Attention Deficit Disorder

Attention deficit disorders are disorders characterized by serious and persistent difficulties in attention span, impulse control, and hyperactivity. Attention Deficit Disorder (ADD) is a chronic disorder that can begin in infancy and extend through adulthood. It can have a significantly negative effect on an individual's life at home, in school, or in the community. There are two types of attention deficit disorders: undifferentiated Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD). In undifferentiated ADD, the primary and most significant characteristic is inattentiveness but hyperactivity is not present. These students still manifest problems with organization and distractibility, even though they may seem quite and passive. These students also tend to be overlooked more easily in the classroom, and may be at a higher risk for academic failure than those with ADHD.

To be diagnosed as having ADHD a student must display, for six months or more, at least eight of the following characteristics prior to the age of seven:
1) fidgets, squirms, or is restless
2) has difficulty remaining seated
3) is easily distracted
4) has difficulty waiting for his/her turn
5) blurts out answers
6) has difficulty following instructions
7) has difficulty sustaining attention
8) shifts from one uncompleted task to another
9) has difficulty playing quietly
10) talks excessively
11) interrupts or is rude to others
12) does not appear to listen
13) often loses things necessary for tasks
14) frequently engages in dangerous actions

After: "Diagnostic and Statistical Manual of Mental Disorders" (3rd ed., rev.) (American Psychiatric Association, 1987).

CHICAGO, Sept. 30 (AP) - The American Academy of Pediatric Me4dcine has issued its first guidelines for treating attention deficit hyperactivity disorder, suggesting that stimulant drugs may be most effective but that behavioral techniques should also be used. The guidelines appear in the October issue of the medical journal Pediatrics, which will be released Monday.

As many as 3.8 million school-age children, most of them boys, are believed to have attention deficit disorders. Symptoms may include a short attention span, impulsive behavior and difficulty sitting still. The guidelines, which fall in line with those issued in recent years by the National Institute of Mental Health, were created in consultation with child psychiatrists and psychologists. They suggest that the evidence favoring medications like Ritalin is stronger than the evidence about behavioral therapy.

Symptoms improve in at least 80 percent of children on stimulants, and medication should be switched if it is not working, the guidelines say. Critics say that many doctors and teachers turn to drugs like Ritalin as an easy fix and that their long-term effects are uncertain. The guidelines say any treatment should begin only after a diagnosis is certain and doctors, parents and teachers have discussed appropriate treatment goals. The guidelines say drugs should be used with behavioral techniques, including time-outs for hitting. They call for rewarding children when they complete tasks, like homework.

General Strategies

• Bring to the student's attention science role models with disabilities with a similar disability to that of the student. Point out that this individual got ahead by a combination of effort and by asking for help when needed.
• Student monitoring, self management, discipline, and encouragement can be a very important aspect for academic success. Below are the two basic aspects of AD/HD facilitation.

• Self-monitoring techniques can be very effective in the school setting. Self-monitoring of attention involves cueing the student so that he/she can determine how well he/she is attending to the task at hand. Cueing is often done by providing an audio tone such as a random beep, timer, or the teacher can give the cue. The student then notes whether he/she was on or off task on a simple recording sheet. Self-monitoring techniques are more likely to be effective when tied to rewards and accuracy checks.

• Behavior management techniques must often be used in the learning environment. By examining a student's specific problem behavior, understanding it's antecedents and consequences, teachers can help students with AD/HD to develop behaviors that lead to academic and social successes.

• Provide supervision and discipline:
• Monitor proper behavior frequently and immediately direct the student to an appropriate behavior.
• Enforce classroom rules consistently.
• Avoid ridicule and criticism. Remember that students with AD/HD have difficulty staying in control.

• Providing Encouragement:
• Reward more than punish.
• Immediately praise any and all good behavior and performance.
• Change rewards if they are not effective in motivating behavioral change.
• Find alternate ways to encourage the AD/HD students.
• Teach the student to reward himself or herself. Encourage positive self-talk (e.g., "You did very well remaining in your seat today. How do you feel about that?"). This encourages the student to think positively about himself or herself.

• Bring to the student's attention science role model who has a disability similar to that of the student with an impairment. Point out that this individual got ahead by a combination of effort and by asking for help when needed.
• Reduce the amount of materials present during activities by having the student put away unnecessary items. Have a special place for tools, materials, and books.
• Reward more than you punish, especially with positive reinforcers.
• Try to be patient with an AD/HD student.
• Seat students with AD/HD in the front near the teacher with their backs to the rest of the class. Be sure to include them as part of the regular class seating.
• Place these students up front with their backs to the rest of the class to keep other students out of view.
• Surround students with AD/HD with good peer models, preferably students whom the AD/HD student views as significant peers.
• Encourage peer tutoring and cooperative/collaborative learning.
• A class that has a low student-teacher ratio will be helpful to a student with AD/HD.
• Avoid all distracting stimuli. Try not to place students with AD/HD near air conditioners, high traffic areas, heaters, doors, windows, etc.
• Avoid transitions, physical relocation, changes in schedule, and disruptions.
• Be creative! Produce a somewhat stimuli-reduced study area with a variety of science activities. Let all students have access to this area.
• Encourage parents to set up appropriate study space at home, with set times and routines established for study. Also, use this home area for parental review of completed homework, and periodic notebook and/or book bag organization.
• Educational, psychological, and/or neurological testing is recommended to determine learning style, cognitive ability, and to rule out any learning disability (LD is common in about 30% of students with AD/HD).
• A private tutor and/or peer tutoring will be helpful to a student with AD/HD.
• Have a pre-established consequences for misbehavior, remain calm, state the infraction of the rule, and avoid debating or arguing with the student.
• Avoid publicly reminding students on medication to "take their medicine."

Teacher Presentation

• Consult with special education personnel to determine specific strengths and weaknesses of each student.
• Maintain eye contact during verbal instructions.
• Make directions clear and concise. Be consistent with all daily instructions.
• When you ask an AD/HD student a question, first say the student's name and then pause for a few seconds as a signal for him/her to pay attention.
• To help with changes in assignments, provide clear and consistent transitions between activities and notify the student with AD/HD a few minutes before changing activities.
• Repeat instructions in a calm, positive manner.
• AD/HD students may need both verbal and visual directions. You can do this by providing the student with a model of what he/she should be doing.
• You can give an AD/HD student confidence by starting each assignment with a few questions or activities you know the student can successfully accomplish.
• Self-monitoring techniques can prove effective in the school setting. Self-monitoring of attention involves cueing the student so that he/she can determine how well he is attending to the task at hand. Cueing is often done by providing an audio tone.
• Behavior management techniques must often be used in the school. By examining a child's specific problem behavior, understanding it's antecedents and consequences, educators can help students with AD/HD develop behaviors that lead to academic and social success.
• Develop an individualized education program. By identifying each student's individual strengths and specific learning needs, you can design a plan for mobilizing those strengths to improve students academic and social performance.
• Gradually reduce the amount of assistance, but keep in mind that these students will need more help for a longer period of time than the student without a disability.
• Require a daily assignment notebook as necessary and make sure each student correctly writes down all assignments. If a student is not capable of this, the teacher should help the student.
• Initial the notebook daily to signify completion of homework assignments. (Parents should also sign.)
• Use the notebook for daily communication with parents.

http://www.as.wvu.edu/~scidis/add.html