Throughout this article the terms ADD and ADHD are used interchangeably. Add stand for attention deficit disorder. At this time the most widely used term is often is not hyperactive. These children are generally not disruptive in the classroom and their behaviours are not necessarily annoying or noticeable to the teacher. However, add can be very problematic to the child, causing him or her to significantly underachieve in the classroom and experience low self-esteem.
Behavioural characteristics of attention deficit disorder without hyperactivity (ADD)
- Easily distracted by extraneous stimuli
- Difficulty listening and following directions
- Difficulty focusing and sustaining attention
- Difficulty concentrating and attending to task
- Inconsistent performance in school work-one day the student may be able to do the task, the next day cannot; the student is “consistently inconsistent”.
- Tunes out-may appear ‘spacey’
- Disorganized-loses/can’t find belongings (papers, pencils, books); desks and rooms may be a total disaster area
- Poor study skills
- Difficulty working independently
The term ADHD is the current descriptive diagnostic term in the revised third edition of the American psychiatric association’s diagnostic and statistical manual (1987). It is the label used to describe the student who may have many of the above-mentioned characteristics in addition to many associated with a hyperactivity component.
Behavioural characteristics of attention deficit disorder with hyperactivity (ADHD)
- High activity level
- Appears to be in constant motion
- Often fidgets with hands or feet, squirms, falls from chair
- Finds nearby objects to play with/put in mouth
- Roams around classroom-great difficulty remaining in seat
- Impulsivity and lack of self control
- Blurts out verbally, often inappropriately
- Can’t wait for his/her turn
- Often interrupts or intrudes on others
- Often talks excessively
- Gets in trouble because he/she can’t stop and think before acting (responds first/thinks later)
- Often engages in physically dangerous activities without considering the consequences (for example: jumping from heights, riding bike into street without looking)l hence, a high frequency of injuries.
- Difficulty with transitions/changing activities
- Aggressive behaviour, easily over stimulated
- Socially immature
- Low self-esteem and high frustration
Note: not all symptoms apply to each child, and symptoms will vary in degree. Each child is unique and displays a different combination of behaviours, strengths, weaknesses, interests, talents and skills.
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It is important to recognize that any one of these behaviour is normal in childhood to a certain degree at various developmental stages. For example, it is normal for a young child to have difficulty waiting for his/her turn, to have a short attention span, and to be unable to sit for very long. However, when a child exhibits a significantly high number of these behaviour when they are developmentally inappropriate (compared to other children their age), it is problematic. These children will need assistance and intervention.
What is the frequency of ADD/ADHD
The estimated incidence of ADHD varies widely, depending on the studies you read and the tools used. It is estimated by experts that 3 percent 10 percent of school-age children are affected. The estimated figures most frequently cited in the literature are 3 percent to 5 percent. However, this is very likely an underestimation due to the fact that many ADD girls often go undiagnosed. ADHD is far more common in boys than girls. Hyperactivity affects at least 2 million children in the United State alone, girls more commonly have ADD without hyperactivity.
What are the possible causes of ADD/ADHD
The causes of ADHA are not known at this time, the scientific and medical communities are gaining more and more knowledge about how the brain works and what affects attention and learning. As with many disorders, it is not always possible to identify a cause. At this time, ADD/ADHA is usually attributed to heredity or other biological factors.
When parents have a child who has problems of any kind medical, physical, psychological, or social they feel guilty typically and blame themselves. Many parents believe that they did something that may have caused their child to have problems. This feeling of guilt and blame should be dispelled, if a child has ADD/ADHD, it is no one’s fault.
The following are possible causes of ADD/ADHD
- Genetic causes: We do know that ADHD tends to run in families, a child with ADD will frequently have a parent, sibling, grandparent, or other family member who has similar school histories and behaviour during their childhood.
- Biological/physiological causes: Many doctors describe ADHD as neurological inefficiency in the area of the brain which controls impulses and aid in screening sensory input and focusing attention. They say there may be an imbalance or lack of the chemical dopamine which transmits neursensory messages. The explanation is that apparently when we concentrate, our brain releases extra neurotransmitters, which enable us to focus on one thing and block out competing stimuli. People with ADD seem to have a shortage of these neurotransmitters.
- Complications or trauma in pregnancy or birth
- Lead poisoning
- Diet: ADHD symptoms linked to diet and food allergies continues to remain controversial in the medical community, current research has not given much support to a dietary connection. However, there are many strong proponents of this theory. Future research will perhaps shed more light on this topic.
- Prenatal alcohol and drug exposure: We are all aware of the impact of the high number of drug exposed infants who are now of school age. These children have often sustained neurological damage and exhibit many ADHD behaviour. Currently the statistics in the state where I teach are very alarming. Over one in every ten babies born in California today are exposed to drugs in the womb. Scientific research has not yet proven a causal relationship between prenatal drug exposure and ADD. However, drug exposed children clinically exhibit many neurological deficits and behaviour that we see in ADD children.
CRITICAL FACTORS IN WORKING WITH ADD/ADHD CHILDREN
There are many critical factors to consider when working with ADD/ADHD students. I have attempted to provide a list that is as useful and complete as possible one that I hope will make a difference in the way students learn and teacher teach.
- Teacher flexibility, commitment, and willingness: to work with the student on a personal level. This means putting forth the time, energy and extra effort required to really listen to students, be supportive, and make changes and accommodations as needed.
- Training and knowledge about ADD/ADHD: It is essential that teachers are aware that this problem is physiological and biological in nature. These children are not out to get us, deliberately. Their behaviour aren’t calculated to make us crazy, this awareness helps us maintain our patience, sense of humor, and ability to deal with annoying behaviours in a positive way. Every school site (elementary and secondary) should have in servicing to educate staff about ADD/ADHD, the effects of the disorder on the child’s learning and school functioning and appropriate intervention strategies.
- Close communication between home and school: It is very important to increase the number of your contacts and establish a good working relationship with this population of parents. If you are to have any success with ADD/ADHD students, you need the support, cooperation and open line of communication with their parent.
- Providing clarity and structure for the students: This guide emphasize the need for structure, students with attentional problem need a structure classroom, a structured classroom need not be a traditional, no-nonsense, rigid classroom with few auditory or visual stimuli. The most creative, inviting, colourful, active and stimulating classroom can still be structured. Students with ADD/ADHD need to have structure provided for them through clear communication, expectation, rules, consequences, and follow-up. They need to have academic tasks structured by breaking assignments into manageable increments with teacher modelling and guided instruction, clear directions, standards and feedback. These students require assistance in structuring their materials, workspace, group dynamics, handling choices, and transitional times. Their day needs to be structured by alternating active and quiet periods. No matter what your teaching style or the physical environment of your classroom, you can provide structure for student success.
- Creative, engaging, and interactive teaching strategies: that keep the students involved and interacting with their peers are critical, all students need and deserve an enriched, motivational curriculum that employs a variety of approaches. If you haven’t had training in multisensory teaching strategies, cooperative learning, reciprocal teaching, leaning styles, or the theory of multiple intelligence, you need to update your teaching skills and knowledge for today’s classroom. These are good topics for staff development days.
- Team work: on behalf of the ADD/ADHD student, many teachers find team teaching extremely helpful. Being able to ‘switch’ or ‘share’ students for part of the school day often reduces behavioural problems and preserves the teacher’s sanity. It also provides for a different perspective on each child. Teachers cannot be expected to manage and educate these very challenging students without assistance. A proper diagnosis is needed. With many ADD/ADHD students, medical treatment is critical to the child’s ability of function in school. Management of the social/behavioral problems these children often exhibit requires help from counseling (in school and often privately). In school counselling centres can assist in many ways, such as: behavior modification (charts, contracts), time-out/time-away, conflict resolution, training in social skills, relaxation techniques, controlling anger, and cooling down.
- You need cooperation and partnership with parents and support and assistance from administration. You are all part of the same team.
Elicit the assistance and expertise of your site resources, refer the child to your site consultation team or student study team, members of the team will probably observe the student in your classroom or other school settings. They can be of great support by attending meetings with you and parents to share concerns, provide information and brainstorm “creative” solutions. Many outside referrals for medical/clinical evaluations are initiated at the school site. Your communication with the team is very important.
You can facilitate matters before coming to your team by:
- Saving work samples: (any papers or work that reflects the child’s strengths and weaknesses) collect a variety of written samples.
- Documenting specific behaviour you see(g, falling out of chair, writing only one sentence in 20 minutes of independent work, blurting out inappropriately in class) it is important that teachers document their observations and concerns about these students. This documentation is crucial for many children to get the help they need, teachers are in a position to facilitate the necessary medical/clinical evaluation and intervention that may be needed for student success.
Note: Many times parents don’t recognize that their child is experiencing the problems that we are seeing in school. Children with ADD/ADHD present their pattern of behaviour year after year. It often takes parents a few years of hearing similar comments from different teachers to become convinced that they should pursue some sort of treatment for their child.
There is another reason for teacher documentation to be placed in the student’s records. Physicians will often see the child during a brief office visit, not notice anything significant and conclude that the student doesn’t have a problem. Often the implication is that the problem is with the teacher/school.
When the school records show a history of inattention, distractability, impulsivity, hyperactivity, a physician would be more prone to take the school/parent concerns seriously. The physician/clinician needs to determine that the child’s problem are pervasive (visible in a number of settings over a period of time). Good documentation (observation and anecdotal records) help supply the necessary evidence.
- Communication with parent: it is important to share positive observations about their child along with concerns. Be careful how you communication and voice concerns. Never tell parents, I’m sure your child has ADD, communicate your concerns by sharing specific, objective observation. ‘Becky is very distractible in my class, I have noticed that she … ‘tell parents the strategies you are using to deal with the problems in the classroom. Then tell parents that you are involving your site team for assistance, and let the school nurse or counsellor make recommendations for outside evaluation if deemed necessary.
- Administrative support: It is critical that administrators be aware of the characteristics and strategies for effectively managing ADHD students so they can support the teacher in dealing with disruptive children. Some of these students are extremely difficult to maintain in the classroom and require highly creative intervention. You will certainly need administrative support (e.g, having a student removed from class when behaviour interfere with ability to teach or other students’ ability to learn). Some intervention from highly disruptive children include: time-outs suspensions, half-days, cross-age tutors rotating into the classroom to keep the child on-task, and having parents spend the day in class with the student and meeting with the consultation team.
It is important to distribute these students and avoid placing a large group of ADD/ADHD students in the same classroom. Loading one classroom with a high number of ADHD students would burn out the best of teachers and push them to seek another profession. However, it is rare to find a classroom without at least a few ADD/ADHD students (as well as students with learning disabilities)
One of the keys to success is home-school communication and cooperation. When parents are difficult to reach and won’t come to school, follow through with home-school contracts, monitor their child’s homework, and so on; administrative assistance is also very much needed.
- Respecting student privacy confidentiality: It is important that a student’s individual grades, test results, special modifications of assignments or requirement, as well as medication issues are not made common knowledge.
- Modifying assignments, cutting the written workload: what takes an average child 20 minutes to do, often takes this student hours to accomplish (particularly written assignments). There is no need to do every worksheet, math problem, or definition. Be open to making exceptions, allow student to do a more reasonable amount (e.g, every other problem, half a page) accept alternative methods of sharing their knowledge such as allowing a student to answer questions orally or to dictate answers to a parent and so on.
Ease up on hardwriting requirements and demands for these students. Be sensitive to the extreme physical effort it takes these children to put down in writing what appears simple to you. Typing/word processing skills are to be encouraged.
- Limit the amount of homework: If the parent complains that an inordinate amount of time is spent on homework, be flexible and cut it down to a manageable amount. Typically, in the homes of ADHD children, homework time is a nightmare. Many teachers send home any incomplete the classwork, keep in mind that if the student was unable to complete the work during an entire school day, it is unlikely that he/she will be able to complete it that evening. You will need to prioritize and modify.
- Providing more time on assessment: These students (often very intelligent children) frequently know the information, but can’t get it down, particularly on tests, be flexible in permitting students with these needs to have extra time to take tests, and/or allow them to be assessed verbally.
- Teacher sensitivity about embarrassing or humiliating students in front of peers: Self-esteem is fragile; students with ADD/ADHD typically perceive themselves as failures. Avoid ridicule, preservation of self-esteem is the primary factor in truly helping these children succeed in life.
- Assistance with organization: Students with ADD/ADHD have major problems with organization and study skills, they need help and additional intervention to make sure assignments are recorded correctly, their work space and materials are organized, notebooks and desks are cleared of unnecessary collections of junk from time to time, and specific study skill strategies are used.
- Environmental modifications: Classroom environmental is a very important factor in how students function. Due to a variety of leaning styles, there should be environmental options given to students that consider where and how they work, where the student sits can make a significant difference. Lighting, furniture, seating arrangements, ventilation, visual displays color, areas for relaxation, and provisions for blocking out distractions during seat work should be carefully considered. Organize the classroom with the awareness that most ADD/ADHD students need to be able to make eye contact with you, have you close by to step forward and cue, be seated near well-focused students and be given a lot of space. There are many environmental factors that can be regulated and modified to improve ADD/ADHD student’s classroom functioning considerably.
- Value student’s differences and help bring out their strengths: provide many opportunities for children to demonstrate to their peers, what they do well, recognize the diversity of learning styles and individual approaches in your classroom.
- Belief in the student-not giving up when plans A, B, and C don’t work: there are always plans D, E, F, .. success will require going back to the drawing board frequently. These children are worth the extra time and effort.