1. ADHD In the classroom: Strategies for success
Megan Bolch, PhD
Licensed Psychologist, Pediatric Care Specialists, P.A.

2. GOALS OF PRESENTATION Provide an overview of ADHD
Symptomatology
Subtypes
Causes
Treatment
Highlight educational strategies that can allow children with ADHD to utilize their strengths and allow for a successful and inclusive academic environment

3. What is ADHD? Common Behavioral condition
11% of school-aged children (Visser, 2014)
Found universally
Symptoms continue into adulthood in more than 75% of cases (Brown, 2013)
Characterized by developmentally inappropriate levels of inattention, hyperactivity, and impulsivity
Symptoms must be present before the age of 12 (DSM-V)
ADD vs. ADHD

4. COMORBIDITY
More than 2/3 of children with ADHD have at least one other co-existing condition (CHADD)
Most common:
ODD/Conduct
Anxiety
Depression
Tic Disorders
Learning Disabilities
Sleep Issues (up to 85% of children with ADHD; (Howard, Campbell, and Allan, 2012)

5. ADHD: SUBTypes Predominately inattentive
Predominately hyperactive/impulsive
Combined presentation
Children should have 6 or more of symptoms to meet criteria (17 or older, 5 symptoms)

6. ADHD IN A NUTSHELL

7. ADHD: Inattentive TYPE (30-40%)
Fails to give close attention to details or makes careless mistakes
Difficulty sustaining attention
Does not seem to listen when spoken to directly
Does not follow thru on instructions
Difficulty organizing tasks or activities
Avoids or dislikes tasks that require sustained mental effort
Often loses things
Easily distracted
Forgetful in daily activities

8. ADHD: HYPERACTIVE-IMPULSIVE TYPE (10%)
Often fidgets or squirms
Difficulty remaining seated
Runs about or climbs in situations; Restlessness in adults
Difficulty engaging in activities quietly
Often “on the go” or acts as if “driven by a motor”
Talks excessively
Blurts out before questions have been completed
Difficulty waiting or taking turns
Often interrupts or intrudes upon others

9. ADHD-ComBINED TYPE (50-60%)
Criteria met for both inattentive and hyperactive-impulsive symptoms
Consider it a disorder of executive functioning (EFHD); it’s not just attention
ANALYZE a task
PLAN how to “attack” the task
ORGANIZE the steps
DEVELOP timelines to complete the task
ADJUST if needed
COMPLETE the task in a timely manner

10. What is the CAUSE?

11. Adhd: causes Strong genetic link (Heritability of .75)
The MOST genetically determined psychological trait (Height=.91)
Brain-based disorder (prefrontal cortex and basal ganglia)
Multiple interacting genes (Cortese, 2012)
Delayed brain maturation (smaller brain structures)
Some nongenetic links include:
Prematurity
Maternal alcohol and tobacco use
High levels of lead exposure

12. Delayed BRAIN GROWTH IN ADHD (2-3 years)

13. ADHD is NOT CAUSED BY: Sugar Too much TV
Family stress (but ADHD can contribute to it!)
Trauma
Parenting style (certain types may make it worse)

14. UNDER OR OVERDIAGNOSED?
The answer is probably both!
Greater bias with hyperactive young boys
Missing inattentive girls
7 minutes with a pediatrician is not enough!
Highlight need for comprehensive testing with multiple informants (teachers, parents, child depending on their age, etc) and testing tools
Ruling out alternative causes for behavior

15. ADHD TREATMENT Comprehensive approach
Parent and child education about ADHD
Behavioral management strategies/behavioral therapy
Medication (if necessary)
Educational strategies
Even if Catholic schools exempt from IDEA, ADA, and portions of Section 504, request a plan of reasonable accommodations

16. ADHD: Classroom STRATEGIES for SUCCESS
Megan Bolch, PhD

17. Basics of BEHaVIORAL MANAGEMENT
Focus on immediate, short-term feedback and rewards
Touch more, talk less!
You will gain more with carrots than sticks!
Goal is to reinforce prosocial behaviors 5 times more than disciplining inappropriate behaviors (Avoid too many corrective comments)
Personalize the rewards and the consequences to the child

18. BASICS OF BEHAVIORAL MANAGEMENT
Describe the desired behavior or what you want to see (e.g., Sit criss cross applesauce, Take out your book and pencil, etc).
Rule of thumb to remember:
Behavior + Attention = More Behavior
Best teaching tool is simple: Describe and Praise!

19. PROVIDE STRUCTURE

20. GENERAL ADHD ACCOMMODATIONS
Preferential seating near the teacher or front of the class
Pair them with a good role model or buddy
Extended time for tests or alternate setting with fewer distractions
Directions one at a time
“Agenda coach” to ensure that they have necessary items and review the planner/homework folder and sign off on it
Breaking down assignments into smaller parts
Modifications in work, if necessary
Additional checks for accuracy on completed work (CHECK: Complete?, Have name?, Errors?, Can it be read?, OK to turn in?)

21. VISUALS, VISUALS, AND MORE VISUALS
Post classroom rules and expectations- must be oral and visual!
Simple post-it notes for expected behaviors or to provide reminders can go a long way
STOP Sign for young kids (Barkley, 2008) (red zone = lecture, yellow= desk work, green= free time)
STAR (STOP, THINK, ACT and REVIEW) for any age
Use timers or visuals for transitions (example: blocks or other trinkets that show how long is left before a transition occurs)

22. CLOCKS OR A TIMER MAY NOT WORK…….

23. DAILY REPORT CARD
Can utilize both a Daily Home and Daily School Report Card
Allows for communication with the parents
Target the major behaviors that the child is having most difficulty with and frame it positively (Examples: Keeping hands to him or herself, working quietly, accepting feedback)
Consider parents ONLY rewarding for a “good day” (unless major offense)
May use a token or ticket system

24. DAILY REPORT CARD

25. DAILY REPORT CARD

26. Daily Behavior REPORT CARD

27. ALLOW FOR SELF-Monitoring
Children with ADHD lack awareness into some of their behaviors
Provide modeling and practice at awareness by self-monitoring
Let them be a part of their plan and even rate themselves!

28. BE CREATIVE WITH REWARDS AND CHANGE THEM OFTEN!
Teacher’s helper
Eat lunch outside
Lunch with teacher
Line leader
“Student of the Day‘”
Prize box
Special note home
Play “teacher”
Messenger to the office
Grade papers
Use computer
Take a note to the office
Choose a game
Extra recess time

29. MANAGING IMPULSIVE or HYPERACTIVE BEHAVIORS
Secret Signal for blurting
Let them stand or move!
Give them a job…they may like to be the “runner” or messenger
Provide opportunities for restlessness and fidgety behavior
Brain breaks
Exercise balls or alternate seating
Don’t take away recess!
Allow a space in the classroom to calm….for everyone!

30. StAR (Stop, THINK, ACT and REVIEW)

31. TEACH THEM TO COPE IN THE CLASSROOM
Integrate deep breathing into brain breaks or counselor lessons
Use a visual like stuffed animal to teach belly breathing
Consider mindfulness or meditation as a calming tool
Use technology (Stop, Think and Breathe app, Headspace app)
Model your own ability to cope

32. TACKLE THE HARDEST TASKS EARLY!
Poor vigilance over time
Prioritize tasks- Hard, Easy, and Middle
Tackle the hardest task first!
Can reinforce then with a easier task after

33. BEHAVIORAL MOMENTUM
Ask the child to complete several high probability behaviors first and then request a lower probability behavior to be completed

34. OTHER TIPS
Use participatory teaching methods (Let the child be actively involved in teaching some lessons) or peer tutoring
Touch when praising, reprimanding or instructing
Have them repeat instructions back to you
Children with ADHD require more forms of external motivation; cues, prompts, rewards or consequences
Noisemaking may be a sign of their brain “working” or self-stimulation; telling them to “be quiet” isn’t always the answer

35. USE THEIR GIFTS AND STRENGTHS

36. HELP THEM FIND THEIR NICHE!
Help cultivate their strengths and allow the opportunity to use these in action
Art
Computers
Sports
Music
Share stories of celebrities or other successful individuals who have ADHD

37. USE THEIR GIFTS AND STRENGTHS

38. BOOKs/WEBSITES/RESOURCES TO CHECK OUT
American Academy for Pediatrics (AAP) Clinical practice guidelines
CHADD website and local support group (ADHDKC.org)
NICHQ ADHD Toolkit
ADAPT Teacher Planbook (Parker, 1992)
Russell Barkley (articles and books); “Taking Charge of ADHD”

39. ADHD: A CASE STUDY
9 year old, 4th grade Caucasian girl presenting in office who lives with supportive parents and attends Catholic school in suburban setting
History of distractibility/poor focus and poor ability to regulate her emotions with frequent outbursts as well as impulsivity (e.g., blurting, poor social boundaries)
Avoidance issues and frustration with homework with comments such as “I can’t do this”; Homework can take up to 3 hours to get through
Tested for Learning Disabilities at the age of 7 due to reading and general processing difficulties
Testing noted some dyslexic tendencies but diagnosed with ADHD, Inattentive Type
Tried on several medications for ADHD but not tolerated side effects
Recent bullying episodes that have culminated in parents considering transfer to public school

40. ADHD: A CASE STUDY
What classroom strategies might help this child find more success?
How can we help her feel like she belongs in this school environment?
What other ways can her parents support her needs at home?
Is there anything we should pay attention to that might be an important (but overlooked) factor?

41. INCLUSion or belonging
Swinton’s view: “The problem we have as a society is a real emphasis- and a quite right emphasis- on inclusion. I think at one level that’s fine. However, inclusion is simply not enough. To include people in society is just to have them there. There is a big difference between inclusion and belonging. To belong, you have to be missed. There’s something really, really important about that. People need to long for you, to want you to be there. When you’re not there, they should go looking for you. In order to integrate people with disabilities, you simply have to create a space where they can be there. Make sure you have large-print music, ramps, etc. These are important. Belonging should be the goal of all communities. Particularly religious communities. And it’s not just for people of disabilities….it’s for all of us.”

42. INCLUSION WORKS!