Attention-deficit Hyperactive

DisorderBy: Aamir K., Aditi J., Anam S., Lama A. & Sarah K.

ADHDDefinition of ADHD Attention-deficit hyperactivity disorder is a

common neurobiological disorder that can be noticed in young children

ADHD affects a high percentage of the population, it is estimated that between 8-12 % of the population has ADHD

It affects boys more than girls (3:1) ADHD is a lifelong condition that changes and

progresses as a person ages

Types of ADHD Inattentive • Inability to pay attention to details• Continuous errors on academic tasks or other activities• Difficulty concentrating on tasks/activities• Some may have auditory deficit• Difficulty following instructions• Disorganized • Become frustrated with tasks that require mental effort• Misplace items (e.g. toys or notebooks)• Easily distracted • In need of reminders for daily activities/routines

Types of ADHD Hyperactive-impulsive • Fidgity or squirmy• Inability to remain seated• Extreme running or climbing• Play activities are often loud • Always seem to be "on the go”• Excessive talking, including a high rate of interruptions• Blurting out answers before hearing the full question• Difficulty waiting for a turn within a social situation A Combined Type: • Involves a combination of inattentive and hyperactive-impulsive• The most common type of ADHD

Etiology of ADHDGenetic Factors Studies have shown that 25 percent of the close

relatives of children with ADHD also have ADHD

Possible environmental factors: Smoking during pregnancy High levels of lead in the bodies of young

preschool children Premature delivery

Diagnosis of ADHD Not all attention deficit and hyperactive behaviors are

ADHD It is difficult to diagnose ADHD, because it is often found in

conjunction with other problems There is no specific test that can detect the presence of

ADHD, so a diagnosis depends on comprehensive evaluations (e.g., DSM, interviews, observations, etc.)

Diagnosis is important to provide appropriate treatment Recent studies indicate that ADHD children showed 3-4

percent smaller brain volumes in the frontal lobes, temporal gray matter, caudate nucleus, and cerebellum

Comorbid Conditions and ADHD

Learning disabilities Tourette Syndrome Oppositional Defiant Disorder Conduct Disorder (Antisocial Behavior) Bipolar disorder

Treatment and ADHD Medical Approach

o To prescribe medication to those diagnosed with ADHD such as Methylphenidate (Ritalin) and Dextroamphtamine (Dexedrine)

o Stimulant (e.g., ritalin) and non stimulant (e.g., antidepressants, anticonvulsants) medications are prescribed

o Medication is aimed at improving attention and impulsivity, socialization, aggression, docut

o This does not work alone

(Firestone & Dezois, 2007)

Treatment and ADHD Social/Behavioural Approach

o Make the accommodations needed for the individual with ADHD

o Behavioural treatments included• Parent training• Child- focused treatment• School based intervention

Combination approaches are most common, medical approach and social/behavioural approach

(Firestone & Dezois, 2007)

Services, Therapy and Community Support for Individuals with ADHD.

Education Act Guidelines (ONT)

On December 19th 2011, students with ADHD/ADD and other neurological disorders that affect learning are entitled to specialized support and education at school.

The memorandum states “The determining factor for the provision of special education programs or services is not any specific diagnosed or undiagnosed medical condition, but rather the needs of individual students based on the individual assessment of strengths and needs.”

Main area of focus: Develop Individual Education Plans, encompassing inclusion of individual learning needs and challenges.

Education Act Guidelines (ONT)

The memorandum has now stretched the concept of ‘exceptional’ to a broad inclusive outlook addressing any condition that impedes learning as opposed to the Special Education Guide that limits the term ‘exceptional’ to five general types of exceptionality.

Care is now taken to ensure implementation of appropriate classroom modifications and enhanced teaching strategies to address their needs and challenges.

The right combination of instructional practices and behavioral management techniques in the classroom setting can enhance the learning environment for a child with ADHD.

Education Act Guidelines (ONT)

• These laws imposed in all educational institutes ensure the success and holistic development of children with ADHD while addressing arising needs and concerns while overcoming their challenges experienced on a day to day basis.

• The introduction of these laws has been met with great enthusiasm and relief by parents, experts and specialists in the field and advocacy groups around Ontario.

Academic Intervention Dr. Rosemary Tannock from OISE and the University of

Toronto in the research into practices by The Literacy and Numeracy Secretariat and the Ontario Association of Deans of Education states that the two principles behind academic intervention are – o Support and improve executive function through modified

instruction.o Reduce the cognitive load of academic tasks and avoid

overloading working memory and

(Tannock, 2007)

Teaching Practices for Individuals with ADHD

Examples of efforts to modify teaching practices for our case example Sam would involve implementing strategies such as

Emphasize direct instruction in specific academic skills Chunk, pause, and repeat critical instructions Use advance organizers, structured note-taking sheets,

manipulatives and visual representations Use teaching/learning strategies such as Mnemonics Introduce class-wide peer tutoring.

(Tannock, 2007)

In depth with Peer Tutoring• For Sam being at a stage where peer relations are of great

importance, we decided to explore the option of peer tutoring to help him meet his learning needs.

• A study by George J. DuPaul et al. (1998) uses peer tutoring as an intervention strategy to address the academic and behavioral difficulties of individuals with ADHD. The purpose of the study was to examine the effects of class-wide peer tutoring on on the task engagement, activity level, and academic performance of 19 children with ADHD and 10 peer comparison students.

• The results of the study indicate that peer tutoring does indeed have significant positive effects on individuals with ADHD and could possible have a greater effect than stimulant medication and contingency management inteventions.

Peer Tutoring ContinuedThe study implies that peer tutoring results in the following Increase in on-task behavior and a drastic decrease in

disruptive/off-task behavior. Increase in attention and active responses to academic

material which could lead to enhanced academic achievement.

The study also states that this form of intervention would focus on academic performance while working hand in hand with other treatment forms such as behavior modification.

It is also fascinating to note how the study points out the inevitable that it, is not the disability that is critical but the manner in which the educational environment is arranged.

Community Support and ADHDCommunity support is connecting adults with other parents of children with ADHD, sharing information and experiences about common concerns and providing emotional support. valuable source for creating change and sustaining an environment

suitable for children with ADHD and their families Parent Support Organizations

• Strive to connect parents of children with ADHD • Role in advocacy of rights for inclusive education • Host workshops and training seminars addressing challenges and

needs

The Ontario region’s parent support organizations include 1. Parent Education Network (PEN) 2. Parents Helping Parents3. People for Education Ontario.

Parental InvolvementParental involvement in education is essential to ensure that their child’s academic and learning needs are met at all schools at all levels. Hence there are advocacy groups and other organizations to help parents with their cause. Some of these include:

1. Ontario Federation of Home and School Associations.2. Coalition for Parent Involvement in Education.

Community Support Other organizations like ADD resources and Centre for ADHD awareness Canada work towards the Holistic growth and development of the cause for enhancing

lives of individuals with ADHD. Without these supports, the risk for early school drop out,

unemployment, and medical, judicial and economical costs to our society goes up. ( Ontario Catches up, Blue Balloon).

Services, therapy, and community supports are largely instrumental in achieving and creating an environment conducive to growth and success for individuals with ADHD

Peer Support Groups Value the importance of relationships for individuals

with ADHD and other disabilities. Serve to promote inclusion in all environments enhances peer relationships and encourages

participation in community activities Some peer support groups in Ontario include:

1. Family Alliance Ontario2. Hamilton Family Network.

Challenges Associated with ADHD

Society often argues whether or not ADHD actually exists.

It often sees a diagnosis of ADHD as an attempt to excuse the child’s inappropriate and antisocial behaviour

This is evident in Sam’s case when the school psychiatrist and the school district refused to accept his diagnosis .

Challenges Associated with ADHD

Constantly thwarted by their limited self-control

Often experience the hurt, confusion and sadness of being blamed for not paying attention or being called names

Challenges Associated with ADHD

There are many different types of attention. Individuals with ADHD could have a deficit in one or more type of deficit.

Selective attention/ distraction: is the ability to concentrate on relevant stimuli and not be distracted by noise in the environment.

Children with ADHD are much more likely than others to be distracted by stimuli that are highly salient and appealing

Challenges Associated with ADHD

Sustained attention: is the ability to maintain a persistent focus over time or when fatigued. A primary attention deficit in ADHD is sustained attention.

This makes it difficult for children with ADHD to maintain focus on uninteresting or repetitive tasks.

Challenges Associated with ADHD

Impulsivity: strong link between hyperactivity and impulsivity

Impulsivity makes it difficult to stop an ongoing behavior, resist temptations, delay gratification

As a result they may blurt out inappropriate comments or give quick, incorrect answers that are not yet complete

Challenges Due to Impaired Executive

Functioning

Challenges Associated with ADHD

The primary attention deficit of ADHD is the inability to engage and sustain attention. And to follow through on directions or rules while resisting salient distractions.

Strengths Associated with ADHD

Most children with ADHD are of at least normal overall intelligence, and many are quite bright

They work best on self-paced tasks that they have chosen

Accommodating ADHD forces the education system to find creative ways for teaching in ways that are engaging

Persons with ADHD may not need expensive devices in order to learn. Often a visual schedule, scheduled breaks and a quiet room is sufficient

Strengths Associated with ADHD

Symptoms of ADHD can be improved through medication, therapies and accommodations

Research has shown support for the benefits of stimulant medication for hyperactive children

Study on stimulant medication indicated that 75% of children with ADHD showed improved attentions, classroom and social behaviour.

Strengths of Students with ADHD

Creativity: it is speculated that children with ADHD are open minded. As a result, they think outside the box and often come up with new solutions to problems.

High energy level: students with ADHD have a lot of energy, especially when they find something that interests them.

Policies, contexts and other socio-political forces which impact on Sam, his family and

support service and therapy providers .

The Policies Canadian Charter of Rights and Freedoms

(1982)

Ontario Education Act (Regulation 181/98)

Ontario Human Rights Commission, 2004 “Guidelines on Accessible Accommodation” “A non-evident disability”

A look at the Policies The Canadian Charter of rights and freedoms (1982) states: 15. (1) Every individual is equal before and under the law and has the right

to the equal protection and equal benefit of the law without discrimination and, in particular, without discrimination based on race, national or ethnic origin, colour, religion, sex, age or mental or physical disability.

(2) Subsection (1) does not preclude any law, program or activity that has as its object the amelioration of conditions of disadvantaged individuals or groups including those that are disadvantaged because of race, national or ethnic origin, colour, religion, sex, age or mental or physical disability. (84)

(Canadian Charter of Rights and Freedoms, 1982)- This provides some fairly vague assurances for someone who has concerns

similar to Sam in his particular scenario.

Policies Continued... Under Regulation 181/98 of the Education Act of Ontario, the

Principal is responsible for ensuring that an IEP is developed for exceptional pupils.

In Sam’s case, his Principal would be bound by Ontario law to ensure that he is identified as a student with an “exceptionality” and subsequently ensure that the process outlined in regulation 181/98 is undertaken to have an IEP (Individualized Education Plan) developed for Sam.

Policies Continued.... The Ontario Human rights Commission: Guidelines on

Accessible Education states: “Individualized accommodation: There is no set formula for

accommodation. Each student's needs are unique and must be considered afresh when an accommodation request is made. At all times, the emphasis must be on the individual student and not on the category of disability. Blanket approaches to accommodation that rely solely on categories, labels and generalizations are not acceptable”.

At the end of Sam’s case, it is indicated that he receives a computer to write with. Sam may need this adjustment to his environment, but others with ADHD may not.

Sam’s Case• Sam is 12 years old• Sam was diagnosed with ADHD (in addition to his

LD).• Sam is described as “disruptive”• Sam thinks he is being “bad”• Medication is involved, but Sam has not “improved”

since taking it.• After modifications to his daily routine at school, Sam

is successful

Sam’s Case Continued…

• School Psychologist says that Sam is “Normal”

• Adjustments were made to Sam’s environment at school, resulting in improvements to his academic acheivement

• What were some of the socio-political barriers to Sam’s progress and meeting of potential????

Ableism and Oppression

• Remember back to Chapter 3 of our Textbook...

• Ableism: The belief that because persons with disabilities are not typical of the nondisabled majority, they are inferior (Mackelprang, 2009).

• Oppression: 4 main manifestations of oppression include.........(Goldenberg, 1978)

Containment• Limiting choices, exposure, and life experiences of

persons with disabilities, as well as opportunities to fully integrate into society.

• Can be geographical, psychological, or social.

Expendable Bodies• Persons with disabilities are disposable.• Pertains to philosophies such as Eugenics.• Fetuses with a high probability of having

Down’s Syndrome aborted due to a focus on pathology.

• “The bogeyman that they would somehow like to get rid of”. (p. 90)

Compartmentalization • The stereotyping of persons with disabilities,

or placing them in predetermined categories.

• “A threat to the fabric of society.” (Arokiasamy et. al., 1978).

Blaming the Victim• Provides justification for discrimination.• Focuses on the effort or perceived lack thereof

of the person with the disability to “overcome” their defect.

• This form of oppression is clear in Sam’s case. Sam is viewed as “normal” (i.e. Does not have a disability) and as such manifestations of his ADHD are seen as “bad” behaviour”

Denial of Disability• The illusion of nondisability created so that

others cannot see a perceived defect.• In Sam’s case, this has led to feelings of being

a “bad” person.• In Sam’s case, with his ADHD dianosis, he is

not the only person in denial of his disability....• Sam’s Psychologist calls Sam “normal”

(meaning he does not have a disability).

Sam as the Client• Sam takes medication because he’s told it’s

what’s good for him.• Sam is told he is normal, and essentially told

that he is some kind of deviant.

Sam as the Consumer• With advocacy from his father, Sam is able to

access technology that helps him to be successful.

• Sam is able to take part in classroom activities with his peers.

Socio-Political Factors• ADHD is not considered a “disability” by many

people.• ADHD is not easily detectable, i.e. There is no

biological test for it. • People who view disability as pathological will

not accept it as a disability as there is no easily discernable pathology.

Opponents of ADHD as a Disability and Their

Arguments • Smelter, et. al. “Is Attention Deficit

Disorder Becoming a Desired Diagnosis?”

• ADHD is not a disability• There is a “natural propensity” of persons to

escape from societal perceptions that they are deviant, and that they are “victims”.

Smelter et. al• Question parents and their motives for seeking an

ADHD diagnosis for their child.• Accuse parents of wanting the diagnosis so that it will

excuse them from being labelled as bad parents.“parents with very low incomes generally qualify for

increased Medicaid or Supplemental Social Security Income benefits if their child is diagnosed as afflicted with ADD or ADHD. Does this offer an additional incentive to have one's child diagnosed thus? Are there individuals in this world who would encourage their children to "act up" in order to obtain more money? “

Some Problems with Smelter et. al

• Indicate that behaviour associated with ADHD may be a choice that people make.

• No evidence cited from any literature sources.• Seemingly based on opinion.• Essay is troubling since the authors are

involved in the field of education.

The Psychologist and Sam

• Note the common themes from Smelter et. al, Sam’s case, the Medical Model of disability and oppression:

• 1. Sam viewed as defective.• 2. Sam’s ADHD not considered a valid “excuse”

for his “defect”.• 3. Sam and his Father are the problem (as

opposed to the environment).

References Canadian Charter of Rights and Freedoms (Section 15)

DuPaul, G. J., Ervin, R. A., Hook, C. L., & McGoey, K. E. (1998). Peer tutoring for children with attention deficit hyperactivity disorder: Effects on classroom behavior and academic performance. Journal of Applied Behavior Analysis, 31, 579-592.

Education Act of Ontario (regulation 181/98 ): http://www.e-laws.gov.on.ca/html/regs/english/elaws_regs_980181_e.htm

Firestone, P., & Dezois, D. (2007). Abnormal psychology perspectives. (3rd ed., pp. 370-374). Toronto: Pearson Education Canada Inc.

Learning Disabilities Association of Ontario, 2011. Retrieved June 25, 2013 from http://www.ldao.ca

Mackelprang, R. W., & Salsgiver, R. O. (2009). Disability, a diversity model approach in human service practice. (2nd ed.). Chicago, Il. Lyceum Books, Incorporated.

References Mental health Canada. Retrieved June 22, 2013 from http://

www.mentalhealthcanada.com/ConditionsandDisordersDetail.asp?lang=e&category=60

Ontario Human Rights Commission, 2004 “Guidelines on Accessible Accommodation http://www.ohrc.on.ca/sites/default/files/attachments/Guidelines_on_accessible_education.pdf

Robinson, T, & Tripp, G(2013). Neuropsychological functioning in children with ADHD: Symptom persistence is linked to poorer performance on measures of executive and nonexecutive function. Japanese Psychological Research, 55, 154- 167

Smelter, R.W., Rasch, B.W., Fleming, J., Nazos, P., and Baranowski, S. Is Attention Deficit Disorder Becoming a Desired Diagnosis? Phi Delta Kappan. 77(6), 429.

Tannock, R. The Literacy and Numeracy Secretariat, (2007). The educational implications of attention deficit hyperactivity disorder. Retrieved from website: http://www.edu.gov.on.ca/eng/literacynumeracy/inspire/research/tannock.pdf

Wier, S. (2010). Abnormal child psychology. (4th ed.). Toronto: Nelson Education Ltd.