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Including students with ADHD; strategies for the classroom and beyond ... By Gareth D Morewood Director of Curriculum Support, Priestnall School, Stockport Stockport NHS ADHD Conference - 19th April 2012 What is going to happen? • Give you a context where including young people with ADHD has recorded some success • Highlight some of the barriers to inclusion that need to be challenged • Offer some ideas on how to meet the challenges facing the inclusion of young people with ADHD in mainstream schools Background • My own journey • My current context • Ranges of needs • Structure of Curriculum Support • Provision & Access Map • Supporting ADHD in mainstream schools Does Every Child STILL Matter? • Being Healthy • Staying Safe • Enjoying and Achieving • Making a Positive Contribution • Economic Wellbeing Risks associated with ADHD in adolescents... Peer Group ADHD Dismissal From Job Sexual Transmission of Disease Teen Pregnancy Repetition of year Peer Group ADHD Attempted Suicide Intentional Injury Incarceration Substance Abuse 0 10 20 30 40 50 60 % of Subjects © Eli Lilly 1998, Barkley RA 1998 Evidence from where… • Success of the young people • Parent/carer feedback • Student’s own views and thoughts • Views of other professionals • OFSTED (2004, 2008, 2011) • SEF and own monitoring and evaluation A reminder - what is ADHD? Now to be considered as a disorder of age-inappropriate behaviour: Hyperactivity-Impulsivity (Inhibition – Executive Function) Impaired verbal and motor inhibition Impulsive decision making; cannot wait or defer gratification Greater disregard of future (delayed) consequences Excessive task-irrelevant movement and verbal behaviour – fidgeting, squirming, running, climbing, touching … • Restlessness decreases with age, becoming more internal, subjective by adulthood • Emotionally impulsive; poor emotional self-regulation • • • • How do we manage ADHD? • We need to think about Risks and Resilience ... RESILIENCE RISK Don’t forget families... • ADHD is not just about: – School – Medication – Brain – Community • Family have a KEY role to play too... So what might you expect? Inattention Hyperactivity Impulsivity Does not attend Fidgets Talks excessively Fails to finish tasks Leaves seat in class Blurts out answers Can’t organise Runs/climbs excessively Cannot wait their turn Avoids sustained effort Loses things, is ‘forgetful’ Easily distracted Cannot play/work quietly Interrupts others Intrudes on others Always ‘on the go’ Talks excessively DSM-IV – Diagnostic and Statistical Manual, 4th Edition (American Psychiatric Association, 1994). ICD-10 – International Classification of Diseases, 10th Edition (World Health Organisation, 1993). What characteristics may we expect? NEGATIVE POSITIVE • Short attention span • High levels of environmental awareness • Responds well when highly motivated • Flexible – ready to change strategy readily • Tireless when motivated • Goal orientated • Imaginative but with periods of intense focus • • • • • Distractible Poor planning/impulsive Disoriented sense of time Impatient Day-dreamer Unproven and Miss-truths.... • Elimination Diets – removal of sugar, additives, etc. (weak • • • • • • • evidence) Megavitamins, Anti-oxidants, Minerals (no compelling proof or have been disproved) Omega 3 Fatty Acids (Fish Oil) – one recent study with mixed results (effects at home on parent ratings, no effect at school on teacher ratings) Sensory Integration Training (disproved) Chiropractic Skull Manipulation (no proof) Play Therapy, Psycho-therapy (disproved) Self-Control (Cognitive) Therapies for Children (disproved) Social Skills Therapies for Children (in clinic) – Better for Inattentive (SCT) Type and Anxious Cases ADHD – in summary... • ADHD is probably a disorder of self-regulation • • • • • • and executive functioning ADHD persists to adulthood in 65+% of cases ADHD largely results from neuro-genetic factors Impairments exist in most domains of major life activities Co-morbidity is very common (80%+) Many advances in treatment occurred in the past decade, especially in medications ADHD can be successfully managed leading to improved life course and outcomes So lets consider Case Studies... Re-cap on characteristics... • Inattention • Hyperactivity • Impulsivity The ADHD-Friendly Classroom... • Seating • Eye contact • Small chunk tasks • Limit instructions/repeat back to you • Visual aids • Keep away from stimulations • Routines • Praise • Class rules on wall - consistency • Systems for tracking work • Immediate rewards • Avoid singling out…name the behaviour Self-help... On-line identification? • http://pediatrics.about.com/cs/adhd/l/bl_adhd_quiz.htm Financial support? • http://www.governmentallowances.co.uk/?gclid=CJtgrmFtqACFdkB4wodRWGpUA Useful websites and downloads: • http://www.chadd.org/ • http://www.adhdtraining.co.uk/downloads.php Homework [if we have to!!!]... • • • • • • • Home-school diary. Bring any homework finished or unfinished into school. Home-work clubs. Check that they hand homework in. Use an exchange system i.e. homework/sticker. Discuss any homework issues with parents/carers. Use homework trays – three different trays, colour coded. - Red – did not understand it at all. - Amber – did it, but not fully understood. - Green – understood it completely. Friendships... • Use circle time/SEAL to promote positive friendships • Allow the child/young person ‘cooling down’ time following • • • • • • play times Effective use of lunchtime assistants – supervision and scaffold – designated places/rooms Organised games at break time/play times Encourage shared tasks with peers Model appropriate behaviours Encourage and support positive friendships If the child/young person displays problem behaviours, identify the problem Inattention... • Inattentive Behaviour • What to try? Impulsivity... • Impulsive Behaviour • What to try? Hyperactivity... • Hyperactive Behaviour • What to try? New Thinking? • Professor Peter Tymms research: ‘There was a 9 month advantage in reading and maths for those (students) who blurted out answers compared with those who never did so but had similar levels of inattention.’ http://www.dur.ac.uk/research/news/item/?itemno=13826 A thought on medication... • See medication in schools policy • If the child/young person needs to take medication in school, discreetly prompt them to go to the school office [or designated place] at the appropriate time • Avoid singling out the child/young person or repeatedly asking them, ‘have you had your tablet?’ • Doctors try and use long acting medication where possible to avoid students needing to take medication in school Triangulation of support... HOME STUDENT SCHOOL MEDICAL Stockport – local offer • Stockport Services for • Young People • • Mosaic • • Primary Jigsaw • • Secondary Jigsaw • Beacon counselling • • Relate • • YOT • Aspirations Central Youth Signpost Young Carers Stockport Women's Centre Parenting Team Aiming High Parent Partnership Books and Further Information... www.addiss.co.uk Teaching the tiger by Dornbush and Pruitt Attention Deficit Hyperactivity Disorder by Russell A. Barkley How to teach and manage children with ADHD by Fintan O’Regan Hot stuff to Help Kids Chill Out: The Anger Management Book by Jerry Wilde And finally.... Working with young people who have ADHD is extremely challenging. Above all – remember to be adaptable, innovative, empathetic, and ... open minded, And remember that not one strategy fits all... Thanks for listening... Gareth D Morewood Director of Curriculum Support [SENCo] Priestnall School, Stockport www.gdmorewood.com