ADHD

=ADHD=

Definition Assessment Incidence Characteristics Causes Trends and Issues Connection to Learning Services and Supports Parents and Teachers

 __**DEFINITION**__

"Persistent pattern of inattention and/or hyperactivity/impulsivity" - [|http://www.adhd.ca]

 __**ASSESSMENT**__

Symptoms must occur for at least six months, with some having been present since before the age of 7 years. There are three main symptoms" Inattention Impulsiveness - http://www.adhd.ca

The DSM-IV (Diagnositcs and Statistics Manual) describes the assessment of ADHD as follows:

I. Either A or B:**
 * DSM-IV Criteria for ADHD

A: Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:


 * Inattention**


 * 1) Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
 * 2) Often has trouble keeping attention on tasks or play activities.
 * 3) Often does not seem to listen when spoken to directly.
 * 4) Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
 * 5) Often has trouble organizing activities.
 * 6) Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
 * 7) Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
 * 8) Is often easily distracted.
 * 9) Is often forgetful in daily activities.

B: Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:


 * Hyperactivity**


 * 1) Often fidgets with hands or feet or squirms in seat.
 * 2) Often gets up from seat when remaining in seat is expected.
 * 3) Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
 * 4) Often has trouble playing or enjoying leisure activities quietly.
 * 5) Is often "on the go" or often acts as if "driven by a motor".
 * 6) Often talks excessively.


 * Impulsivity**


 * 1) Often blurts out answers before questions have been finished.
 * 2) Often has trouble waiting one's turn.
 * 3) Often interrupts or intrudes on others (e.g., butts into conversations or games).
 * 4) Some symptoms that cause impairment were present before age 7 years.
 * 5) Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).
 * 6) There must be clear evidence of significant impairment in social, school, or work functioning.
 * 7) The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).


 * Based on these criteria, three types of ADHD are identified:**


 * 1) ADHD, //Combined Type//: if both criteria 1A and 1B are met for the past 6 months
 * 2) ADHD, //Predominantly Inattentive Type//: if criterion 1A is met but criterion 1B is not met for the past six months
 * 3) ADHD, //Predominantly Hyperactive-Impulsive Type//: if Criterion 1B is met but Criterion 1A is not met for the past six months.

 __**INCIDENCE**__

The rate of incidence for ADHD is under dispute, mainly because of the difficulty of assessing ADHD and the fact that there is no biological marker. Estimates range from 1% to 20% of school-aged children have ADHD, although the most commonly cited rate of incidence is 3% to 5% of school-aged children.

 __**CHARACTERISTICS**__

ADHD present various common characteristics that may be displayed. However, it is important to note that as each individual is different, so traits may vary. - Students with ADHD often have problems with organization and may lose things often - Forgetfulness - Students may become defensive or blame others if frustrated - Low self esteem and mood swings are quite common - Sleep disorders - May be prone to social conflicts or may have a problem working with others - Gets frustrated easily - May be viewed as being immature or very impulsive - Often daydreams - Display anxiety if feeling overwhelmed - Hyperactivity followed by sessions of fatigue - Students may appear restless/fidgeting constantly or may have difficulty paying attention. - May engage in Dangerous activities (as a result people with ADHD are often prone to addictions and additive behavior). - They may be viewed as erratic academically - Intelligent and creative - Likely to have multiple disabilities or disorders (e.g. oppositional defiant disorder)

- Inattentive - Impulsive - Overacting - Socially Inappropriate
 * The most common traits are the following**


 * __CAUSES__**

There is much speculation as to the cause of ADHD, though there is research that indicates that there is no single cause for ADHD. Many people who have ADHD may have other conditions as well. There is also mention that ADHD can be broken into two categories for causes, these are; genetic and non-genetic factors.


 * Non-genetic factors** may include environmental affects such as family structure, or parenting style.

Many studies have indicated that it is a lifelong inherited condition caused predominately by abnormalities in the structure of the brain. Although in the past, it was once believed that children can grow out of ADHD the fact of the matter is, that children who have ADHD will not grow out of this condition. Many forget to realize that there are many adults who have ADHD. With this in mind, it is important to note that this is not something that the parent can control. It is common for parents may take on the blame for their child’s condition.
 * Genetic factors** may include family members who have had ADHD or similar conditions. Growing evidence suggests that structural or morphological abnormalities in the brain may be causes of ADHD.


 * ADHD** is normally associated with other conditions which frequently coincide with it. For example, some students who were diagnosed with ADHD were also diagnosed with Oppositional-defiant disorder (ODD), or learning disabilities.


 * __TRENDS AND ISSUES__**

There are two main trends, which can also be considered the main issues when it comes to ADHD. These are diagnosis and treatment. Who is being diagnosed with ADHD? From 1997-2003 the number of children being diagnosed with ADHD has remained quite stable. The interesting part is white, non-Hispanic males were being diagnosed with ADHD more than any other group or class of people.

(part of the table) **
 * Percentage of Children Ages 3 to 17 who Have Been Diagnosed by a Doctor or Health Professional as Having Attention Deficit Hyperactivity Disorder (ADHD), 1997-2003

|| 8.4 || 9.3 || 9.1 || 10.3 || 9.0 || || 2.7 || 3.8 || 3.5 || 4.0 || 3.6 || || 0.6 || 1.0 || 0.8 || 1.0 || 0.7 || || 5.3 || 6.5 || 6.3 || 6.8 || 6.3 || || 7.7 || 8.6 || 8.3 || 9.6 || 8.3 || || 6.7 || 8.0 || 7.4 || 8.3 || 7.5 || || 4.3 || 5.0 || 5.7 || 7.8 || 6.0 || || 2.7 || 3.8 || 3.5 || 3.7 || 3.7 || || 3.8 || 2.1 || 3.7 || 1.8 || 3.1 || [|Child Trends Databank] There is great debate going on about whether ADHD is really a medical condition or if it is just a way for parents to label their child and avoid the fact that they have poor parenting skills. Is this something that parents are putting on their children in order to avoid accepting such things as changing family structures, the loss of a community feeling, and increasing single parent families? The idea of this ‘cop out’ has recently received more backing due to the ever increasing acceptance in the public of ADHD. ADHD is no longer considered a medical term but a mainstream explanation for bad behaviour. This was clearly demonstrated when Bart Simpson was labeled with ADHD by his principal on televisions world wide ([|Prosser, 2006]). This leads to the question of whether or not ADHD is being over diagnosed, which no one is able to answer yet.
 * || **1997** || **1998** || **1999** || **2000** || **2001** || **2002** || **2003** ||
 * **Total** || 5.5 || 5.9 || 5.6 || 6.6 || 6.4 || 7.2 || 6.4 ||
 * **Gender** ||  ||   ||   ||   ||   ||   ||   ||
 * **Male** || 8.3 || 8.5
 * **Male** || 8.3 || 8.5
 * **Female** || 2.6 || 3.2
 * **Age group** ||  ||   ||   ||   ||   ||   ||   ||
 * **Ages 3-4** || 0.5 || 0.7
 * **Ages 3-4** || 0.5 || 0.7
 * **Ages 5-11** || 5.9 || 6.1
 * **Ages 12-17** || 6.8 || 7.5
 * **Race and Hispanic Origin2** ||  ||   ||   ||   ||   ||   ||   ||
 * **White, non-Hispanic** || 6.5 || 7.0
 * **White, non-Hispanic** || 6.5 || 7.0
 * **Black, non-Hispanic** || 4.3 || 4.9
 * **Hispanic** || 3.3 || 3.5
 * **Non-Hispanic other** || 2.4 || 2.2

While diagnosis is a hot topic around the world, perhaps the biggest trend and therefore issue related to ADHD is the use of medication in treating those who have been diagnosed. Psychostimulants are the treatment of choice these days for ADHD. Peterson and Hittie (2003) say the number of children on Ritalin in the 1970's was about 150 000 and in 2000 the number was between 5 and 8 million. A 700% increase in stimulant use has been observed throughout the 1990’s ([|LeFever et.al, 200]3). Some say that there is concern of over diagnosis and over treatment with medication. Many schools may push parents to have their child diagnosed and medicated and some have even gone so far as to report the parents to the government for child abuse and neglect if they refuse (Peterson & Hittie, p. 294, 2003) It is argued that the characteristics of ADHD are visible in every child, but they appear at varying degrees. Some of the dangers of over prescribing medication as treatment for ADHD include; reduction in other steps being taken to help children, inadequate monitoring of drug treatment, low self esteem possible, and drug abuse among those treated with drugs. Sadly, one of the benefits of having so many children on medication is the creation of large cohorts which allow researchers to conduct many studies.


 * __CONNECTION TO LEARNING__**

Students with ADHD may display poor handwriting or problems with writing. Students with ADHD may also have poor math, spelling, and reading skills. As a result, students who have difficulty in these areas may become easily frustrated and discouraged. The main problems children with ADHD face in school stem from weaknesses in executive functions of the brain, working memory and processing speed. Their performance varies greatly and can be quite inconsistent. Children with ADHD often have negative attitudes towards authority figures, due to the negative attention they so often receive.
 * Impact on learning**

There are four distinctive ways to help treat issues related to Attention Deficit Hyperactivity Disorders. That being said, these treatments are not 'cures' for ADHD. - Medication - Behavioral-cognitive modifications - Accommodations - Parental Training
 * Treatments**

Medication is viewed as the most popular form of helping students with ADHD. Medications and stimulants such as Ritalin, Dexedrine, and Cylert. However, most medications and stimulants have various side effects. Some have found that the medication may wear off after prolonged use; therefore the prescription would have to increase. Other side effects may include; loss of appetite, weight loss, stomach cramps, irritability, and even depression. Over-medication may also present issues regarding to this type of treatment.
 * Medication**

This technique tends to focus on teaching students self-control. This includes strategies for teaching students alternatives to any behavior that may be considered inappropriate. This is where the use of tokens or rewards is used in order to promote positive behaviors.
 * Behavioral-Cognitive Modification**

Here, schools and teachers provide assistance, or allow the student to work in a setting that would assist the child in completing his/her work are essential for students who have ADHD. For example, during tests or exams, providing a safe and quite area as well as offering more time to that student may be beneficial.
 * Accommodations**

Educating parents so that they understand about the condition and provide strategies for what they can do to help their child who has ADHD.
 * Parental Training**

Both parents and teachers should refrain from labeling children with ADHD. Just because they have a condition does not mean that they are not intelligent. In fact, many can be referred to as gifted, as many children and adults who are viewed as “normal” and do not have ADHD are unable to match the creativity or energy level of those with ADHD.
 * Other Strategies**

Always avoid using negative comments such as “If you’d only try harder” or “Don’t do it that way”. These comments are damaging to one’s self-concept and will be carried with them throughout their life.


 * __SERVICES AND SUPPORTS__**

There are numerous services and supports available for parents of children with ADHD, children who have ADHD, and teachers of students with ADHD. Most of these supports are on-line but there are local in person supports and services in most larger communities. Students with ADHD do not currently qualify for funding under the current guidelines from [|MECY]. There are many supports and services available for parents who have a child that has been diagnosed with ADHD. There are numerous websites that offer information on what ADHD is, how parents can help their children once they have been diagnosed, and where they can find support themselves.
 * Parents**

One website, [|The ADHD Information Library 2.0], is a portal site that offers links to everything and anything you want to know about ADHD. There is information on characteristics of ADHD, treatment options, advice, helping your child and yourself, newspapers articles about what is happening in the world with ADHD and much, much more.

For more personal support and service, parents can become part of a support group. [|Addcoach4u] offers information about national and provincial level support groups, as well as books, websites, videos, and articles about ADHD. Winnipeg has an ADHD (LD) Support Group which is run by the [|Learning Disabilities Association of Manitoba].

It is more difficult to find services and support for students than it was for parents and teachers. One reason is that parents and teachers should be the biggest support for students. There is one group in Manitoba which offers summer camps especially for students with Learning Disabilities and ADHD. The program is run world wide and more information can be found at [|MySummerCamps].
 * Students**

The [|Province of Manitoba] announced in October 2007 that they would be investing $738 000 to further develop programs to help students with ADHD. Services are available through the Manitoba Adolescent Treatment Centre and include a wide range of interventions.

There are numerous supports and services available for teachers of students with ADHD. More information will be available from the provincial government through the funding discussed above. There are also online supports and in person groups available for teachers who want to learn more about ADHD.
 * Teachers**

One online resource that offers ADHD supports for teachers is part of the [|ADHD Information Library]. This site breaks information into different categories for teachers by age of students. The site offers advice of things such as room set up, lesson planning, student tasks, behaviour management, and much more.

Another resource that is available for professionals, as well as parents is a two day workshop called [|ADHD Basics] which is offered by the Learning Disabilities Association of Manitoba.

Here are some books on ADHD. Really all of the books would be beneficial for parents or teachers, however at the end of each title is the group, parent/student/teacher, that the book is intended for.
 * Books**

The ADHD Companion: Attention Deficit Hyperactivity Disorder by Molly Lyle Brown (teachers)

Practical Ideas that Really Work for Students with ADHD by Kathleen McConnell, Gail Ryser, and Judith Higgins (teachers)

The ADHD Book of Lists: A Practical Guide for Helping Children and Teens with Attention Deficit Disorder by Sandra Rief. (parents and teachers)

Putting on the Brakes (for ages 8-13) by Patricia Quinn and Judith Stern (students)

The Putting on the Brakes Activity Book by Patricia Quinn and Judith Stern (parents and students)

Learning to Slow Down and Pay Attention, 3rd edition by Kathleen Nadeau and Ellen Dixon (students)

50 Activities and Games for Kids with ADHD by Patricia Quinn and Judith Stern (parents, students, and teachers)

Phoebe Flower; 4 Book Set by Barbara Roberts (students)

Many services are also available through the Manitoba School Divisions. By searching on the different [|Manitoba divisions’ websites] lists of the available books and other resources can easily be found. These few services and supports are by no means the limit of what is available to parents, students, or teachers. There is a huge amount of information available on-line about ADHD that can be useful for all three groups of people. In person supports or services are not as easy to find, but are generally available in most major cities in Canada.

 __**PARENTS AND TEACHERS**__

//**For Parents and teachers it is important to ensure that we do the following...**//

Teachers and parents need to be clear and concise when giving instructions. Be sure to give step by step instructions/requests (one step at a time) to limit any possible frustration and confusion. Check to ensure that students understand. When in doubt, keep it simple.
 * Communicate**

Many parents and teachers forget how important setting a good example can be. This is especially true with children who have ADHD. By showing your child the behaviors that you WANT to see such as; being patient, having good manners and being organized can dramatically help decrease any negative behaviors.
 * Set a good example**

Each child has different ‘triggers’. Make sure that you know these triggers and what situations lead to problems. If a child finds him/herself getting frustrated with a task, find ways to reduce frustration and stress by showing them a solution from another perspective. Ask them to take a break and come back when they feel less anxious.
 * Plan for any problems that may occur by Anticipating and avoiding them**

Praise can be a positive tool for reinforcement both in and outside of the classroom. This encourages students to do their best while staying motivated.
 * Praise Good Behavior**

As a teacher it’s important to display negotiation skills by offering more then one option.
 * Negotiate**

Consistency provides a solid foundation of what to expect. By establishing predictable routines students will feel less anxious.
 * Be Consistent**

Allows students with ADHD to realize that there are other people with their condition. For example, actor/comedian Robin Williams.
 * Famous People with ADHD**

References