Attention Deficit Hyperactivity Disorder (ADHD)
According to the Diagnostic and Statistic Manual of Mental Disorders Fourth Edition (DSM –IV) the essential feature of Attention-Deficit/Hyperactivity Disorder is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development (DSM-IV, 1994, p.78). Most boys appear to be affected by ADHD than girls, the ratio of boys to girls is somewhere in the region of 4:1 (O’Regan, 2007, p. 12). ADHD can be found at every IQ level, most individuals may have average or above average intelligence.
According to Prosser, Reid, Shute & Atkinson (2002) the authors claim that ADHD is now one of the most commonly diagnosed disorders among Australian and United States children. There are no known causes for ADHD, but extreme behavioral manifestations of inattention/and or hyperactivity or impulsivity are linked to abnormalities in brain neurochemistry involving neuro-transmitters. Researchers are unclear about the specific mechanisms by which these transmitters actually influence attention, impulse control and activity levels. However, there are a number of medical treatments available to students affected by ADHD that can result in improvements in the symptoms of the disorder. Doctors can prescribe methylphenidate or Ritalin, d- amphetamine or Dexedrine, Adderall, and, in rare cases, pemoline or Cylert to manage hyperactive, impulsive and inattentive behaviours (Larkins, October 2012).
List of policies and legislation relevant to ADHD
In addition to the legislation mentioned on the home page, According to the Australian Human Rights Commission website, http://www.humanrights.gov.au/disability_rights/faq/Who_is_protected_/who_is_protected_.html#defin the definition of disability for the purposes of the Disability and Discrimination Act (DDA) 1992 is:
Unfortunately, in Australia, the Commonwealth Disability Discrimination Act (DDA) 1992 covers categories in the Diagnostic and Statistical Manual of Mental Disorders (thus indirectly defining ADHD as a disability), but the DDA may not always recognise ADHD as a disability. Most states use their own equal opportunity legislation (which does not include ADHD as a disability) as the basis of special education policy because by law schools are meant to support all students. In other words, there are no specific ADHD state or federal legislation or policies specifically relating to ADHD. Some federal funding assists the states to provide education services, but primarily states must respond to demand from within their annual general education funding (Prosser, B., Reid, R., Shute, R., Atkinson, I, 2002)
Abilities Based Learning and Education Support (ABLES) 2012 http://www.eduweb.vic.gov.au/edulibrary/public/stuman/wellbeing/ABLES/ABLES_Introductory_Guide.pdf provides teachers and schools with evidence-based curricula, teaching strategies and resources to support the development of targeted learning programs that utilise the schools Ultranet to share and collaborate, provides students with access to learning tasks and support schools to help every student with a disability meet their individual learning goals. However, it is a little confusing based on information available if ABLES is actually a resource tool for teachers or a policy response to a review of the Disability Standards for Education 2005 and the Victorian Auditor’ General’s audit of programs for students with special needs recommendation that the DEECD introduce key performance indicators for the Program for Students with Disabilities that are tied to educational outcomes, as ABLES also provides schools with options for tracking performance of special needs learners. It would seem from the article Teachers Gain a new ability to help by Denise Ryan in the Age on 19/03/2012 that ABLES could be both a resource tool for teachers as well as a policy response for all special needs learners.
Characteristics of the special needs group
According to the DSM-IV diagnostic criteria for ADHD the student may have either (1) or (2) (The following points are taken from the DSM-IV, pp. 83-84)
(1) six or more of the following symptoms of inattention that have been displayed for at least 6 months to a degree that is maladaptive and inconsistent with the developmental level:
a) often fails to give close attention to details or makes careless mistakes in schoolwork
b) often has difficulty sustaining attention to tasks or play activities
c) often does not seem to listen when spoken to directly
d) often does not follow through on instructions and fails to finish tasks
e) often has difficulty in organising activities
f) often avoids or dislikes or is reluctant to engage in tasks that require sustained mental effort
g) often looses things necessary for tasks to get completed
h) is often easily distracted by extraneous stimuli
i) is often forgetful on a daily basis
2) Six or more of the following symptoms of hyperactivity impulsivity that have persisted for at least 6 months to a degree that is maladaptive and inconsistent with the developmental level:
hyperactivity
a) fidgeting
b) leaves seat in classroom or in other situations in which remaining seating is expected
c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescence)
d) often has difficulty playing or engaging in leisure activities
e) is often ‘on-the-go’ or acts as if ‘driven by a motor’
f) often talks excessively
Impulsivity
g) often blurts out answers before questions have been completed
h) often has difficulty waiting their turn
i) often interrupts or intrudes on others in conversations
The DSM-IV recognises three types of typical overall behaviour presentations of ADHD:
1) The student displays a combination of inattention and hyperactivity characteristics
2) The student displays predominantly characteristics of inattentiveness
3) The student displays predominantly characteristics of hyperactivity- and impulsiveness
The implications for classroom teachers of the findings of recent research about this area of special need
For adolescents it is really important that the teacher provides strategies to self-manage their behaviours. In a paper by Shapiro, DuPaul, Bradley-Klug 1998 on self-management strategies for improving classroom behaviour of students with ADHD their research found that when students with ADHD are taught to systematically rate their own behaviour according to the rating criteria given by the teacher the student the ADHD student was able to successfully self regulate their unhelpful behaviours. In terms of instruction approach, Esther Minksoff and David Allsop (2003) have developed an Active Learning Approach to students with ADHD. This approach has three key elements:
Strategies, which would be beneficial to the student with this special need
The ADHD student normally benefits from a direct instruction teaching approach because this approach provides clear rules and expectations about behaviours around what is expected from learning tasks. A behaviourist approach that focuses on rewards/punishments can also benefit the student particularly those students struggling to master appropriate behaviours.
Key strategies depend on the characteristic area that the teacher needs to address to ensure that the curriculum is most accessible to the ADHD student. According to (O’Regan, 2007, p. 49) the priority schedule for secondary students is as follows:
Academic achievement: Strategies dealing with improving attention
According to (O’Reagan, 2007) Hyperactive and impulsive behaviour is linked back to the issue of having a poor attention span. The teacher needs to be explicit about what attention span is and demonstrate strategies for the student to be aware of self-regulating it. (O’Reagan, 2007) suggests for the teacher to be explicit in modelling a series of incidents or examples that demonstrate when poor attention span is being demonstrated. For example the teacher might role-play distracting behaviour when watching a video. In this example the student would be asked to clarify the examples of why the teacher wouldn’t get to hear or understand the story or to rate the teachers listening skills. The teacher could also model what daydreaming is like and get the students to rate your performance in a detective-way all the while linking back to how the teacher is not paying attention. Once the students understand what paying attention is, the teacher can get the students to evaluate and reflect on how they pay attention, being aware of the times when they lapsed into not-paying attention and reasons that triggered it. The teacher needs to keep in mind, that student’s optimal attention span is actually quiet short. In 1996 two professors from Indiana University in USA found that students optimal focus period was between 8-10 minutes (Khan, 2012).
Behavioural strategies dealing with activity level
One technique to help adolescent students to build endurance is for the teacher for the learning session to be broken down for them into a series of ‘parts’ and the teacher reinforcing when each part is over.
Behavioural strategies dealing with impulse control
Impulsivity is one of the most problematic area that can have very negative impacts for the student. Teachers should again be explicit about getting the student to be aware of what is impulsive behaviour. This could be done through role-playing what it is and getting students to relay back in their own words what impulsive behaviour looks like. The teacher should also model what considered thought out action is and could role play or develop scenarios that get students to actually articulate stop, think, act concepts to manage impulsivity.
Day to day classroom management strategies
In regards to setting homework, the teacher should also remember that it takes the ADHD child about three times as long for the child with ADHD to complete their homework at home than when they do it at school (O’Reagan, 2007). The teacher should provide opportunities for the student to complete homework at school through a homework help club, or teacher supervision.
List of support networks within schools/school system for students with ADHD
The responsibility for students with ADHD has largely remained with special education practitioners or classroom teachers.The parents of students with ADHD are a great resource as well, particularly as they are likely to provide information to the teacher about what type of interventions have already been put in place.
Educational and developmental psychologists can also assist by devising suitable programs for the teacher and by monitoring the child’s behaviour.
http://www.psychology.org.au/community/adhd/
List of support networks outside of the community for students with this ADHD
The ADHD Coalition of Victoria Inc. http://www.adhdcoalitionvic.org.au/
It includes clinicians from psychiatry, psychology, paediatrics, and general practice. There are also nurses, teachers, researchers and some past and present co-ordinators of Victorian support groups for ADHD.
Bullying. No Way! Is a useful website because it provides students with strategies to reduce bullying www.bullyingnoway.com.au
List of whole-school wide interventions to support positive behaviour http://www.pbis.org/
Recommendations for the future
It is recommended that the teacher choose from the most relevant strategy based on which area the ADHD student struggles with and consult the student to ensure that the intervention is actually in their best interest. The teacher should also consider developing an Individual Learning Plan to assist the ADHD student with academic achievements and behavioural management goals. This should be done in consultation with the student and parents.
According to the Diagnostic and Statistic Manual of Mental Disorders Fourth Edition (DSM –IV) the essential feature of Attention-Deficit/Hyperactivity Disorder is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development (DSM-IV, 1994, p.78). Most boys appear to be affected by ADHD than girls, the ratio of boys to girls is somewhere in the region of 4:1 (O’Regan, 2007, p. 12). ADHD can be found at every IQ level, most individuals may have average or above average intelligence.
According to Prosser, Reid, Shute & Atkinson (2002) the authors claim that ADHD is now one of the most commonly diagnosed disorders among Australian and United States children. There are no known causes for ADHD, but extreme behavioral manifestations of inattention/and or hyperactivity or impulsivity are linked to abnormalities in brain neurochemistry involving neuro-transmitters. Researchers are unclear about the specific mechanisms by which these transmitters actually influence attention, impulse control and activity levels. However, there are a number of medical treatments available to students affected by ADHD that can result in improvements in the symptoms of the disorder. Doctors can prescribe methylphenidate or Ritalin, d- amphetamine or Dexedrine, Adderall, and, in rare cases, pemoline or Cylert to manage hyperactive, impulsive and inattentive behaviours (Larkins, October 2012).
List of policies and legislation relevant to ADHD
In addition to the legislation mentioned on the home page, According to the Australian Human Rights Commission website, http://www.humanrights.gov.au/disability_rights/faq/Who_is_protected_/who_is_protected_.html#defin the definition of disability for the purposes of the Disability and Discrimination Act (DDA) 1992 is:
- total or partial loss of the person's bodily or mental functions
- total or partial loss of a part of the body
- the presence in the body of organisms causing disease or illness
- the presence in the body of organisms capable of causing disease or illness
- the malfunction, malformation or disfigurement of a part of the person's body
- a disorder or malfunction that results in the person learning differently from a person without the disorder or malfunction
- a disorder, illness or disease that affects a person's thought processes, perception of reality, emotions or judgment or that results in disturbed behaviour.
Unfortunately, in Australia, the Commonwealth Disability Discrimination Act (DDA) 1992 covers categories in the Diagnostic and Statistical Manual of Mental Disorders (thus indirectly defining ADHD as a disability), but the DDA may not always recognise ADHD as a disability. Most states use their own equal opportunity legislation (which does not include ADHD as a disability) as the basis of special education policy because by law schools are meant to support all students. In other words, there are no specific ADHD state or federal legislation or policies specifically relating to ADHD. Some federal funding assists the states to provide education services, but primarily states must respond to demand from within their annual general education funding (Prosser, B., Reid, R., Shute, R., Atkinson, I, 2002)
Abilities Based Learning and Education Support (ABLES) 2012 http://www.eduweb.vic.gov.au/edulibrary/public/stuman/wellbeing/ABLES/ABLES_Introductory_Guide.pdf provides teachers and schools with evidence-based curricula, teaching strategies and resources to support the development of targeted learning programs that utilise the schools Ultranet to share and collaborate, provides students with access to learning tasks and support schools to help every student with a disability meet their individual learning goals. However, it is a little confusing based on information available if ABLES is actually a resource tool for teachers or a policy response to a review of the Disability Standards for Education 2005 and the Victorian Auditor’ General’s audit of programs for students with special needs recommendation that the DEECD introduce key performance indicators for the Program for Students with Disabilities that are tied to educational outcomes, as ABLES also provides schools with options for tracking performance of special needs learners. It would seem from the article Teachers Gain a new ability to help by Denise Ryan in the Age on 19/03/2012 that ABLES could be both a resource tool for teachers as well as a policy response for all special needs learners.
Characteristics of the special needs group
According to the DSM-IV diagnostic criteria for ADHD the student may have either (1) or (2) (The following points are taken from the DSM-IV, pp. 83-84)
(1) six or more of the following symptoms of inattention that have been displayed for at least 6 months to a degree that is maladaptive and inconsistent with the developmental level:
a) often fails to give close attention to details or makes careless mistakes in schoolwork
b) often has difficulty sustaining attention to tasks or play activities
c) often does not seem to listen when spoken to directly
d) often does not follow through on instructions and fails to finish tasks
e) often has difficulty in organising activities
f) often avoids or dislikes or is reluctant to engage in tasks that require sustained mental effort
g) often looses things necessary for tasks to get completed
h) is often easily distracted by extraneous stimuli
i) is often forgetful on a daily basis
2) Six or more of the following symptoms of hyperactivity impulsivity that have persisted for at least 6 months to a degree that is maladaptive and inconsistent with the developmental level:
hyperactivity
a) fidgeting
b) leaves seat in classroom or in other situations in which remaining seating is expected
c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescence)
d) often has difficulty playing or engaging in leisure activities
e) is often ‘on-the-go’ or acts as if ‘driven by a motor’
f) often talks excessively
Impulsivity
g) often blurts out answers before questions have been completed
h) often has difficulty waiting their turn
i) often interrupts or intrudes on others in conversations
The DSM-IV recognises three types of typical overall behaviour presentations of ADHD:
1) The student displays a combination of inattention and hyperactivity characteristics
2) The student displays predominantly characteristics of inattentiveness
3) The student displays predominantly characteristics of hyperactivity- and impulsiveness
The implications for classroom teachers of the findings of recent research about this area of special need
For adolescents it is really important that the teacher provides strategies to self-manage their behaviours. In a paper by Shapiro, DuPaul, Bradley-Klug 1998 on self-management strategies for improving classroom behaviour of students with ADHD their research found that when students with ADHD are taught to systematically rate their own behaviour according to the rating criteria given by the teacher the student the ADHD student was able to successfully self regulate their unhelpful behaviours. In terms of instruction approach, Esther Minksoff and David Allsop (2003) have developed an Active Learning Approach to students with ADHD. This approach has three key elements:
- Individualised Evaluation and Intervention that relies on the teacher being familiar with the student learners characteristics in terms of strengths and weaknesses and catering for them through the pedagogy
- Cognitive Learning Strategy Instruction that involves explicit instruction about learning strategies and then the teacher showing how to apply them to their subjects
- Systematic, Explicit Instruction that is given by the teacher to the student about learning objectives
Strategies, which would be beneficial to the student with this special need
The ADHD student normally benefits from a direct instruction teaching approach because this approach provides clear rules and expectations about behaviours around what is expected from learning tasks. A behaviourist approach that focuses on rewards/punishments can also benefit the student particularly those students struggling to master appropriate behaviours.
Key strategies depend on the characteristic area that the teacher needs to address to ensure that the curriculum is most accessible to the ADHD student. According to (O’Regan, 2007, p. 49) the priority schedule for secondary students is as follows:
- Completing works and tasks
- No physical or verbal aggression towards others
- Following school policy (e.g. use of mobile phones)
- No eating or drinking in class
- Timekeeping
- Adhering to the uniform or dress code
Academic achievement: Strategies dealing with improving attention
According to (O’Reagan, 2007) Hyperactive and impulsive behaviour is linked back to the issue of having a poor attention span. The teacher needs to be explicit about what attention span is and demonstrate strategies for the student to be aware of self-regulating it. (O’Reagan, 2007) suggests for the teacher to be explicit in modelling a series of incidents or examples that demonstrate when poor attention span is being demonstrated. For example the teacher might role-play distracting behaviour when watching a video. In this example the student would be asked to clarify the examples of why the teacher wouldn’t get to hear or understand the story or to rate the teachers listening skills. The teacher could also model what daydreaming is like and get the students to rate your performance in a detective-way all the while linking back to how the teacher is not paying attention. Once the students understand what paying attention is, the teacher can get the students to evaluate and reflect on how they pay attention, being aware of the times when they lapsed into not-paying attention and reasons that triggered it. The teacher needs to keep in mind, that student’s optimal attention span is actually quiet short. In 1996 two professors from Indiana University in USA found that students optimal focus period was between 8-10 minutes (Khan, 2012).
Behavioural strategies dealing with activity level
One technique to help adolescent students to build endurance is for the teacher for the learning session to be broken down for them into a series of ‘parts’ and the teacher reinforcing when each part is over.
Behavioural strategies dealing with impulse control
Impulsivity is one of the most problematic area that can have very negative impacts for the student. Teachers should again be explicit about getting the student to be aware of what is impulsive behaviour. This could be done through role-playing what it is and getting students to relay back in their own words what impulsive behaviour looks like. The teacher should also model what considered thought out action is and could role play or develop scenarios that get students to actually articulate stop, think, act concepts to manage impulsivity.
Day to day classroom management strategies
- Use a direct instruction approach making sure that directions/explanations about what is expected in relation to learning tasks is communicated clearly by using eye contact.
- Check for understanding by getting students to relay back instructions.
- Teacher should avoid multiple instructions and commands by being direct, and clear about expectations around learning tasks.
- Surround the ADHD student with good role models, or students who are able to peer coach.
- Avoid distracting stimuli, trying not to place the ADHD student in a position in the classroom where there could be too many distractions.
- The teacher might provide options for the ADHD student to have two desks, that the student could work from as they see fit.
- Make sure that assessments are created to check for understanding and not attention span.
- Depending on how well the ADHD student is able to comprehend and complete work tasks the teacher may need to develop an Individualised learning plan.
- Keep in mind that the ADHD student can easily get frustrated. Stress, pressure and fatigue can break down the child’s self control and lead to poor behaviours.
In regards to setting homework, the teacher should also remember that it takes the ADHD child about three times as long for the child with ADHD to complete their homework at home than when they do it at school (O’Reagan, 2007). The teacher should provide opportunities for the student to complete homework at school through a homework help club, or teacher supervision.
List of support networks within schools/school system for students with ADHD
The responsibility for students with ADHD has largely remained with special education practitioners or classroom teachers.The parents of students with ADHD are a great resource as well, particularly as they are likely to provide information to the teacher about what type of interventions have already been put in place.
Educational and developmental psychologists can also assist by devising suitable programs for the teacher and by monitoring the child’s behaviour.
http://www.psychology.org.au/community/adhd/
List of support networks outside of the community for students with this ADHD
The ADHD Coalition of Victoria Inc. http://www.adhdcoalitionvic.org.au/
It includes clinicians from psychiatry, psychology, paediatrics, and general practice. There are also nurses, teachers, researchers and some past and present co-ordinators of Victorian support groups for ADHD.
Bullying. No Way! Is a useful website because it provides students with strategies to reduce bullying www.bullyingnoway.com.au
List of whole-school wide interventions to support positive behaviour http://www.pbis.org/
Recommendations for the future
It is recommended that the teacher choose from the most relevant strategy based on which area the ADHD student struggles with and consult the student to ensure that the intervention is actually in their best interest. The teacher should also consider developing an Individual Learning Plan to assist the ADHD student with academic achievements and behavioural management goals. This should be done in consultation with the student and parents.