Help! How Do I Manage These Strong-Willed Hyperactive Kids?

Presented by:Mayra Rodriguez, Ed.S.

School Psychologist

ATTENTION DEFICIT DISORDERS

• Teachers, child care workers, and school personnel are key to diagnosis and successful outcomes

INTRODUCTION ACTIVITY

Identify a current student you suspect might have

A.D.H.D.

Many Names for A.D.H.D.

Early 1900’s....Minimal Brain DamageEarly 1900’s....Minimal Brain DysfunctionMid 1900’s....Hyperkinetic Reaction of ChildhoodEarly 1980’s....Attention Deficit Disorder w/wo

HyperactivityLate 1980’s.....Attention-Deficit Hyperactivity DisorderPresent............Attention-Deficit / Hyperactivity

Disorder (Type I, Type II, or Combined)

A.D.H.D. STATISTICS• Occurs in 3-5% of school-age children–All socioeconomic, cultural,

and racial backgrounds–All intelligence levels• More prevalent in males–4:1 male to female ratio in general

population–9:1 male to female ratio in clinical

population

A.D.H.D. STATISTICS

• Symptoms identified in up to 80% of adolescents with A.D.H.D.–Problems continue after childhood in

66% of cases• Hereditary link suggested

Is ADHD Over-Diagnosed?

Is ADHD Over-Diagnosed?

• FACT – 3.5 million children meet criteria for ADHD; only 50% are diagnosed and treated

• FACT – 57% of children with ADHD receive accurate diagnosis

• FACT – Only 20% of black children with ADHD are diagnosed

• FACT – Overall parental knowledge about ADHD among African-American parents may play an important role in delaying diagnosis

The Societal Burden ofNot Treating ADHD

• 30% of children in special education

• 30% repeat a grade• 25% of adolescents expelled

from school• 35% of students drop out of

school• 26% arrested• 55% untreated grow up to be

substance abusers• Engage in other high risk

behaviors, more partners

Children With A.D.H.D. Exhibit Age-Inappropriate Behavior Patterns

• Inattention

• Impulsivity

• Hyperactivity

A.D.H.D. Interferes with School Success

Inattention Symptoms: Child experiences difficulty in….• Starting, staying with, and completing tasks that

require sustained attention• Making careless mistakes• Making transitions• Following directions / listening• Performing consistently• Organizing tasks• Losing things / forgetfulness

Impulsivity Symptoms• Low frustration tolerance• Difficulty waiting turn• Interrupts others & ignores boundaries• Blurting out answers before question is

completed• Difficulty anticipating outcomes• Often irritable/ impatient; but otherwise

quite charming

Impulsivity Symptoms

• Cannot keep hands to themselves• Often appear reckless, clumsy, or

accident-prone• Often provoke conflict just for the

love of excitement!!!!• Can easily produce chaos in class

or turn home into a battleground

Hyperactivity Symptoms

• Fidgeting• Rarely seated, or squirms in seat• Moving excessively• Difficulty playing or working quietly• Always “on the go”• Excessive talking

• Varies with age & developmental level

• Often makes noise during quiet activities

• Up often during meals

Symptoms often disappear when the child is with another

person who is closely scrutinizing him, when

confronted with an interesting task, or a novel situation

DSM-V DIAGNOSTIC TERMS

Attention-Deficit / Hyperactivity Disorder

• Inattentive Type

• Hyperactive-Impulsive Type

• Combined Type

Persistence, Pattern, and Frequency of Symptoms

• A persistent pattern… more frequent & severe than developmentally appropriate

• First appeared before age 7• Persist for 6 months or more• Present in at least 2 settings• Interference with social or academic

functioning

Symptoms Change Over the Years

Adolescence• Restlessness• Talks out of turn• Problems at school• Problems with

peers• Poor judgment• Difficulty getting

independence from parents

Elementary School• Fidgety• Excessive talking• Erratic performance• Bossy• Constant demand

for attention• Easily loses control

DIAGNOSTIC PROCESS

TIER 1: Presence of Symptoms• Interview parents and teachers• Obtain developmental history• Review school and medical records• Complete behavioral rating scales• Observe during an auditory vigilance task.• Interview student / self-report

DIAGNOSTIC PROCESS

TIER 2: Degree of Impact on Functioning• Classroom observation• Psychoeducational tests

Intervention Strategies Should Target...

• Classroom behavior

• Academic performance

• Social interactions

Strategies That EnhanceProductivity and Behavior

Classroom Management Strategies

• Schedule academic skills subjects in AM

• Provide regular and frequent breaks• Agree on “secret signal” for student• Develop “time-to-begin” cues

Classroom Management Strategies

• Teach self-monitoring techniques• Devise & practice attention-getting

strategies• Divide assignments and present in

smaller segments• Use behavioral reinforcement system

Organization Strategies

• Orderly, predictable, structured, consistent environment

• Minimal distractions, quiet work area, background noise (white noise)

• Prominent display of rules, schedules, and assignments

• Advanced warning before transition of activity

Curriculum Accommodations

• Reduced homework / classwork • Increased time for completing

assignments and tests• Mixture of high- and low-interest

activities (task novelty)• Curriculum integration• Seek meaning/ purpose

Curriculum Accommodations

• Use of computers for written assignments

• Teach/ prompt organization and study skills

• Interactive instruction vs. lecture• Visual references for oral

instructions• Avoid timed tests

Social Skills Strategies/ Impulse ControlSocial Skills Strategies/ Impulse Control

• Social skills training• Conflict resolution training• Anger management therapy• Compliance training

Family IssuesFamily Issues

• Parent training to learn how to parent an ADHD child• Parent training to reinforce social

skills training• Family therapy to heal damaged

relationship issues

What About Psychostimulant Medication?

What About Psychostimulant Medication?

• 70-75% of children with A.D.H.D. improve• Degree of response may vary• Effective dosage may vary

Medication is sometimes useful in helping ADHD children….

• become less irritable & restless• improve attention & motor

coordination• become less impulsive, therefor,

better liked by others• improve in pro-social & appropriate

school behavior

What About Psychostimulant Medication?

• Effective with adolescents and adults, although the extent of improvement is smaller than with younger children• Medication is only one part of a

total management program

Successful Management of A.D.H.D. Takes a Team Effort

AND…a great deal of prayer!Let your ADHD student know you love them & care about them regardless of how they

behave!