adhd and the counselor -...

ADHDand

The CounselorCounselor & Educational Strategies for the

Various Types of ADHD

F. Russell Crites

(C) 2004 F. Russell Crites 2

Who Gets ADHD?Barkley suggested that 7-8% of school –aged children have ADHD

ADHD has historically been identified primarily in boys. However, a substantial number of girls suffer from ADHD as well.

Based on Clinic referred samples, the male/female ratio of ADHD is 9-10 to 1.

In community samples the ration is approximately 2-3 to 1 male/female.


ADHD Studies60-70% of students who go on stimulant medication show improvement.ADHD kids on medication have a 50% less chance of having a car accident. Barkley reports ADHD students have:

More citationsMore accidentsWorse accidentsMore suspensions/revocations

35% of childhood ADHD kids have ADHD as adults.22% of hyperactive children studied were found to be chronic snorers (Pediatrics 2002, University of Michigan).Children with sleep apnea are likely to be diagnosed as being ADHD (Pediatrics 2002, University of Michigan).Stimulants decrease adolescent drug use by 5.8% (Pediatrics 2003)Barkley determined that the symptoms of ADHD decrease with age.Approximately 70-80% of adolescent maintain the disorderApproximately 46-66% of young adults (age 20-26), maintain the disorder.


Four Types of ADHDDSM-IV-TR

ADHD Predominantly Inattentive

ADHD Predominantly Hyperactive/Impulsive

ADHD Combined Type

ADHD NOS


The risk for comorbidity with other psychiatric disorders is high.Long-term follow-up studies have demonstrated that individuals with ADHD and comorbid disorders have poorer prognoses and greater hospitalization rates than those with ADHD alone.

Butler and colleagues observed that amongHospitalized children with ADHD:

36% had depression22% had bipolar disorder3% had dysthymia8% had an affective psychosis.Only 31% had no concurrent affective diagnosis.

Barkley observed

40-70% had Oppositional Defiant Disorder20-56% had Conduct Disorder10-40% had Anxiety Disorder

Comorbidity Studies


ADHD and Depression

In a long-term follow-up study by Biederman and colleagues, the baseline rate of major depression in children diagnosed with ADHD was approximately 30%.

At 4 years, the rate was over 40% in children with

ADHD compared with approximately 5% in controls.


Depression PrimaryBased on the Biederman study, 70% of children referred for either severe or mild depression were found to have comorbid ADHD. In addition, the younger the age of onset of depression, the higher the prevalence of ADHD in the children.

When classified by age, rates of ADHD were 84% in children ages 0 to 7 years,

66% in children ages 8 to 12 years,

39% in children ages 13 to 18 years.


ADHD and Bipolar Disorder

Because of the symptoms shared between mania and ADHD, it is often difficult to discern whether the child has bipolar disorder, ADHD, or both.

Mania and ADHD in children are similar with respect to distractibility, physical hyperactivity, and talkativeness.

Children with non-comorbid ADHD do not manifest mood disturbances. This suggests that the presence of mood instability is indicative of bipolar syndrome.


Neuroscience and ADHD

SPECT Scans or Blood Flow Studies (Nuclear Medicine studies that reflect blood flow in the brain).

www.amenclinic.comwww.brainplace.comwww.brainmattersinc.com

Six types of ‘ADHD’ have been identified using SPECT and other functional studies of the brain (PET, FMRI, EEG, QEEG).

http://www.amenclinic.com/

http://www.brainplace.com/

http://www.brainmattersinc.com/


Six Types of ADHD Based on Neuroscience

Using SPECT scans Dr. Daniel Amen identified six types of ADHD.

InattentiveClassicOver-focusedTemporal Lobe LimbicRing of Fire

See www.amenclinic.com or readDr. Amen’s book entitled, Healing ADD:

The Breakthrough Programthat Allows You to See and Heal the

6 Types of ADD.

http://www.amenclinic.com/


Inattentive ADDInvolves a normal resting brain, with reduced metabolic activity in the dorsolateral prefrontal cortex during concentration. Primary symptoms include:

inattentiveness, sluggishness, slow-moving, low-motivation, frequent boredom, with sufferers frequently described as space-cadets, daydreamers, or couch potatoes. (13)


Classic ADDInvolves a normal resting brain, but during concentration there are decreases in metabolic activity in the underside (orbito-frontal) and topside (dorsolateral) prefronal cortex. (9)It should be noted that the “lion’s share” of brain metabolic activity - about 40%-goes to operating the membrane sodium-potassium pumps that make the brain electrical activity possible. (10) Thus, reduced brain metabolic activity necessarily equals reduced brain electrical activity. And since brain electrical activity drives neurotransmitter release (11), reduced brain metabolic activity also equals reduced brain neurotransmitter activity.Amen has defined the primary symptoms of “classic” ADD (really ADHD) as:

inattentiveness,distractibility, disorganization, hyperactivity, restlessness and impulsiveness. (12)


Over-focused ADD

SPECT findings show increased metabolic activity at rest and during concentration in the anterior cingulategyrus, (a brain region connecting the prefrontal cortex and limbic system). During concentration there is also reduced metabolic activity in the orbitofrontal and dorsolateral prefrontal cortex. Over-focused ADD people:

have trouble shifting attention and frequently get stuck in negative thought or behavior patterns.they are also obsessive and worry excessively.they tend to be inflexible and are frequently argumentative and oppositional. (14)


Temporal Lobe ADD

At rest and during concentration there is decreased (occasionally increased) temporal lobe activity. During concentration there is typically reduced activity in the orbitofrontal and dorsolateral prefrontal cortex. Temporal lobe ADD symptoms include:

inattentiveness, impulsiveness, learning difficulties, unstable moods, irritability, dark thoughts, and aggressiveness. (15)


Limbic ADDSPECT findings include increased deep limbic activity (thalamus and hypothalamus) both at rest and during concentration, and decreased activity in orbitofrontaland dorsolateral prefrontal cortex. Symptoms include:

inattentiveness, low-grade depression, low energy, feelings of hopelessness, chronic negativity, and perceiving situations in the worst possible light. (16)


Ring of Fire ADDSPECT findings include, both at rest and during concentration, patchy increased activity across the cerebral cortex, with focal areas of increased activity, especially in the parietal lobes, temporal lobes, and prefrontal cortex. Symptoms are:

inattentiveness with extreme distractibility,anger/irritability, moodiness, verbosity, and extremely oppositional.


General Treatment Information for All forms of ADHD

You must intervene immediately to assist with change.Skills can be taught, but there must be external reminders (post lists, schedules, rules, etc.).Use a Planner to break up long tasks.Use external motivation (internal or intrinsic motivation does not work well).Discipline: Must be held accountable for actions.


Managing Inattentive ADHD


Areas of Executive Function and Inattentive ADHD

Planning (includes Prioritizing and Time Management)Organizing Materials & SpaceActivating to Work (Initiate)Focusing (Regulating Alertness & Sustaining Attention)Processing SpeedSelf-Monitoring (Monitoring Behavior & Emotions) Shift or TransitioningEmotional ControlWorking MemoryAccessing Recall & Short-Term MemoryInhibition or Response Regulation


Problems with Planning

Strategies for Planning

Once he has thought about what he must do to complete a task, structure planning and organization efforts around it.Assign a peer study buddy who can model appropriate behavior.

A good student who can help ‘teach’. Someone who knows how to plan.

Teach the student to accurately predict how much time it will take to complete a task or project. You can start doing this by asking the student how long a shorter task might take if he really focused on it. Use a reward to help the student maintain on task behavior. Give this student helper ‘cards’ that have steps for common routines or assignments. This can be used for math formulas, approaches to specific types of writing, etc. Use the Planning Backwards worksheet.


Problems with OrganizationStrategies for Organizing

Have this student keep everything in a specific place. If his desk area becomes untidy have him clean it up before he leaves that day. Students will need assistance in developing and maintaining an organizational system. Students will periodically need to be checked to make sure that their organizational system is being used properly. This can be done at the beginning or the end of the day. Students will need to have clean out times for their desk, backpack and locker.Use the Organizational Checklist (see Book entitled, Executive Dysfunction).Teach the student how to understand time better (Time ManagementWorksheet). Teach the student how to Prioritize what is most important.


Problems with Activationto Work

Strategies for Activation to Work

Assist the student in starting the assignment.Increasing structure in the environment or in the activity at hand will help the student activate to tasks more quickly. Make sure the student understands teacher instructions. Place this student around peers that can serve as models to help him get started on tasks.


Problems with Processing Speed

Strategies for Processing Speed

Have students write down brief notes--not extensive. Allow them to turn in their notes for teacher notes at the end of class. SSummarize frequently in class to help give the student more time to process and review information.The rate of presentation for new material may need to be altered for some students. If too much is given at a time it will overload him and he will learn very little.Give this student additional processing time, or time to rehearse the new information before he is asked to share or use it.Give this student more time to formulate answers and respond to questions.Teach the student to write down brief bullets about things he did not understand.


Problems withSelf-Monitoring

Strategies for Self-Monitoring

Students who have problems with self-monitoring may not understand the impact of their behavior on those around them. Discuss the behavior and how it impacts others in a private setting away from their peers.Encourage the student to self-monitor his own behavior. This helps build responsibility, and will often cause the student to watch his own behavior more closely, thus reducing inappropriate behaviors (see section that has worksheets for self-monitoring). SHave the student set goals for accuracy rather than speed. This slower speed can help him increase attention to errors and improve his work.


Self-Monitoring Single Area By Frequency

Behavior to Be measuredMeasure by Class PeriodOnly ten marks per day or use a form that checks by period.


Self-Monitoring Options

Self-Monitoring Worksheet Single Behaviors by FrequencySelf-Monitoring Worksheet Multiple Behaviors by FrequencySelf-Monitoring Worksheet Single Behavior by PeriodSelf-Monitoring Worksheet Multiple Behaviors by Period


Problems with Sustaining Attention

Strategies for Sustaining Attention

Make frequent eye contact with the student to assist him in sustaining attention. A simple glance can bring the student back from a daydream.Utilize a wink, smile, nod or touch to the shoulder or desk to help redirect a student to the work at hand.Verbal redirection to task (preferably a whisper and in close proximity).Use visuals, colors to help maintain attention.Use a flashlight.


Provide this Student With Low-Distraction Work Areas

Provide this student with a quiet, distraction free area for quiet study time and test-taking. It is the responsibility of the teacher to take the initiative to privately and discretely (do not draw peer attention to the student) "send" this student to a quiet, distraction-free room/area for each testing session. It is important to assure that once the student begins a task requiring a quiet, distraction-free environment that no interruptions be permitted until the student is finished.Always seat this student near the source of instruction and/or stand near student when giving instructions in order to help the student by reducing barriers and distractions between him and the lesson. In order to reduce distractions, computers and other equipment with audio functions operated in this student’s classroom or designated work areas must be used with earphones to eliminate the sound being broadcast into the classroom or designated work area.


Problems with Transitioningor Flexibility

Strategies with Flexibility (transitioning)

Provide lots of structure. Post schedules and changes on the board, verbally remind the class what will be happening during the day and put the schedule on the students desk if he has difficulty with transitioning. Prepare the student for any change in routine (preferably a day in advance if possible). Announce what is going to happen and give repeat warnings as the time approaches. Use cue cards that can be placed on the students desk to aid in transition. The card would have the specific steps you would want to teach. For instance, the title would be, ‘How to Make Transitions’ The three steps to transition efficiently might be:

1. Begin transition as soon as you are told to do so.2. Put away unnecessary materials3. Get what you need for the next activity.


Daily Schedule for Increasing Flexibility

Transitioning can be a hard thing for many students. If this is the case daily schedules can be beneficial. Schedules can be developed for:

HomeSchool


Problems with Emotional Control

Strategies for Emotional Control

Students should be taught response delay techniques. For instance, consider alternatives before you react, practice leaving a situation that is frustrating, counting before responding, etc. It is important that you teach this student to think about how people would feel, what they would think, etc., before he reacts emotionally.Students would benefit from being able to discuss upcoming situations or events that may provoke an emotional outburst. When an outburst occurs help the student process the situation that led up to the event. This should be done in a calm, non-threatening manner. How could you have handled this in a better way? What could you do different next time?Use a self-monitoring form to help with monitoring emotional control.


Basic Abdominal Breathing For Emotional Control

This is a classic method for reducing stress and anxiety. It can also be used to help a student who is experiencing unwanted emotions. When he is utilizing this method it is hard for him to experience the negative or unwanted feelings. Find a quiet place to sit or rest.Breathe deeply and slowly through your nose (take 3-4 seconds to breathe in and 3-4 seconds to breathe out).As you breathe focus on the air as it goes in and out of your nose. Use abdominal breathing, not your chest when you breathe. If you are lying down you should see your stomach rising and falling, not your chest.


Problems with Utilizing Working Memory

Strategies for Utilizing Working Memory

Due to working memory issues the student may have difficulty keeping track of more than one or two steps at a time. He should be provided with a written checklist of steps required to complete a task. Allow the use of a visual aids, checklists, etc.Teach the student to use outlines and underlining to help with learning and memory. Frequently change tasks for students in order to alleviate some of the drain on working memory.Use the Working Memory worksheet.


Problems with Accessing RecallStrategies for Accessing Recall

Allow the use of a visual aids.You may teach the student to use a card system for memorizing.Many students have difficult assessing recall. It’s not that they don’t have the information in their brain. It’s that they have trouble with retrieval. Use recognition based assessments to obtain a true measure of what the student is learning.Have students look up when trying to remember something….not down.See Memory and Eye Position handout.


Memory and Eye PositionGrinder, 1995 studied eye position and suggested that different eye positions

occurred when the mind was doing different things. Here are some examples:

Eye Position Probable MeaningLooking up to the left Memory

Looking up to the right Imagination

Looking to the right Auditory Imagination

Looking to the left Auditory Recall

Down to the left Self-talk

Down to the right Kinesthetic—how it feels

This is accurate for about 90% of learners. So…..1.) Recommend that a student look up when he is trying to recall something.2.) Encourage students to check if their auditory memory improves when they look to the left (most people recall auditory information best when they look to the left….a smaller group does better when they look to the right.

DON’T: Force a student to look at you when he is trying to recall something. You may be shutting down the student’s ability to think and find things in memory.


Building Frameworks for Memoryand Recall

One very helpful method for building memory and recall is called Mental Frameworks. Mental frameworks are systems that are meant to helpthe individual remember designated information. Frameworks allow you to store and recall vast amounts of information.

Mental frameworks can be based on anything your child chooses to use. Each mental framework that he builds should only have ten areas and each framework should be as different from the other as is possible. This helps reduce the confusion of information. Some examples ofpossible frameworks are:

Your homeYour businessSpecial points of interest between your home and the grocery store, church, different cities, etc. A journey!Your officeYour bodyClassroomSchool


Mental Framework: The BodyForehead Tomatoes: See a huge bright red tomato pulsating on your

forehead.Nose Molasses: See a huge glob of Molasses as they drop

from your nose.Mouth Steak: See an oversized steak that is stuck in your mouth. Chin Orange: See a hundred small oranges that form a beard on your

chin.Chest Bananas: See a bunch of yellow bananas waving across

your chest. Stomach Ice Cream: See a huge ice cream maker strapped to

your belly. Thigh Mustard: See bright yellow mustard stains on your upper pants. Knee String: See a ball of string bouncing up and down on your knee.Calf Band-Aid: See a huge pink band-aid that wraps around your

knee.Foot Eggs: See hundreds of little eggs falling off your feet and

cracking open on the floor.


Inhibition or Response RegulationTeach the student to give good apologies when he reacts or is impulsive.Provide more structure in his environment. The less structure he has the more impulsive he will be. Teach specific skills for multiple situations. For instance:

How to join in on a conversationHow to join in play with other kidsHow to get the teacher’s attention

Pre-teach in every situation that you can. If it is about to be quiet time tell the class what that means and when it will start. Always communicate expectations prior to a change in activities.When a student exhibits an impulsive behavior like talking out of turn attempt to model the correct action. For instance, if the student interrupts the teacher can raise her hand as she looks at him and wait for him to get her attention appropriately. Ignore any student who speaks without raising his hand. Focus on students who do raise their hand first. If the impulsive child does raise his hand immediately reinforce him by selecting him to talk or make a comment. If a student is impulsive, using a verbal prompt remind him of what is appropriate. For instance, you may say, “What are you supposed to do to get my attention?”


Six Steps to Addressing Impulsive Behaviors

1. When your child exhibits an impulsive behavior identify a positive statement that counters the behavior.For Example: I will raise my hand before I speak in class. This counters ‘Talking without permission.’

2. Every evening when he goes to bed he should say his counter five times. The same thing should be done every morning.

3. When he is at school have him say the counter before each class starts. 4. If he exhibits the impulsive behavior have him say the counter to

himself ten times. 5. Have him use a self-monitoring worksheet to help him keep track of

how well he is doing. 6. If he does well he should be rewarded either at home or at school. This

should be predetermined so he will have additional motivation to work on the impulsive behavior.


Strategiesfor Classical ADHD


Adaptations for a Student with Hyperactivity

Strategies

Allow the student to move around. Provide opportunities for physical action – pace in the rear of the classroom, do an errand, wash the blackboard, get a drink of water, go to the bathroom, etc.Make sure the student is always provided opportunities for physical activities. Do not use daily recess as a time to make-up missed schoolwork. Do not remove daily recess as punishment.Permit the student to play with small objects kept in their desks that can be manipulated quietly, such as a soft squeeze ball, if it isn’t too distracting.


Over-Focused ADHD


Pre-Correction for Anxiety Reductionin ADHD

If you know you have a student that has a tendency to react, use pre-correction. Each time you need to ask the student to accomplish a task that he might be reactionary about do the following. Here is an example of how you can reduce reactionary behavior when you give back a paper to a student.Step One: State that you are going to give back a paper he has completed that you have scored. Step Two: Say something positive about the paper.Step Three: Explain what needs to be corrected on the paper.Step Four: Tell the student exactly how much time he has to correct it (minutes, day, etc.).


Example:

1. Johnny, I’m going to hand back the worksheet you did for me yesterday.

2. You did a great job on most of your questions. I was really impressed.

3. However, there are three questions that I would like you to look at again and correct.

4. I’d like you to have this completed by tomorrow when it’s time for class.”

NOTE: This is an also an example of a ‘Feedback Model’ that actually helps students learn how to more efficiently produce work at school. Simply marking red through wrong responses do not teach the student anything of value.


Quick Relaxation Techniquefor ADHD Students

Step One: Recognize worry, anxiety, tension.Step two: Do a body scan. Start with the top of your head. Relax your eyes, open your mouth a little, relax your shoulders,arms, back, stomach. Relax your hips, legs, wiggle your toes and let them relax.Step Three: Breath through your feet. Feel the air as it rises up your legs and centers in your stomach. Sense the air as it moves.Step Four: Exhale slowly and feel the air go back down your legs and out your feet. Focus on how the air feels as it goes down your legs and out the bottom of your feet.Step Five: Repeat three and four times or until you feel more relaxed and calm.


Face-Saving Strategy to Improve Compliance

The following technique is used to help a student save face and not be embarrassed when confronted by a teacher when his behavior is unacceptable. Although this cannot always be used it is important to attempt to use this as much as possible. When used, this technique will promote a better relationship with the student as a result of not making him look bad in front of his peers. This also helps reduce power struggles in the classroom.Inappropriate Teacher Statement: “Johnny, I need you to take out your science book now and pay attention, or I will have to send you to the office!" Result: This causes the student to be put in a position where he looks bad. He cannot comply without appearing to have done so merely to avoid the threatened disciplinary consequence. To comply would suggest to his peers that the threat is a ‘concern’ to him.Appropriate Teacher Statement: “Johnny, I need you to take out your science book and pay attention. We have a test coming up an we need to make sure that you do well so that you can continue to be eligible to play for the basketball team. They certainly would miss having you on the team!"


Strategies for Over-Focused ADHDAnxiety or Obsessive Compulsive Issues

StrategiesAs with all disabilities it is important that the students peersunderstand what is happening. In many cases it is helpful to educate the students in regards to the specific disability that may be present, e.g., ADHD, Obsessive Compulsive.Due to compulsive tendencies you may need to accommodate situations and behaviors that the student has little or no control over.Watch to see if this student is experiencing too much stress or pressure as a result of school assignments, homework, tests, or other activities. If there is it would be in this student’s best interest to reduce pressure. Allow the student to redo assignments to improve scores or finalgrades. This reduces self and other imposed pressure and stress.When a student is obsessing you may want to use distraction to get him ‘unstuck’. Sometimes simply giving the student something to do, providing a physical activity or changing the environment can help redirect him..


Be attentive to any changes in the student’s behavior. Mild changes may suggest agitation or anxiety which can lead to bigger problems. It is important to help these students learn how to relax and de-stress. The counselor may need to teach them relaxation exercises and breathing techniques to help decrease symptoms of anxiety.Provide a place where it is safe to make mistakes. Obsessive/Compusive students have extreme anxiety and need to have as much of their anxiety reduced as is possible. Provide a safe place to calm down, a safe place to do testing, etc. When a student seems to be anxious or stressed out you should consider using physical exercise to help reduce the symptoms. Use soothing music (the Mozart Effect). Such music is peaceful and relaxing to most students.


Limbic ADHD


Teaching Positive Self-TalkNegative tapes are negative messages you send to yourself that are destructive or

unhealthy.Negative Tapes

Negative tapes do not have to be obvious to be damaging. There are two types of negative tapes that can cause serious problems for yourself and relationships. Obvious Negative Tapes: These types of tapes are the kind that can be easily identified. Here are some examples of negative tapes.

"I can't believe how stupid I am." "I just can't do that." "He'll never be interested in me." "I could never learn to be a ___!”

Subtle negative tapes: These tapes are often deceptive. They may appear to be positive in nature, but in reality are extremely negative. To better understand what these tapes sound like let's look at some examples. A subtle negative tape appears to be a positive message, but is framed in a negative way. Here are some examples of subtle negative tapes and a positive counter:

Subtle Negative Positive Counter"I won't let people make me feel bad." “I control how I feel.” “I will not be negative." “I will be a positive person.”


Reducing Depression By Doing Things for Others

Tell a peer that they look good…you like the way they are dressed, etc. Send a card of encouragement to someone.Write a letter to your parents telling them how you appreciate how they have watched out for you…and anything else you can think of that is positive. Don't avoid other students who make you unhappy. Think of ways to be nice to them. If they don’t respond, don’t worry, just go to the next one and do something nice. As you walk through the hallways, cafeteria, classes at your school, smile and say "hi" to the other students even if you don’t know them. Most people won’t expect you to be nice. Regardless, it will make many students you meet feel better. Find people who need help in some way and do something to help them. Get out of yourself and focus on others.


Strategies for Limbic ADHD

Teacher/CounselorSeek out and reinforce success as much as possible. ADHD students need and benefit from praise, encouragement and positive reinforcement.Find things that the student does well and allow him to successfully do them in front of his peers. Allow the student to spend time with a preferred peer doing something enjoyable, e.g., a game, activity, etc. This will help reduce depressive tendencies.Identify fun activities that the student can participate in. Set him up for success. Call this student by name and let him know how important he is to you.


Temporal Lobe ADD


Proactive Interventions for Angry ADHD Students

When you have a student in your classroom that has a tendency toexhibit angry behavior you can do a number of things to be pro-active in managing the behavior. These interventions are more effective if they are accomplished when the student is not in an angry state.They are primarily preventative in nature. As such, they are not intended to be used to de-escalate anger when it occurs.General

Help the student focus on accomplishments instead of failures. This can help keep the student’s anger in check. Teach the student to use positive self-talk. This can help the student talk himself down from a situation where he normally would act out his feelings. Let the student know about the consequences that may occur when he gets angry.

Classroom AidsStuffed animals to help a student calm down.Post the class schedule. EWrite down changes in routine in advance (at least one day if possible) and place on overhead and/or board.


Environmental ChangesUse proximity control. Stay close to this student when he is in your classroom.Provide a quiet place where the student can work independently, away from any peer interaction that may ‘trigger’ him. Move the student away from other students who may try to ‘trigger’ his anger.Put the angry or defiant student in the middle of a group of students who are hard workers.

Relationship BuildingStudent gets to eat lunch with teacher.Spend 2-5 minutes with student 3-5 times a week.Greet the student by name in hallway in front of others.Praise the students accomplishments in front of others.

Things to checkIs student on medication?If so has he taken it today? Does he take it regularly?Monitor behavior in relationship to medication.Check to see if anything has changed, e.g., home, physically, etc.?


Diffusing Anger Student Strategies

Remember, You Can’t Be Rationalwith an Irrational Person

When Anger is Not directed toward you:1. If a classmate gets angry you should ignore him as much as is possible. Do not try to ‘fix’ the problem. Let your teacher take care of the problem.2. If you are physically close to a student who is angry and you think he may strike out at you, get up and walk to the teacher and express your concern.

Only do the following if you know the person and you are assured that you are not in danger!1. Sit down with him, let him vent and give him time to calm down.2. Give feedback to the person. Restate what he has said in summary and/or tell him what you believe he is feeling, e.g., anger, frustration, hurt, etc.3. Help him problem solve the situation. What could be done to improve the situation?


If Anger is Directed at You:1. Learn how to use the ‘Protective Shield’.2. Learn how to use assertive responses when

someone is angry or critical (Fogging).3. Find allies that you can keep close to you.4. If you’re cornered listen to what the person has to

say. Don’t argue (Fogging)!5. Don’t become counter-aggressive. Stay calm when

the person directs his anger towards you.6. If someone is being verbally abusive tell him you will

leave if he continues. If he continues, walk away.

7. Don’t show angry people that they have gotten to you. Smile, use a little humor and ease your way out of the situation.


Protective Shield

Purpose: The purpose of the Protective Shield is to have a way to protect yourself emotionally when a someone is saying things that are hurtful or negative in any way. It also gives the student a chance to vent without you becoming counter aggressive.

Steps1. When some one is being angry or hurtful towards you, you must put up your shield.2. Visualize a large invisible shield that covers you from head to foot.3. This shield keeps any words from harming you. Not only that, but if you focus enough it will actually help you tune out negative things that the other person is saying.4. Focus on the shield, see what it looks like. Actually see the words splattering against the shield and dropping to the ground where they can do you no harm or going to each side of you.5. Hold up your shield as long as it is needed and put it away when it is no longer necessary.


Fogging

Fogging is a skill that helps you diffuse anger & defiance. Youdo this by accepting criticism or anger by calmly acknowledging that there may be some truth to what the person is saying. This allows you to maintain your own belief system about self and others yet takes the joy of putting others down away from those who are negative. It can also reduce anger states because you are not disagreeing with the person.Example:John: "You are not fair. You let some of the kids get away with stuff and I can’t get away with anything."

Teacher: "You could be right John. If you want, we can talk about this later after I’ve thought about it.”


Strategies for Temporal Lobe ADHD

Teach anger control techniques.Be very specific about what expectations you have in the classroom. In addition, when you correct focus on explaining what a studentshould do, not what he shouldn’t do.Remain calm and speak with a non-emotional voice when attempting to redirect an angry student. Do not try discipline a student who is out of control physically or emotionally. Attempt to get them out ofthe classroom and to a safe place so you can address the problemonce the student has calmed down.Provide a safe place where student can deescalate.Have staff trained in safe restraint techniques for when student is an immanent danger to self, others or when significant property damage may occur.Staff should also be trained in self-defense techniques.


School should have a crisis team that can handle physically aggressive students. Specific staff (counselor) should be trained in the development of therapeutic report to assist in bringing down the student from any dark or aggressive tendencies.Teach this student to remove himself from the classroom before asituation escalates out of control. When he does this reward him.Teachers should have a method for classroom clears* if the student goes into a rage or becomes aggressive.Make a laminated pass that the student can use to leave class when he feels that a situation getting out of control. If the student has a tendency to get upset easily you may want to seat him close to the door.Teachers should be trained to avoid being pulled into power struggles. When possible they should utilize humor to defuse and deescalatetension.Relaxation strategies….again!* Classroom Clear: If you cannot get the angry student out of the classroom, you must get the rest of the kids away from him to reduce the possibility of harm to other students. Have a student lead his classmates out to the library while another student goes to the office to get help.


Additional Strategies


General Treatment Information for All forms of ADHD

You must intervene immediately to assist with change.Skills can be taught, but there must be external reminders (post lists, schedules, rules, etc.).Use a Planner to break up long tasks.Use external motivation (internal or intrinsic motivation does not work well).Discipline: Must be held accountable for actions.


General Classroom Management Strategies For ADHD

Communicate a Set of Expectations and Rules.Teach what is acceptable or unacceptable.Provide maximum structure and routine.Be predictable and consistent.Practice, model and review behavioral expectations and rules.Give consequence immediately if a rule is broken!!!!


Setting the Proper Environment

Seat the student closest to where the teacher is most often in the classroom.Avoid putting the student near distracting stimuli.

For example:Air conditioner, Heater, Door,Windows, High traffic areas

Provide a stimuli reduced study area that can be used by all students.Surround ADHD students with good role models. Encourage cooperative learning.


Alter Presentation of Lessons or Accommodations for Assignments

Make sure all homework instruction and assignments be clear and provided in writing (not simply aloud). Provide this student with information that is clear and in writingProvide a consistent, predictable schedule. Post the schedule inthe classroom and/or tape it to the inside of the desk or student assignment book.Write down key words on the board to aid in note-taking during sections that are "lecture-based.“Provide the student with a legible outline before a lesson/lecture and with legible teacher’s notes of lesson/lecture.Provide this student with a note-taker at all times to record classroom discussions and lectures.Provide student with a weekly syllabus, in advance, of upcoming week’s assignments and lessons. Keep instruction clear and assure that instructions and assignment criteria are always provided in writing (not just outloud) by providing the student with the above requested syllabus and by writing the assignments on the board as they are given to the class.


Alter Testing and Evaluation Procedures

Prior to the test, provide the student with specific information, in writing if necessary, about what will be on the test or quiz.Provide the student with a practice test or quiz to study the day before the actual test or quiz. (Pre-review)Allow the student more time to complete quizzes, tests, exams and other skill assessments when needed (including standardized tests) to eliminate possible test anxiety. Information retrieval can be complicated by ADD/LD. When more time is available to complete an assignment, test, quiz or final exam, should it be needed, memory retrieval is improved and test pressure interferes less with the ability to retrieve and express what is known.The student will inform the teacher of his need for additional time by writing a note on the test to arrange for more time whenever he/she is unable to finish a test in the standard amount of time provided to other students.Provide the student with other opportunities, methods or test formats to demonstrate what is known.Allow the student to take tests or quizzes in a quiet place in order to reduce distractions.Consider allowing this student to use a calculator when it is clear the student understands math calculation concepts.Always allow this student to use a calculator to check his/her work.


Create a Safe Environment for Learning

Look for positives and reinforce them.Praise in public.Reprimand in private.Determine effective motivational techniques for the student.Match student’s needs and learning style with teachers who can identify, recognize, reinforce and build upon the student’s strengths and interests.Recognize the students efforts and be encouraging.Recognize the difference between skill deficits vs. non-compliance and what should be done for each.Provide immediate feedback each time the student accomplishes a desired behavior no matter how small the accomplishment.Create a learning environment where it is safe to ask questions, make mistakes, seek help.Provide clear, specific rules and consequences and provide consistent follow through.


So…….Why is it important to address these students needs?Why is important to channel these students energies?Why is important to do what we can to give them the best chance for success?

BECAUSE………..


Untreated ADHD Disorder

RESEARCH SUGGESTS35% never finish high school.43% of hyperactive boys are arrested for a felony by age 16.Have significantly higher motor vehicle accidents and speeding tickets.They are five times more likely to die in adolescence, secondary to their impulsive behavior.52% abuse alcohol and drugs.19% smoke at near twice the rate of the general population.Studies suggest that at least 50% of prison inmates are ADHD.Individuals with Bipolar disorder have the highest suicide rate.

adhd and the counselor -...

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