
- 19. • Children and teens with ADHD may exhibit many of the characteristics in the lists that follow. Although each of these behaviors is normal in children at different ages to a certain degree, for those with ADHD, the behaviors far exceed that which is normal developmentally (in frequency, level, and intensity). Again, the behaviors written in italics are those listed in the DSM – IV and DSM – IV - TR. – IV - TR. • Most children, teens, and adults with ADHD have the combined type of the disorder. That means they have a significant number of inattention, impulsive, and hyperactive symptoms that are chronic and developmentally inappropriate, evident from an early age, and are impairing evident from an early age and are impairing their functioning in at least two environments (such as home and school).
- 20. CHARACTERISTICS AND SYMPTOMS OF HYPERACTIVITY • “On the go ” or acts as if “ driven by a motor “ • Leaves seat in classroom or in other situations in which remaining seated is expected • Cannot sit still (instead, jumps up and out of chair, falls out of chair, sits on knees, or stands by desk) • Cannot sit still (instead, jumps up and out of chair, falls out of chair, sits on knees, or stands by desk) • Talks excessively • Highly energetic; almost nonstop motion • Runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
- 21. • A high degree of unnecessary movement (pacing, tapping feet, drumming fingers) • Restlessness • Seems to need something in hands; finds or reaches for nearby objects to play with or put in mouth • Is not where he or she is supposed to be (for example, roam around) roam around) • Difficulty playing or engaging in leisure activities quietly • Intrudes in other people’s space; difficulty staying within own boundaries • Difficulty settling down or calming self • Overall difficulty regulating motor activity
- 22. CHARACTERISTICS AND SYMPTOMS OF IMPULSIVITY • Much difficulty in situations requiring waiting patiently • Difficulty with raising hand and waiting to be called on • Interrupts or intrudes on others (for example, butts into conversations or games) • Has difficulty waiting for his or her turn in games and activities activities • Cannot wait or delay gratification; wants things immediately • Knows the rules and consequences but repeatedly makes the same errors or infractions of rules • Gets in trouble because he or she cannot stop and think before acting (responds first, thinks later) • Difficulty standing in lines • Makes inappropriate noises
- 23. •Does not think or worry about consequences, so tends to be fearless or gravitate to high - risk behavior •Accident prone and breaks things •Difficulty inhibiting what he or she says, making tactless comments; says whatever pops into his or her head and talks back to authority figures •Begins tasks without waiting for directions (before listening to the full direction or taking the time to read listening to the full direction or taking the time to read written directions) •Hurries through tasks, particularly boring ones, to get finished, and consequently makes numerous careless errors •Gets easily bored and impatient •Does not take time to correct or edit work
- 24. OTHER COMMON CHARACTERISTICS IN CHILDREN AND TEENS WITH ADHD • Disorganized, frequently misplaces or loses belongings; desks, backpacks, lockers, and rooms extremely messy and chaotic • Little or no awareness of time; often underestimates length of time a task will require to complete • Procrastinates • Procrastinates • A high degree of emotionality (for example, temper outbursts, quick to anger, gets upset, irritable, moody) • Easily frustrated • Overly reactive • Difficulty with transitions and changes in routine or activity • Displays aggressive behavior
- 25. •Difficult to discipline •Cannot work for long - term goals or payoffs •Low self - esteem •Poor handwriting, fi ne motor skills, written expression, and output getting their ideas down on paper and amount of work produced •Overly sensitive to sounds and other stimuli in the environment environment •Motivational difficulties •Receives a lot of negative attention and interaction from peers and adults •Learning and school performance difficulties; not achieving or performing to level that is expected given his or her apparent ability
- 26. Academic Strategies for Home and School READING STRATEGIES AND INTERVENTIONS •These strategies should be taught and modeled in order to encourage the child to think about and interact with the reading material. This is crucial for comprehension and maintaining focus on the text. •Teach the student how to paraphrase a paragraph or section, putting into his or her own words the main idea and significant details. •Paraphrasing and stating it into a recorder is a helpful technique. •Give a few stopping points at strategic locations throughout the text for readers to interact with the material in some manner: to stop and question, •Give a few stopping points at strategic locations throughout the text for readers to interact with the material in some manner: to stop and question, react to, discuss, summarize, predict, clarify, or record. •Teach the student how to find and pay attention to the introductory and summary paragraphs, how to find the subject and main ideas, and how to sift out the key facts and important details from the irrelevant and redundant words and text. •Provide a pad of sticky notes. Encourage students to jot down notes, unfamiliar words to clarify, and questions by items they do not understand as they read. They can place the sticky note next to key points and main ideas for fast reference.
- 27. •Teach story mapping: identifying the setting (time and place), characters, conflicts and problems, action and events, climax, and resolution of conflicts. •Help children learn to self - monitor their own comprehension by asking themselves questions while reading: What is the problem or conflict? What might the character do to resolve the problem? Why did she say that? What was the main point of this section? Did I understand this? What were the steps for this procedure? What part does not make sense? Questioning and self - questioning keep readers actively thinking about and processing the material. •Teach and model strategies for resolving difficulties when comprehension breaks down: slowing the pace, going back and rereading, reading ahead to breaks down: slowing the pace, going back and rereading, reading ahead to see if their questions are clarified later, talking with someone about their confusion, or jotting down questions to check later. •Students who have trouble maintaining their attention when reading silently can go to a quiet corner and read to themselves aloud. Whisper - reading also helps. Consider providing a whisper phone for this purpose: a curved, hollow plastic tube that the child holds like a telephone. •When whisper-reading into it, the child clearly hears his or her voice without disturbing others. •Whisper phones can also be constructed with two elbow-shaped PVC pipes.
- 28. •Encourage the student to set mini - goals in pacing his or her reading, such as reading a specified number of pages or reading to a certain point in the text before taking a break. • For children who have trouble staying visually focused on the text and lose their place while reading, try using some form of marker such as a strip of cardboard or a boxed frame with a piece of colored transparent paper inside to place on the book. • Teach clustering, webbing, and mapping to pull out the main idea and supporting details from the text. • Photocopy chapter pages, and have the child color – highlight important information directly on those pages; they can use one color for key vocabulary and definitions, another for topic sentences and main ideas, and so forth. and definitions, another for topic sentences and main ideas, and so forth. • Provide study guides to aid in looking for key information in the text. • Make or obtain an audio recording of books for individual or group listening at a listening post. While listening to the recording, the child should be following along in the text. •Use any of the instructional strategies involving collaborative reading and analysis of the material, such as reciprocal teaching, book clubs, and buddy or partner reading. Learning and recall are greatly enhanced by the act of talking about the text. These and other such techniques are described in detail in my other books.
- 29. •These strategies involve the reader in deeper thinking and exploration of the reading material. • After reading the text, students use their new insights and understanding to complete filling out charts and graphic organizers. • Have deep discussions about the concepts or events in the text or in character analysis. in the text or in character analysis. • Make connections through related writing activities. • Do further extension activities related to the theme and content of the reading to apply the learning. • Many of the strategies used during reading are also continued or completed after the reading.
- 30. • Story frames. These are sentence starters to fi ll in that provide a skeleton of the story or chapter. For example: “The setting of this chapter takes place ____________. The character faced a problem when __________. First he ______________. when __________. First he ______________. Next, _______________. Then ____________. I predict in the next chapter _____________.”
- 31. MATH STRATEGIES AND INTERVENTIONS • The following strategies strengthen and build mathematical skills, and the accommodations and modifications support students with and modifications support students with ADHD and learning disabilities who struggle with math.
- 32. Strategies for Memory and Recall of Math Facts and Procedures •Have multiplication fact sheets, charts, and tables readily available for reference. • Use mnemonic devices (memory clues, images, and associations) to help students remember facts, sequential steps, procedures, and abstract concepts and vocabulary. • Make use of rhymes, chants, raps, or songs to help students • Make use of rhymes, chants, raps, or songs to help students memorize the multiplication tables. •Use mnemonics, such as Dead Monsters Smell Badly, for learning the steps of long division ( divide, multiply, subtract, bring down). •Some mnemonic programs are available that use picture associations and clever stories to help master multiplication facts as well.
- 33. •Practice one sequence of multiples at a time (the 2 or 3 times tables, for example) in a variety of multisensory formats until the child achieves mastery. •Encourage students to keep a card file of specific math skills, concepts, rules, and algorithms taught, along with specific examples of each on the card for along with specific examples of each on the card for reference. •Practice and review facts in frequent, brief sessions This can be done at home in a fun, relaxed manner. •Have students chart their own progress and mastery. Do not display this information for the whole class to see.
- 34. Strategies to Compensate for Spatial Organization and Perceptual - Motor Difficulties •Encourage students to write and solve their computation problems on graph paper rather than notebook paper. •Experiment with graph paper of varying square and grid sizes. • Reduce the requirement of copying problems from the • Reduce the requirement of copying problems from the board or book by photocopying the page or writing out the problems on paper for students who need this help. • Provide a large work space on tests. If necessary, rewrite test items on other paper with lots of room for computation. • Provide lots of space on the page between problems and the bottom of the page.
- 35. Instructional and Assessment Strategies and Modifi cations • Reduce the number of problems assigned (half - page, evens only, odds only). • Make the abstract more concrete. Provide many kinds of manipulatives to help students visualize and work out math problems. Cubes, chips, tiles, counters, beans, base – ten blocks, and number lines are some of the many possibilities. • Model and encourage the use of drawing, diagramming, and labeling in the problem - solving process. • Allow and encourage students to use calculators, particularly for checking their work. • Allow extra time on math tests so students are not rushed and make careless errors. • Avoid the anxiety of timed tests and drills, especially those posted for all students in the class to see, and extend the amount of time permitted for certain students as “passing. “ see, and extend the amount of time permitted for certain students as “passing. “ • Grade by number of correct problems over the number assigned (which could be different for students receiving modified homework or class work). • Provide frequent checks for accuracy and immediate feedback whenever possible. This reduces the frustration of having to erase and fix a number of problems done incorrectly. Set a certain number of problems to complete (for example, one row only or three to four problems) and then check students before they are permitted to continue. Student partners can also compare answers after working every few problems on their own. If they don’t agree on any of the answers after reworking the problem together, those students can then ask other classmates or the teacher. • List steps and procedures to multistep problems and algorithms. Post clear numbered steps, or give students a desk copy model of steps for solving problems.
- 36. • Keep sample math problems on the board, and have students keep them in a notebook for reference. • Work problems on the board, overhead projector, or document camera using color to make the steps and processes visually clear. • Teach key words that indicate the process. For example, the words product, times, doubled, and tripled all indicate multiplication. The words average, quotient, equal parts, sharing, and divisible by all indicate division. • Teach and model a variety of problem - solving strategies: finding clue words, looking for a pattern, constructing a table, making an organized list, using objects, drawing a picture, working backward, making a model, eliminating possibilities, and guessing and checking, among others. • Always build in time during the lesson for students to share how they solved the problem, and emphasize the variety of ways, not just one method, to solve them. • Increase the amount of practice and review. Make sets of practice and review problems (a few per page) with answers on the back for independent practice. • Use computer games for drill and practice of math skills. These programs have the benefit of being adjusted for speed and level of difficulty. They also provide immediate feedback and are fun, nonthreatening, and motivating for children. nonthreatening, and motivating for children. • Motivate the practice of skills through the use of games. Many board games and card games such as Battleship and Uno are excellent for building such math skills as counting, logic, probability, and strategic thinking. • Provide many opportunities for using math in the context of real - life situations: using money, balancing a checkbook, determining mileage on a fantasy road trip, comparison shopping, and paying for a meal, with tax and tip, for example. • Practice functional math skills (measurement, time concepts, counting money and change) as much as possible at home. These are critical skills that teachers often do not have enough time to teach until mastery. Parents can include their child in activities such as cooking, baking, constructing, sewing, gardening, and home improvements, which are great ways to teach and reinforce functional math skills and fun to do together.
- 37. WHY WRITING IS A STRUGGLE • Written language tends to be the most common area of academic weakness in children and teens with ADHD or learning disabilities because the process is complex. It involves the integration and often simultaneous use of several skills and brain simultaneous use of several skills and brain functions (for example, organization, spelling, fine motor, planning, self - monitoring, memory, language). These children are often verbal and knowledgeable but struggle to effectively show what they know on paper.
- 38. Preplanning and Organization • This requires being able to generate, plan, and organize ideas. When given a written assignment, students with ADHD often get stuck here. They do not know what to write stuck here. They do not know what to write about, how to organize and begin, or how to narrow down and focus on a topic.
- 39. Memory •Working memory is necessary in order to juggle the many different thoughts that one might want to transcribe onto paper. It involves: 1. Keeping ideas in mind long enough to remember what one wants to say. 2. Maintaining focus on the train of thought so the flow of the writing will not veer off course writing will not veer off course 3. Keeping in mind the big picture of what you want to communicate, while manipulating the ideas, details, and wording • The process of writing also requires other memory functions: 1. Retrieval of assorted information from long - term memory, such as facts and experiences) to share about the writing topic 2. Recall of vocabulary words, spelling, mechanics, and grammatical use
- 40. Language • Writing requires the ability to: •Express thoughts in a logical, fl uid, and coherent manner •Use vocabulary and word knowledge to express oneself and communicate to the express oneself and communicate to the reader effectively •Use descriptive sentences while maintaining proper sentence and paragraph structure
- 41. Spelling •People with attention difficulties are often: 1. Inattentive to visual detail and do not notice or recall the letters, sequence, or visual patterns within words 2. Prone to making many careless mistakes • Those who also have coexisting learning disabilities are typically weak in spelling due to: 1. Auditory - sequential memory deficits, causing great difficulty learning letter – sound associations, as well as 1. Auditory - sequential memory deficits, causing great difficulty learning letter – sound associations, as well as hearing and remembering and then writing those sounds in the correct order. 2. Visual - sequential memory, causing them diffi culty in recalling the way a word looks and getting it down in the correct order or sequence. This results in misspelling common high – frequency words, such as said, they, and because, which cannot be sounded out phonetically and must be recalled by sight.
- 42. STRATEGIES FOR COMPOSITION AND WRITTEN EXPRESSION • Written expression is the most common academic area of difficulty among students with ADHD. As discussed several brain processes are involved and used simultaneously (language, attention, memory, sequencing, organization, planning, self - monitoring, and critical thinking) when composing a written piece of and critical thinking) when composing a written piece of work. Students are expected to meet grade – level expectations and standards in a variety of writing formats and genres. Teachers are expected to differentiate instruction to teach writers of all levels and abilities. The following strategies and tips are designed to help students become more successful writers.