Chapter 7: Children with Attention Deficit/Hyperactive Disorders

• SPE 209 Survery of Exceptionalities
• Year 4

Chapter 7: Children with Attention Deficit/Hyperactive Disorders

Elijah Coates 

February 16th, 2022

SPE 209 D - Survey Of Exceptional 22SP

Do you or anyone that you know posses ADHD?

Yes

No

A Quick Intro

“He is in constant motion, his energy is non-stop and his exuberance is sometimes overwhelming!” “She seems to be in a world of her own… it is hard to get her to focus and even though she is bright, tasks often remain half done.”

Have you met these children? Have you taught these children? Do you know these children? Children with attention deficit/hyperactive disorder (ADHD) can find life, and especially school, a bit daunting. For some it is hard because their energy is difficult to harness, others have a hard time maintaining focus, and some struggle with both of these challenges. The major symptoms of ADHD—inattention, impulsivity, and hyperactivity—can lead to an inner chaos that manifests in fidgety, loud, disorganized, disruptive, off-task, or daydreaming behaviors, and missing or incomplete work. Children with ADHD form one of the largest groups of exceptional learners, and teaching them can test our stamina and our patience!

History of the Field of ADHD

The field of ADHD largely evolved through the medical community, as early as 1798, with physicians taking the lead in describing patients who seemed unusually fidgety, inattentive, and/or unruly. After a 1917–1918 epidemic of encephalitis, the term “minimum brain damage” came into use to describe the cluster of symptoms. Dr. Kurt Goldstein noted that soldiers who had experienced traumatic brain injuries during World War II suffered from disorganization, perseveration, hyperactivity, and problems with figure-ground focus. Well it was taken up again 10-20 years later by Alfred Strauss. Strauss studied children who were thought to have brain damage, and the term “Strauss Syndrome” was used to describe the cluster of characteristics. Minimal brain damage  was replaced in the 1960s as the focus shifted to the child’s hyperactivity.  

Inattention

• Fails to give close attention to the details or makes careless mistakes in schoolwork, work, or other activities
• Has difficulty sustaining attention in tasks or play activities

• Does not seem to listen when spoken to directly
  
• Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
  
• Has difficulty organizing tasks and activities
  
• Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
  
• Loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
  
• Is easily distracted by extraneous stimuli
  
• Is forgetful in daily activities

Hyperactivity 

• Fidgets with hands or feet or squirms in seat
  
• Leaves seat in classroom or in other situations in which remaining seated is expected
  
• Runs about or climbs excessively in situations in which it is inappropriate
  
• Has difficulty playing or engaging in leisure activities quietly
  
• Is often “on the go” or acts as if “driven by a motor”
  

Talks excessively

Impulsivity

• Blurts out answers before questions have been completed
  
• Has difficulty awaiting turn
  
• Interrupts or intrudes on others (e.g., butts into conversations or games)

Which IS NOT a characteristic of ADHD??

1. Hyperactivity
2. Paranoia
3. Inattention
4. Impulsivity

Information Processing Model and ADHD

 ADHD show a range of executive function deficits.  Since the executive function oversees attention, decision making, and self-regulation, all other areas of information processing are also impacted by ADHD. It is as though the child’s ADHD throws a blanket over her or his ability to process information; sometimes medications can lift this blanket. For children with ADHD, distractibility occurs because they are unable to screen out stimuli that are irrelevant to the present task. Therefore, all input seems to be given equal weight, and the information-processing system can be overwhelmed. So imagine this in schools or on the job or out with friends anywhere. The brain of a child with ADHD is like having 30 different radios all tuned into 30 different stations and trying to concentrate on ONE. 

Identification of Students with ADHD

Students with ADHD can legally qualify for services through the Other Health Impaired category of IDEA 2004 or they can be found eligible for services through Section 504 of the Rehabilitation Act (1973). Identifying a student as having ADHD should be a team effort, with input from key individuals who know the child well and can document behavioral, social, emotional, and academic impacts of the disability across a variety of settings. Parents and teachers often provide information through an observational checklist showing how the student performs and indicating areas of concern. One form of determining is the Conners 3 scale.

Conners-3 

The Conner's rating scale is a questionnaire that asks about things like behavior, work or schoolwork, and social life. The answers show your doctor which ADHD symptoms you might have and how serious they are. They can show how these symptoms affect things like grades, job, home life, and relationships. Parents and teachers usually fill out scales for children. Older children complete their own rating scale. Adults answer a questionnaire about themselves and may ask a spouse, co-worker, or close friend to do one as well. Conner's scale assesses symptoms such as: Hyperactivity, Trouble paying attention, Problems keeping friends, Emotional problems, Problems eating or sleeping, Impulsiveness, Problems with math or language, Temper tantrums, Compulsiveness, and Fears of being separated from loved ones.

When answering questions on the Conner's rating scale, you enter a number from 0 to 3 to indicate how often you notice a symptom or behavior. A "0" means never, while a "3" means it happens very often.

Potential Biases and Challenges

Identifying students through checklists and rating scales can be challenging, however, because perceptions can sometimes be biased. One area where potential bias may influence referrals for ADHD is gender. In school- or community-based settings, boys are identified two to three times more often than girls, and the girls who are identified often have higher levels of impairment. Teachers’ interpretations of student needs were different for boys and girls. Testing results favor boys when it comes to hyperactivity so any of those qualities found in females were deemed "abnormal" which could often lead to misplacement. 

Another area of potential bias is with the identification of children from culturally/linguistically diverse and/or economically disadvantaged families. Using some rating scales, African-American students are twice as likely to be identified with ADHD . The concerns for identification patterns of ethnic minority and poor children are complex:

• Are we over identifying some students because the rating scales are primarily designed for and normed with white, middle-class students?
• Do additional risk factors for children whose families live in poverty increase the number of children with ADHD?
• How do the family’s cultural expectations of child behaviors impact their view of what is “appropriate”?

Neurological Causes of ADHD

Several studies examining differences in brain size, structure, development, and function have established a clear neurological basis for ADHD. Studies found that when compared with typically developing children, the brains of individuals with ADHD seem to develop more slowly, reaching key maturation points somewhat later, and that the size of some brain areas is smaller.  Studies with MRI (magnetic resonance imaging) show differences in brain structure and function that seem to be linked to problems with executive functioning including off-task behaviors, attention, planning, sequencing for problem solving, time management, and the ability to keep future consequences of present actions in mind. 

Genetic Causes for ADHD

ADHD runs in families; approximately one-third of the fathers who were diagnosed in childhood have a child who is also diagnosed.  Genetic factors can account for up to 80 percent of phenotypic variance. Phenotype, the set of observable characteristics of an organism, includes physical form, development, and biochemical make-up. Because clear phenotypical differences have been established for the brains of individuals with ADHD, mapping these differences to genetic factors should be possible. While multiple genes may contribute to the phenotype of ADHD, no genome-wide significant associations have been firmly established.

Environmental Causes for ADHD

Environmental factors that are potentially linked with ADHD include cigarette and alcohol use by the mother during pregnancy, premature birth, high levels of exposure to lead, and brain damage or injury.  Commonly held beliefs about the role of sugar and food additives as causes of ADHD have also been studied. These studies seem to discount the role of sugar in increasing symptoms of ADHD, but they do provide some support for the role of food additives in increasing symptoms of hyperactivity.

Using Medication for ADHD Symptoms

Pharmacological interventions for ADHD are one of the most common treatments. While medication will not make them learn, for some children it may give them an opportunity to learn. An estimated 66 percent of the children with ADHD between the ages of 4 and 17 received medication as at least part of their treatment. Children between ages 11 and 17 showed the highest prevalence for medication and boys were almost 3 times more likely to take medication than girls. Stimulant medications, used with children with ADHD, are believed to affect the portion of the brain that produces neurotransmitters, the chemical agents at the nerve endings that help move electrical impulses among nerve cells.

FDA-Approved Medications for ADHD

• Adderall
  

amphetamine 3 and older

• Concerta
  

methylphenidate (long acting) 6 and older

• Ritalin
  

methylphenidate 6 and older

• Strattera
  

atomoxetine 6 and older

The Wrap Up

The difficulties experienced by children with ADHD may change as they grow up; however, the challenges do not seem to diminish, social difficulties with peers may worsen,  abuse of alcohol, drugs, and nicotine may emerge, and individuals may be a greater risk for involvement with the juvenile justice system. A disappointing trajectory for students with ADHD, however, is not written in stone. Protective factors for youth include: early intervention and support, strong parenting, and intensive educational support including strategies for coping and learning. While teens and adults are often more likely to stop taking medicines, studies have shown that continued use of medication as part of a multimodal approach to regulate ADHD symptoms may be helpful. To place a child with ADHD on the pathway toward a successful life it takes a concerted team effort. Early intervention, consistent and continued support for the child and family, and multimodal approaches that combine medicine, behavioral therapies, and educational interventions are needed to help children with ADHD grow into happy productive adults.

What is one fact you've learned about ADHD?