Attention Deficit Disorder (ADD)/ Attention Deficit Hyperactivity Disorder (ADHD)

1. Attention Deficit Disorder (ADD)/ Attention Deficit Hyperactivity Disorder (ADHD) A condition of the brain that makes it difficult for children to control their behavior in school and social settings. It is one of the most common chronic conditions of childhood and affects between 4 and 12 percent of all school-age children. About three times more boys than girls are diagnosed with ADHD.

2. ADD & ADHD • ADD - Used by the U.S. Department of Education and many of the schools • ADHD – is taken from the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)

3. Characteristics of ADD/ADHD • Attention deficit disorder is a chronic neurological condition characterized by developmentally inappropriate attention skills, impulsivity, and in some cases, hyperactivity.

4. Characteristics of ADD/ADHD • Inattention – is the inability to concentrate on a task • Impulsivity – is the tendency to respond quickly without thinking through the consequences of an action • Hyperactivity – refers to behavior that is described as a constant, driving motor activity in which a child races from one endeavor or interest to another

5. Characteristics of ADD/ADHD Children with ADD/ADHD have difficulty staying on task, focusing attention, and completing their work. They are easily distracted, rushing from one idea or interest to another, and they may produce work that is sloppy and carelessly executed. They give the impression that they are not listening or have not heard what they have been told. Children with attention deficit disorder have attention problems and/or problems with hyperactivity, displaying symptoms of age-inappropriate behavior.

6. Symptoms of ADD/ADHD Symptoms must meet the following criteria, according to the American Psychiatric Association: • Severity. The symptoms must be more frequent and severe than are typical of other children at similar developmental levels • Early Onset. At least some of the symptoms must have appeared before the child reaches age 7. • Duration. The child’s symptoms must have persisted for at least six months prior to the diagnosis

7. ADD/ADHD • ADD/ADHD affects children in all areas, disrupting the child’s home life, education, behavior, and social life. At home, children with this condition have difficulty accommodating to home routines and parent expectations. They may resist going to bed, refuse to eat, or break toys during play.

8. ADD/ADHD • At school, they have trouble completing their class work, often missing valuable information because of their problems paying attention. They speak aloud out of turn and find themselves in trouble for their behavior. Their social interactions may be undermined by their impulsivity, hyperactivity, and inattention, hampering their ability to make and keep friends. In terms of gender, more boys than girls are diagnosed with ADD/ADHD.

9. Eligibility for Services The condition of attention deficit disorder is not listed as a separate category of disability in the special education law, IDEA – 1997. However, because of the hard work of parents and professionals concerned about children with ADD, two significant laws have been passed that allow children with ADD to be eligible for special education services under existing categories of disabilities.

10. Two Laws for Eligibility • 1991 – Clarification of Policy to Address the Needs of Children with Attention Deficit Disorders within General and/or Special Education • 1999 – The Regulations for the Individuals with Disabilities Education Act of 1997 (IDEA – 1997)

11. Subtypes of ADHD in the DSM-IV ADHD-IA: Symptoms of Inattention ADHD-HI: Symptoms of Hyperactivity and Impulsivity ADHD-C: Combined Type

12. ADHD-IA: Symptoms of Inattention • Fails to give close attention to details, makes careless mistakes • Has difficulty sustaining attention • Does not seem to listen • Does not follow through or finish tasks • Has difficulty organizing tasks and activities • Avoids or dislikes tasks requiring sustained effort • Loses things needed for tasks • Is easily distracted by extraneous stimuli • Is often forgetful in daily activities

13. ADHD-HI: Symptoms of Hyperactivity and Impulsivity Hyperactivity • Fidgets with hands or feet, squirms in seat • Leaves seat in classroom or in other situations • Runs about or climbs excessively • Has difficulty playing or engaging in leisure activities quietly • Talks excessively • Acts as if “driven by motor” and cannot sit still Impulsivity • Blurts out answers before questions are completed • Has difficulty waiting in line or awaiting turn in games or activities • Interrupts or intrudes on others

14. ADHD-C: Combined Type Symptoms of both IA and HI: Inattention Hyperactivity Impulsivity

15. Legal Protections for Students with ADD • Children with ADD may be eligible under the category of “other health impaired” A child with attention deficit disorder may be eligible for special education services under the existing disability category of other health impaired (OHI). A child with ADD/ADHD may also be eligible for services under other existing categories of disability under IDEA – 1997 if he or she meets the applicable criteria for those disabilities. Thus, children with ADD/ADHD may be eligible for services under other health impaired, learning disabilities, or emotional disturbance.

16. Legal Protections for Students with ADD • Children with ADD may receive services under the legislation of Section 504. The Department of Education further indicates that a child with ADD/ADHD may be eligible for services in the general education classroom under Section 504 of the Rehabilitation ACT of 1973, even if that child does not qualify for special education and related services. Section 504 mandates that any agency receiving federal funds must provide reasonable accommodations for people with disabilities.

17. Legal Protections for Students with ADD • The disability of ADD/ADHD is listed as a specific condition under “other health impaired” (OHI). The 1999 Regulations are written policies designed so that schools can implement the Individuals with Disabilities Education Act for 1997 (IDEA – 1997). In the Regulations, ADD and ADHD are specifically listed as conditions that could render a child eligible for services under the “other health impaired” (OHI) category of IDEA – 1997.

18. Treatments for ADD/ADHD

19. Treatment Many different kinds of treatments are prescribed for children with attention deficit disorder, including medication, alternative therapies, education, and counseling. It is important to stress that medication must be only one part of a broader treatment plan. A multimodal plan of treatment combines education, effective instruction, behavior management strategies, family and child counseling, and good parenting and home management.

20. Treatment Many students with attention deficit disorder receive medication to improve their attention and to control their hyperactive behavior. In fact, the National Institutes of Health found that medication is prescribed in 96.4 percent of all cases of ADD/ADHD. The ideal medication should control hyperactivity, increase attention span, and reduce impulsive and aggressive behavior without inducing insomnia, loss of appetite, drowsiness, or other serious toxic effects.

21. Medications

22. First-Tier Medications First-Tier Medications: Psychostimulants • These medications are usually tried first. As the most widely used type of medication prescribed for attentional and hyperactivity disorders, they are very effective for most patients. More than 75 percent of individuals with ADD improve with psychostimulants. The psychostimulant medications include Ritalin, Dexedrine, Cylert, Adderall, and Concerta.

23. First-Tier Medications • Research on ADD/ADHD suggests that the psychostimulant medication affects the brain in these individuals by increasing the arousal or alertness of the central nervous system.

24. First-Tier Medications • It is thought that these individuals do not produce sufficient neurotransmitters—chemicals within the brain that transmit messages from one cell to another across a gap, or synapse—and that the psychostimulants work by stimulating the production of the chemical neurotransmitters needed to send information from the brain stem to the parts of the brain that deal with attention. The psychostimulant medications appear to lengthen the children’s attention spans, control impulsivity, decrease distractibility and motor activity, and improve visual-motor integration

25. First-Tier Medications • The duration of effect for Ritalin and Dexedrine is three to five hours. Consequently, unless a second dose is taken during the school day, the effects of a morning dose of either of these two medications will wear off during the course of the day. The psychostimulants Cylert and Adderall are taken in one daily dosage, and their effects are long-lasting. Concerta, a newer medication which contains Ritalin, is purported to last eight to twelve hours because it is released throughout the day.

26. Second-Tier Medications: Antidepressants and Other Medications • As noted, about 75 to 85 percent of children with ADD/ADHD show general improvement with psychostimulant medications. For those who do not improve, second-tier medications, antidepressant medications (Norpramin, Tofranil, Elavil, Prozac, Pamolar, and Wellbutrin), can be used. Also, an antihypersentive medication (clonidine) may be prescribed.