Transcript Addressing Barriers to Learning: Helping Students Cope

Addressing Barriers to
Learning: Helping Students
Cope with Disruptive
Behaviors (ADHD, ODD, CD)
Mental Health in the Schools: Module II
QUESTION: WHAT DO THESE
DISORDERS LOOK LIKE IN
THE CLASSROOM?
ADHD: Core Symptoms
Fidgets
Squirms in seat
Easily distracted
Difficulty waiting turn
Blurts out answers
Difficulty following
directions
Difficulty sustaining
attention
Shifts quickly and often
between activities
Forgetful
Avoidance of tasks that
require sustained
attention
Poor organization
Interrupts/intrudes
Restlessness
Talks excessively
Subtypes of ADHD (DSM-IV)
ADHD, Combined Type
ADHD, Primarily Hyperactive-Impulsive
Type
ADHD, Primarily Inattentive Type
New Thinking (Barkley, 2008)
DSM-V will probably not have ADHD,
Primarily Inattentive Type – another
disorder altogether (not impulsive,
sluggish cognitive tempo, hesitant, shy,
socially anxious)
Definition: ADHD
ADHD is a developmental disorder, or a
disorder of age-inappropriate behavior,
that is characterized by difficulties with
persistence toward a goal, working
memory, impulsiveness, and inhibition.
Onset is during childhood.
What causes ADHD?
Multiple causes
Not parenting skills
Not social factors
All reliably supported causes fall in the
realm of biology (neurology, genetics)
25-35% attributed to acquired brain
injuries
65-75% due to genetics/ heredity
Oppositional Defiant Disorder (ODD)
Argues
Loses temper, angry
Defies rules
Easily annoyed, deliberately annoys
Resentful
Spiteful, vindictive
Non-compliant
Blames others
ODD VS. ADHD-HYPERACTIVE
ODD
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AGGRESSIVE
PURPOSELY ANNOYS
DENIES BEHAVIOR
MORE DIFFICULT TO
MANAGE
ABILITY TO
CONTROL ACTIVITY
LEVEL
ADHDHYPERACTIVE
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IMPULSIVE
NOT PURPOSEFUL
SHOWS REMORSE
INABILITY TO
CONTROL ACTIVITY
LEVEL
Conduct Disorder (CD)
Aggression to people and animals
(bullies, fights, weapons)
Destruction of property (fire setting,
vandalism)
Deceitfulness or theft (lies, forgery)
Serious violations of rules (stays out at
night, runs away, truant)
Relationship between
ADHD/ ODD/ CD
ADHD can cause ODD – negative cycle
of coercive behavior
50% of ODD alone goes away in 2
years; if ODD is comorbid, it is more
resistant and a precursor to CD
CD is a precursor to Antisocial
Personality Disorder
MEDICATION
STIMULANTS
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Methylphenidate: Ritalin,
Concerta, Medadate CD,
Daytrana
Amphetamine: Dexedrine,
Adderall, Vyvanse
STRATERRA
(ATOMOXETINE)
ANTIHYPERTENSIVES

Guanfacine, Guanfacine XR,
Clonidine
Why use medication?
Results of hundreds of studies indicate
that stimulant medication and
Atomoxetine (Strattera) are the most
effective treatments available for ADHD.
Safety is well established.
Medication treatment improves 70-90%
of clinical cases and normalizes 50-60%
of such cases.
Why use medication? Cont.
Medications are convenient to administer,
with the least effort.
Can be used for years, even into adulthood.
Active in community settings where no
caregivers may be present to provide active
treatment (unsupervised activities, driving
alone or with friends, free time in schools,
bus rides, etc.)
Stimulants
Most well studied drugs in psychiatry.

Used for more than 40 years, 350+
studies, and thousands of cases.
What’s new?
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Extended release delivery systems
 The 5 P’s- Pills, pumps (Concerta), pellets,
patches, pro-drug (Vyvanse™)
Behavioral Benefits of Stimulants
Increased concentration and persistence
Decreased impulsivity and hyperactivity
Increased work productivity
Decreased likelihood of grade retention
Decreased days absent from school
Increased reading achievement by age 18
Better emotional control
Decreased aggression and defiance
Decreased antisocial activities
Benefits of Stimulants (cont.)
Improved compliance and rule following
Better working memory and
internalizing language
Improved handwriting and motor
control
Improved self-esteem
Improved attention and reaction time
during driving performance
Benefits of Stimulants (cont.)
Note on use of stimulants in
preschoolers
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Stimulant medication is considered safe to
use with preschoolers; however,
preschoolers exhibit a decreased degree of
change relative to older children.
Additionally, preschoolers exhibit an
increased risk of side effects (e.g.,
insomnia, poor appetite, and weight loss)
Side Effects of Stimulants
Largely benign; <5% discontinue use due to
adverse events.
Mild Weight Loss (mean= 1-4 lbs.)
Growth effects are short term and limited to
first 3 years of therapy
Most common:
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Insomnia (50% +)
Loss of appetite (50% +)
Headaches (20-40%)
Stomach Aches (20-40%)
Strattera (Atomoxetine)
Effective for kids, teens, and adults;no
abuse potential.
Reduces ADHD, ODD, and aggression
Also, treats anxiety
Less insomnia
Takes 3-4 weeks to get the full result
MANAGEMENT OF ADHD
BEHAVIORS
Planning and
Organization
Attention to task
Work completion
Impulsivity
Social Skills
WHAT IS YOUR ROLE AS A
TEACHER?
CLEAR RULES AND
EXPECTATIONS
FAIR AND LOGICAL
CONSEQUENCES
STUDENT
PARTICIPATION IN
ESTABLISHING
CONSEQUENCES/
REWARDS
ROLE MODEL
LOOK FOR
STUDENT
STRENGTHS
FLEXIBILILTY
Basic Considerations for
Classroom Management
Decrease total workload (How much
work does the student need to do to
show he knows and/or is proficient in
the task?)
Give smaller amounts of work at a time
Target productivity first, accuracy later
More Basic Considerations
Use the traditional desk arrangement
Seat the student close to teaching area
Keep homework to 10 minutes per grade
level
Do not retain
Establish a school ADHD liaison
Classroom Management Tips
Allow some restlessness at work area
Build in frequent exercise breaks
Organize by using color-coded binders
Use white erase boards for question
and answer times instead of hands in
the air
Classroom Management Tips,
cont’d
Always be thinking “How do I involve
this child within my lesson plan”
Schedule more difficult subjects in AM
Intersperse low with high appeal
activities
Be more animated and theatrical
Require continuous note taking
18 Great Ideas
Know that parents are Shepherds, not
Engineers
Reduce Delays, Externalize Time
Externalize Important Information
Externalize Motivation (Think Win/Win)
Externalize Problem-Solving
Use immediate Feedback
18 Great Ideas, cont’d
Increase frequency of consequences
Increase accountability to others
Use more salient and artificial rewards
Change rewards periodically
Touch more, talk less
Act, Don’t Yak
Use rewards before punishment
18 Great Ideas cont.
Keep your sense of humor
Anticipate problem settings (make a
plan)
Keep a sense of priorities
Maintain a Disability Perspective
Practice Forgiveness (student, self,
parents, others)
Punishment cont.
Loss of tokens /Response Cost
Moral essays/Reflection papers
Establish a “Chill Out” location
Formal time out in class or private room
In-school suspension or go to IBS class
The Punishment Hierarchy
ADHD children are punished 2 to 8 times
more than other children SO:
Swift justice is the key to discipline
“Do a Task” – variation of time out
-have desk in back of class with
worksheets
-child told what they did wrong and given a
number
-child goes to desk and completes number of
worksheets assigned
Peer Tutoring
Children are more sensitive to other
children so peer tutoring can be
effective.
Teach new concepts and skills to class
Break class into dyads
Have one student tutor and quiz the other
Alternate student/tutor roles
Re-organize into new dyads weekly
STRATEGY INFORMATION
SHARE
WHAT WORKS?
WHAT DOESN’T?
CASE STUDY
AVAILABLE SCHOOL-BASED
SUPPORT SERVICES