ADHD: Accommodations & Socialization Presented by: Jason B. Ness, Ph.D. Principal Niles Central Day School

Diagnostic Criteria – 3 Subtypes ADHD, Combined Type ADHD, Predominately Inattentive Type ADHD, Predominately Hyperactive- Impulsive Type

ADHD - Diagnostic Features Persistent pattern of inattention and/or hyperactivity- impulsivity. Behavior is more frequent and severe than is typically observed in individuals at a comparable level of development. Some symptoms present before 7 years of age. Symptoms must be present in at least two settings. Clear evidence of social, academic, or occupational functioning. Rule out PDD, Psychotic Disorder Not better accounted for by another mental disorder (i.e., differential diagnosis).

Prevalence and Comorbidities ADHD is estimated at 3-5% in school-age children (DSM-IV TR). Familial Pattern Children with ADHD frequently have comorbid LDs and behavior disorders: 50-80% (Tannock, 1998). ADHD – I often occurs with LDs and internalizing disorders such as depression. ADHD – H/I often occurs with emotional disturbances such as ODD or CD. Written language disorder more likely to occur.

“ADHD Thinking Profile” Sustained attention (visual & auditory) Working memory Processing speed Executive functioning Barkley (1997): Self-regulation, working memory, internalization of speech, planning, goal-directed behavior, & problem solving. Frontal-subcortical circuit disorder

Educators Should Be Aware That: ADHD is considered a biologically based, educational disability that is treatable (Rule of 1/3). ADHD is not due to a lack of skill or knowledge. Difficulties with sustaining attention, effort and motivation and inhibiting behavior consistently over time. Lag in social skills and organization development (>30%, Barkley, 2000). Most effective school-interventions are consistent, immediate, and strong. Collaboration between home-school is critical for positive student outcome.

Key Points: General Behavioral Guidelines Focus on teaching students a set of skills and adaptive behaviors to replace the problems. Incorporate both academic & behavioral goals. Functional Assessment (A-B-C’s). Change the environment NOT the student. Modifying academic tasks to increase novelty, address different learning styles, and incorporate physical movement (IEP or 504 driven). Consequences must be immediate, unemotional, brief, and consistently backed up.

Intervention Principles Punishment should be used sparingly. When teachers use negative consequences, they should teach and reinforce children for alternative appropriate behaviors. Punishment involving the removal of a positive reinforcer (e.g., response cost) is usually preferable to punishment involving the presentation of an aversive stimulus.

Home-Based Contingencies Select important target behaviors. The number of target behaviors may vary. Ratings should be quantifiable. Students should be monitored and given feedback during each period, subject, or class throughout the school day. Parental involvement from the outset is critical to ensure understanding and cooperation with the procedures.

Other ADHD Factors to Consider: Social Skills Training Increasing Computer Assisted Instruction Out of School versus In School Suspension Peer Interventions Self-Management/Self-Control Techniques Use of paraprofessionals

Key Points Students with ADHD have considerable comorbidity as well as considerable advantageous characteristics. Knowledge is power. Home-school collaboration is critical. Know your ABC’s. Know your ABC’s. “Thinking Profile” Social Skills Training Need for better understanding of how to match instructional materials and behavioral management techniques.

Resources for Educators and Parents Hallowell, E., & Ratey, J. (2005). Delivered from Distraction: Getting the Most out of Life with Attention Deficit Disorder. NY: Ballatine Books. Barkley, Russell A. (2000). Taking Charge of ADHD: The Complete Authoritative Guide for Parents (Revised). NY: Guilford Press Children and Adults with Attention Deficit Disorder Website: National Association for School Psychologists Website: Barkley, Russell A. (2006). Attention Deficit Hyperactivity Disorder – Third Edition. A Handbook for Diagnosis and Treatment. NY: Guilford Press