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ATTENTION DEFICIT HYPERACTIVE DISORDER (ADHD)

ATTENTION DEFICIT HYPERACTIVE DISORDER (ADHD). PRESENTER Harry E. McCormick, Ed.D. School Psychologist Metropolitan Nashville Public Schools. OVERVIEW. FACTS AND MYTHS Pre-Test CHARACTERISTICS DIAGNOSTIC FEATURES DIAGNOSTIC ISSUES TREATMENT MEDICAL PSYCHOSOCIAL EDUCATIONAL.

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ATTENTION DEFICIT HYPERACTIVE DISORDER (ADHD)

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  1. ATTENTION DEFICIT HYPERACTIVE DISORDER(ADHD) PRESENTER Harry E. McCormick, Ed.D. School Psychologist Metropolitan Nashville Public Schools

  2. OVERVIEW FACTS AND MYTHS Pre-Test CHARACTERISTICS DIAGNOSTIC FEATURES DIAGNOSTIC ISSUES TREATMENT MEDICAL PSYCHOSOCIAL EDUCATIONAL

  3. Many Names for AD/HD

  4. Many Names for AD/HD (cont’d)

  5. PRIMARY CHARACTERISTICS • Inattention • Hyperactivity • Impulsivity

  6. Inattention • Fails to pay close attention to details • Difficulty sustaining attention • Does not seem to listen • Does not follow through on instructions • Difficulty with organization • Avoids tasks that require sustained mental effort

  7. Inattention (cont’d) • Often loses things • Often easily distracted • Forgetful in daily activities

  8. Hyperactivity • Fidgets • Out of seat • Runs or climbs excessively • Difficulty playing quietly • Is often “on the go” • Talks excessively

  9. Impulsivity • Often blurts out answers before questions have been completed • Often has difficulty waiting turn • Often interrupts or intrudes on others

  10. SECONDARY CHARACTERISTICS • Academic • Social • Emotional

  11. Academic Difficulties • Poor study habits • Difficulty beginning and completing assignments • Disorganized • Poor handwriting • Inconsistent/poor recall • Difficulty generalizing • Auditory processing problems • Poor visual perception • May have additional learning problems

  12. ADHD is not a specific developmental disorder or learning disability as these disorders are currently defined, but there may be some overlap, or comorbidity, of these two types of disorders. Approximately 20 to 25% of ADHD children will have significant delays in the development of math, reading, or spelling, and 10 to 30% may have problems with language.

  13. Social Difficulties • Does not take responsibility for actions • Needs to be the center of attention • Difficulty relating to peers • Disturbs others who are trying to work and listen • Bullies or bosses other children • Teases peer excessively • Difficulty following rules of games • Aggressive, spiteful and vindictive • Rejected by peers

  14. Emotional Difficulties • Low self-esteem • Irritable, low frustration tolerance • Loses temper, gets mad easily • Defiant attitude • Argumentative • Emotionally immature • Frequent, unpredictable mood swings

  15. Major life events may cause added stress resulting in some of the same types of behaviors that are characteristic of children who have ADHD.

  16. Where are Students with AD/HD Educated • General education • Teacher initiated accommodations in general classroom, curriculum, and instruction • Support Team Intervention Plan • Identification of a disability under Section 504: development of a 504 Service Plan for accommodations in general curriculum and modifications in instruction • Identification of need for special education and related services - - IDEIA

  17. Chances Are You Will Be Teaching a Student Diagnosed with AD/HD • Occurs in 3% to 7% of school-age children • All socioeconomic, cultural, and racial backgrounds • All intellectual levels • More prevalent in males 4:1 male to female ratio in the general population 9:1 male to female ratio in the clinical population

  18. AD/HD can span throughout the individual’s life. 50% to 80% of AD/HD children continue to have some degree of their symptoms in adulthood. • AD/HD is a chronic or life-long condition. As one grows older the symptoms may become less severe, especially in the case of hyperactivity, but some manifestations of the condition may be expected to be present throughout adulthood.

  19. Hereditary link has been suggested • One can not tell by looking at a child’s overt behavior.

  20. Symptoms May ChangeAD/HD Is Not Outgrown • Preschool • Excessive activity • Increased talking • Resistance to routines and rules • Aggressive in play • Demanding personality • Accident prone

  21. Symptoms May ChangeAD/HD Is Not Outgrown (cont’d) • Elementary School • Fidgety • Excessive talking • Erratic performance • Bossy • Constant demand for attention

  22. Symptoms May ChangeAD/HD Is Not Outgrown (cont’d) • Adolescence • Restlessness • Talking out of turn • Problems at school • Problems with peers • Difficulty establishing independence from parents • Poor judgment

  23. CRITERIA FOR SYMPTOMS • Age-Inappropriate behaviors • First appeared before age 7 • Persist for 6 months (or more) • Present in at least 2 settings • Significant clinical impairment

  24. DSM-IV Subtypes of AD/HD • Inattentive Type • Hyperactive-Impulsive Type • Combined Type

  25. Executive Functioning Executive functions are a collection of inter-related processes that are responsible for goal-directed, problem solving behavior which involves the prefrontal lobe.

  26. Types of Executive Functioning • Inhibit (the ability to inhibit, resist or not act on impulse) • Shift (the ability to move freely from one activity to another) • Initiate (beginning a task, generating ideas or problem-solving) • Working Memory (the capacity to hold information in mind for the purpose of completing a task)

  27. Types of Executive Functioning (cont’d) • Plan/Organize (the ability to manage current and future demands) • Organization of Materials (orderliness of work…) • Monitor (assess work-checking habits)

  28. Teachers, parents, psychologists, and physicians are key to diagnosis and successful outcomes

  29. AD/HD Procedures andBest Practicesfor Metro-Nashville Public Schools

  30. Student is Currently on Medication • Teacher completes “Medication Effectiveness Documentation” (MED) form • Concerns - Follow new Support Team process • No concerns - Place MED form in cumulative record. The process ends.

  31. Student with Academic/Behavioral Concerns • Follow the New Support Team process • Forms and procedures have changed • Training will occur in the very near future • Try interventions for at least one month • Reconvene Support Team to review progress or lack of progress and make other recommendations

  32. Student with Academic/Behavioral Concerns (cont’d) • The severity of the case will determine the need to move more quickly through the Support Team/504/IDEIA Process. If the student has severe enough behavioral issues, then the Support Team can begin the AD/HD evaluation process.

  33. AD/HD Evaluation Process • Assessment Specialist (psychologist) must be in attendance at Support Team • Obtain parental consent for evaluation • Global Behavior Rating Scale (Home/School) • Specific Behavior Rating Scale for AD/HD (Home/School)

  34. AD/HD Evaluation Process (cont’d) • Teacher Checklist • Classroom Observations in Multiple Settings • Social/Developmental/Medical History • Vision/Hearing Screenings (within one year) • Psychologist writes report of the AD/HD screening results.

  35. Review Support Team • Review results of AD/HD Evaluation and determine if an “educational diagnosis” of AD/HD can be made. • If Yes - determine if 504 eligible (follow the 504 procedures) If not 504 - Write Support Team Intervention Plan

  36. After Leonard took his case to the Support Team, he was given a 504 Service Plan which allowed him to play his armpit in the school band.

  37. Review S-Team (cont’d) • If No - Review/Rewrite Support Team Intervention Plan to address other pertinent concerns. • Both plans should be reviewed (at least yearly). • A “medical diagnosis” is not required for eligibility under Section 504.

  38. IDEIA - Other Health Impairment • A student with AD/HD can qualify for special education as Other Health Impairment (OHI) if: • The student must have a current (within one year) medical statement from a licensed health service provider* which includes the diagnosis, prognosis, information regarding medications (if applicable), special health care procedures, special diet, and/or activity restrictions.

  39. IDEA - Other Health Impairment (cont’d) • A comprehensive developmental or educational assessment which indicates the effects of the health impairment on the student’s educational performance, and documents deficit skills resulting from the health impairment in pre-academics or academic functioning, adaptive behavior, social/emotional development, motor, communication, and cognitive. If an AD/HD evaluation has not been conducted to address the above mentioned areas, then one should take place using the previously outlined procedures.

  40. IDEA - Other Health Impairment (cont’d) • If the student is found to be eligible under IDEIA, then the IEP Team completes the Eligibility Report, OHI Documentation Form, OHI/ADHD Documentation Form, and writes the IEP. • If the student is not found to be eligible under IDEIA, then follow 504 or Support Team procedures.

  41. RE-EVALUATION FOR OHI • Special Education Teacher’s Responsibilities: • List all students due for re-evaluation • Give a copy to appropriate assessment specialist • Complete or collect observations, checklist parent information, current vision and hearing, and current academic information • Schedule IEP Re-evaluation Team Meeting

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