ADD and ADHD Joyce A. Hill, Ph.D. New Mexico State University—Alamogordo Colleen M. Hill, B.A.

Definitions ADHD—3 types predominantly inattentive type predominantly hyperactive-impulse type combined type OHI—other health impaired: this is the category that children can be given special education services

Diagnostic Criteria: DSM—diagnostic and statistical manual of mental disorders 6 or more symptoms of inattention OR hyperactivity-impulsivity that have persisted or at least 6 months to a degree that is maladaptive and inconsistent with developmental level Symptoms present before age 7 Impairment in 2 or more settings Clear evidence of clinically significant impairment in social, academic, occupational functioning Symptoms not part of another diagnosis

Myths Careful research has shown that sugar DOES NOT cause hyperactivity Television and video games are NOT linked to hyperactivity A diet free of food colorings and additives is not beneficial ADHD disappears in adulthood—2/3rds continue to have the condition ADHD is a fad—reports of cases back to mid 19 th century

Current Research Evidence Some indication that ADHD results from neurological dysfunction rather than actual brain damage Abnormalities in frontal lobes, basal ganglia, cerebellum Neurotransmitter abnormalities (chemicals that help in the sending of messages between neurons)

Current Research Evidence Abnormal levels of dopamine Some toxins related, exposure to lead, abuse of alcohol Strong hereditary basis

Behavioral Characteristics Russell Barkley’s Model Limitations in behavioral inhibition withholding a response, protecting a response from interruption Limitations in executive functions self-directed behaviors such as working memory, inner speech, emotional control, analyzing problems Limitations in goal-directed behavior focus on task, persistence, longer time frames

Meeting needs…What research says. Allow time between asking a child to do or say something and expecting a response Avoid overloading working memory by limiting number of steps in directions, explains, etc. Create routines for transitions Prepare children in advance for changes

Meeting Need… More strategies Planning: Divide instructional sequence into meaningful chunks Clearly Introduce: Let children know the objectives for the day Modeling: Model steps of instructions, lessons

Behavior Helpers Frequent breaks Behavior charts kept by child Cue charts and reminders on desk Posted charts of everyday routines Prepare the child ahead of time for changes in routines, or special events Visuals to cue working memory

The Medication Controversy

Frequent Questions… What are some common stimulant medications available for children with ADHD? What are possible side effects of stimulant medication? Does stimulant medication help or harm a child? Alternative treatments for children with ADHD

Common Stimulant Medications… Ritalin Adderall Dexedrine Concerta Strattera

Potential Side Effects Insomnia Dry mouth Nausea Loss of appetite Headaches Jitteriness Increased blood pressure Growth suppression

How Does Stimulant Medication Harm Children? Some children never fully stop taking their medication Side effects for adults are worse Children become lethargic Medication alone does not do the trick

How Does Stimulant Medication Help Children? Enhanced response inhibition Enhanced item recall Enhanced performance of paired associate learning tasks

Alternative Treatments Behavior modification Parent education Management training Classroom environment manipulations Motivational training

References Chelonis, J. J., Edwards, M. C., Schulz, E. G., & Baldwin, R. B. (2002). Stimulant medication improves recognition memory in children diagnosed with attention deficit/hyperactivity disorder. Experimental and Clinical Psychopharmacology, 10(4), Diller, L. H. (1996). The run on Ritalin: Attention deficit disorder and stimulant treatment in the 1990s. In M.A. Byrnes (Ed.), Taking sides: Clashing Views on controversial issues in special education (pp ). Boston, MA: McGraw/Dushkin. Hallahan, D.P., & Kauffman, J. M. (2003). Exceptional learners. Boston: Allyn and Bacon.