Transcript IDEA-Definition of Serious Emotional Disturbance (SED)

Chapter 11
ADHD
Attention-Deficit/Hyperactivity Disorder
• The essential feature of ADHD is a persistent pattern of
inattention and/or hyperactivity-impulsivity (DSM-IV)
• Problems paying attention and controlling their “impulses”
and behavior.
– “Andy never stops moving”
– “Mike is withdrawn and disorganized”
– “He has difficulties planning ahead and often does not
complete his assignments”
• Controversial diagnosis
– Some believe there is no such disability, the behaviors are
merely a product of environmental experiences such as poor
parenting or poor teaching
– ADHD is recognized by the courts, US Dpt of Education, etc.
Inattentive symptoms
• Failure to give close attention to details, prone to careless
mistakes
• Difficulty completing tasks
• Appears that mind is elsewhere
• Shifts from one activity to another
• Difficulty organizing activities
• Avoid activities that require sustained effort
• Disorganized work habits
• Distracted by irrelevant stimuli
• Forgetful of daily activities
Hyperactive/Impulsive symptoms
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Tendency to fidget and squirm when seated
Not remain seated when needed
Excessive running or climbing when inappropriate
Difficulty playing quietly
Often “on the go”
Talks excessively
Difficulty delaying responses – answers before question is
completed
• Difficulty waiting one’s turn
• Frequently interrupting others
Academic and Social Characteristics
• Typically do not achieve their academic potential
• Greater risk of grade retention and school drop out
– Student may be good at math, but makes careless mistakes
– Student may be bad at math do to a learning disability in addition to
ADHD
• Difficult peer relationships
– Great tendency to display bullying behaviors
– Aggression or withdrawn (more impulsive or inattentive type,
respectively)
• Half of students have another disability
Identification
• Symptoms must be present for at least 6 months
• Some of the symptoms must be displayed before the age of 7
(controversial)
• Behavior caused by a temporary situation (e.g., divorce) not
diagnosed
• Symptoms need to be exhibited at multiple settings.
• Impact social, academic and occupational areas.
• Inconsistent with developmental level.
• Usually seen by doctor first
• Interviews, scales, checklists, direct observation (Talking out,
Out of seat, Attention problems, Disruption, etc.
ADHD
• Children with ADHD can be served under the “other health
impairments” category
– Not considered a separate disability under IDEA 04, may fall
under “other health impairments”
– May also qualify under LD or ED because of co-morbidity
– Or are allowed accommodations under section 504 of
rehabilitation Act (allow for instructional accommodations for students who do not qualify
for special ed, but still need help)
• They usually attend general ed classes, requiring support.
Prevalence
• Estimates of prevalence of ADHD range from 3% to 5% of
all school-age children (APA, 2000)
• About two students in a 30-35 student class will have
ADHD
• Disorder will not be outgrown. 70% of children continue
with the disorder into adolescence, and 50% into
adulthood.
• Lots of children go undiagnosed.
Causes
• Why is finding the cause important?
• Myths about ADHD
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Poor diet
Food additives
Too much sugar
Too much TV
Fluorescent lights
• Although poor teaching and/or parenting may contribute to the
increase of problem behavior, it does not cause them
Causes
• Although most research has focused on brain and genetic causes
there are some evidence for possible nongenetic causes such as:
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Premature birth
Maternal smoking
Alcohol use
Exposure to lead
• Brain anatomy and function (lag in development)
– Although no perfect correlation between these differences and ADHD
• Genetic Causes
– Result of multiple interacting genes
– Child of an adult with ADHD has 25% of having it.
Drug Therapy
• Two treatment approaches that are widely used with
children with ADHD are drug therapy and behavioral
intervention
• Psychostimulants such as Ritalin, Dexedrine, Cylert, or
Adderall, or nonstimulants such as Strattera
• Increases the concentration of neurotransmitters,
improving memory, cognition and attention.
• Improvement in behavior and ability to learn. Although
controversial
– Academic problems need to be dealt with.
– May be dependent on the medication
Behavioral Treatment
• Direct Instruction (presentation, guided practice,
demonstration of mastery)
– Clear and explicit
– Repeat and highlight concepts many times
– High levels of accuracy before moving to another activiy
• Precision Teaching
– Method of evaluating instruction
– Direct, continuous, and precise measurements of student
performance – fluency
• Functional-based treatments
– FBA
– Behavior intervention programs should be embedded in
teaching activities
– Similar strategies used with students with EBD and ASD such
as reinforcement, token systems, contracting, etc.
Other Strategies
• Peer tutoring
– Immediate, frequent feedback following students pace
– Peers can also be behavior modifiers, providing differential
reinforcement
• Computer-Assisted Instruction (CAI)
– Use of computers to introduce new materials with graphics, words,
and sounds
• Attention maintained technology
– Response cost, token systems, self monitoring (support ABA
strategies)
Ervin et al.
• Background
– Use of FBA for intervention selection
– Antecedent manipulations for decreasing problem behavior
(task duration)
• Purpose
– Test school-based assessment model to select interventions
for ADHD
– Teacher involvement and acceptability
• Participants
• Setting
• Dependent Measures
Ervin et al.
• Hypothesis development
• Informant and structured FBA
– Joey –Paper and pencil task evoked off task
– Carl – Lack of attention evoked off task behavior
• Hypothesis testing
– Reversal design – typical conditions alternated with potential
interventions
– Joey – use of computer + escape extinction, or brainstorm with peer
– Carl – Self-evaluation of peer attention seeking behavior +
reinforcement or extinction