The A-B-C's of ADD/ADHD

    One of the most pressing concerns of students entering the field of teaching is how to deal with students whose behavior is disruptive to the learning of both themselves and others.  The causes for concern are several, including but not limited to:  meeting the needs of all students in the class including those who are disruptive, disciplining fairly and consistently, and addressing parents' and administrators' concerns about the learning environment.

    There are a number of reasons that students may be exhibiting behavior that detracts from a quality learning environment.  One of those reasons may be that the child has an Attention Deficit Disorder (ADD) or an Attention Deficit/Hyperactivity Disorder.

What follows is a list of characteristics of ADD/ADHD.  According to H. C. Parker, Ph.D. (1992), "in order to receive a diagnosis of ADD a child must exhibit at least eight of the following characteristics for a duration of at least six months with onset before age seven."

    1.  often fidgets with hands or feet or squirms in seat (in adolescence may be limited to subjective feelings of restlessness)

    2.  has difficulty remaining seated when required to do so 

    3.  is easily distracted by extraneous stimuli

    4.  has difficulty awaiting turns in games or group situations

    5.  often blurts out answers to questions before they have been completed

    6.  has difficulty following through on instructions from others (not due to oppositional behavior or failure of comprehension)

    7.  has difficulty sustaining attention in tasks or play activities

    8.  often shifts from one uncompleted activity to another

    9.  has difficulty playing quietly

  10.  often talks excessively

  11.  often interrupts or intrudes on others, e.g. butts into other children's games

  12.  often does not seem to listen to what is being said to him or her

  13.  often loses things necessary for tasks or activities at school or at home (e.g. toys, pencils, books)

  14.  often engages in physically dangerous activities without considering possible consequences (not for the purpose of thrill-seeking)  e.g. runs into street without looking

During adolescence, students with ADD/ADHD may also exhibit the following characteristics:

    1.  lack of organization

    2.  inability to "read" people

    3.  more likely to be destructive, aggressive, non-compliant or belligerent in class

    4.  more likely to blame others for problems

    5.  lack of age/grade appropriate social skills

In the high school years, ADD/ADHD students may show signs of:

    1.  being unmotivated by usual rewards (e.g. grades)

    2.  low self-esteem

    3.  depression

    4.  continued poor social relations

    5.  apathy toward school; poor study habits

    6.  avoidance behaviors

    7.  unrealistic career goals

    Students with ADD without hyperactivity show signs of significant inattentiveness without hyperactivity.  They also may show more signs of anxiety and learning problems.  These students may have Undifferentiated Attention Deficit Disorder (UADD).

    It is VERY IMPORTANT to realize that as educators, we are not diagnosticians.  We observe and report behavioral observations to parents and to others (psychologists, medical personnel, etc.) as requested and with a consent form signed by the parent/guardian.  Other disorders, for example, depression, Asperger's Syndrome, or social anxiety) may mirror the signs of ADD/ADHD and it is up to a physician to make the diagnosis based on input from those who work most closely with the child.

ACCOMMODATIONS TO HELP STUDENTS WITH ATTENTION DEFICIT DISORDERS

    Relatively simple and straightforward accommodations to the classroom environment can be implemented by teachers to build on the strengths  and address limitations of ADD/ADHD students.  The following accommodations are suggested by Harvey C. Parker, Ph.D.  Although the strategies are grouped according to the area of difficulty, it is important to remember that not every strategy will work for every child.  Notice that the categories of concern often invite the use of similar strategies.  This is "crossing over" is often necessary to find "what works" for each student within classroom settings.

INATTENTION

• seat student in quiet area

• seat student near good role model

• seat student near "study buddy"

• increase distance between desks

• allow extra time to complete assigned work

• shorten assignments or work periods to coincide with span of attention; use timer

• break long assignments into smaller parts so student can see end to work

• assist student in setting short-term goals

• give assignments one at a time to avoid work overload

• require fewer correct responses for grade

• reduce amount of homework

• instruct student in self-monitoring using cueing

• pair written instructions with oral instructions

• provide peer assistance in notetaking

• give clear, concise instructions

• seek to involve student in lesson presentation

• cue student to stay on task, i.e. private signal

IMPULSIVENESS

• ignore minor, inappropriate behavior

• increase immediacy of rewards and consequences

• use time-out procedure for misbehavior

• supervise closely during transition times

• use "prudent" reprimands for misbehavior (i.e. avoid lecturing or criticism)

• attend to positive behavior with compliments, etc.

• acknowledge positive behavior of nearby student

• seat student near good role model or near teacher

• set up behavior contract

• instruct student in self-monitoring of behavior, i.e. hand raising, calling

• call on only when had is raised in appropriate manner

• praise student when had raised to answer question

MOTOR ACTIVITY

• allow student to stand at times while working

• provide opportunity for "seat breaks" i.e. run errands, etc.

• provide short break between assignments

• supervise closely during transition times

• remind student to check over work product if performance is rushed and careless

• give extra time to complete tasks (especially for students with slow motor tempo)

MOOD

• provide reassurance and encouragement

• frequently compliment positive behavior and work product

• speak softly in non-threatening manner if student shows nervousness

• review instructions when giving new assignments to make sure student comprehends directions

• look for opportunities for student to display leadership role in class

• conference frequently with parents to learn about student's interests and achievements outside of school

• send positive notes home

• make time to talk alone with student

• encourage social interactions with classmates if student is withdrawn or excessively shy

• reinforce frequently when signs of frustration are noticed

• look for signs of stress build up and provide encouragement or reduced work load to alleviate pressure and avoid temper outburst

• spend more time talking to students who seem pent up or display anger easily

• provide brief training in anger control:  encourage student to walk away; use calming strategies; tell nearby adult if getting angry

ACADEMIC SKILLS

• if reading is weak:  provide additional reading time; use "previewing" strategies; select text with less on a page; shorten amount of required reading; avoid oral reading

• if oral expression is weak:  accept all oral responses; substitute display for oral report; encourage student to tell about new ideas or experiences; pick topics easy for student to talk about

• if written language is weak:  accept non-written forms for reports (i.e. displays, oral, projects); accept use of typewriter, word processor, tape recorder; do not assign large quantity of written work; test with multiple choice or fill-in questions

• if math is weak:  allow use of calculator; use graph paper to space numbers; provide additional math time; provide immediate correctness feedback and instruction via modeling of the correct computational procedure

ORGANIZATIONAL PLANNING

• ask for parental help in encouraging organization

• provide organization rules

• encourage student to have notebook with dividers and folders for work

• provide student with homework assignment book

• supervise writing down of homework assignments

• send daily/weekly progress reports home

• regularly check desk and notebook for neatness, encourage neatness rather than penalize sloppiness

• allow student to have extra set of books at home

• give assignments one at a time

• assist student in setting short-term goals

• do not penalize for poor handwriting if visual-motor deficits are present

• encourage learning of keyboarding skills

• allow student to tape record assignments or homework

COMPLIANCE

• praise compliant behavior

• provide immediate feedback

• ignore minor misbehavior

• use teacher attention to reinforce positive behavior

• use "prudent" reprimands for misbehavior (i.e. avoid lecturing or criticism)

• acknowledge positive behavior of nearby student

• supervise student closely during transition times

• seat student near teacher

• set up behavior contract

• implement classroom behavior management system

• instruct student in self-monitoring of behavior

SOCIALIZATION

• praise appropriate behavior

• monitor social interactions

• set up social behavior goals with student and implement a reward program

• prompt appropriate social behavior either verbally or with private signal

• encourage cooperative learning tasks with other students

• provide small group social skills training

• praise student frequently

• assign special responsibilities to student in presence of peer group so others observe student in a positive light

A CAUTIONARY NOTE:

As mentioned above, characteristics of ADD/ADHD may resemble behavioral traits of other disorders.  Some characteristics may also be inherent in cultural behaviors; for example, lack of eye contact with adults is a traditional sign of respect in children of the Native American and Hmong cultures.  In addition, African Americans may often talk loudly in conversation or when stressing a point.  There may be other characteristics often associated with particular ethnic or cultural groups which may be misinterpreted.  We, as teachers, must be mindful of cultural norms and differences and not prejudge based on white, Western cultural expectations without doing our "homework".

RESOURCES

Internet Sites for ADHD:

Children and Adults with Attention Deficit Disorders - http://www.chadd.org

Teaching Children with ADHD - http://www.kidsource.com/kidsource/content2/add.html

A.D.D. Warehouse (catalog) - http://www.addwarehoue.com

ADD Treatment Information - http://www.mediconsult.com/add/shareware/decad_brain/cope.html

ASK (Adults Seeking Knowledge) - http://www.healthyplace.com/Communities/ADD/ask/index.htm

Videos:

Films for the Humanities & Sciences (Producer).  (1995).  Coping with attention deficit disorder in children.    (Available from Films for the Humanities & Sciences, Box 2053, Princeton, NJ 08543-2053).

Films for the Humanities & Sciences (Producer).  (1995).  The diagnosis and treatment of attention deficit disorder in children.  (Available from Films for the Humanities & Sciences, Box 2053, Princeton, NJ 08543-2053).

National Professional Resources, Inc.  (Producer).  (1995).  ADHD:  Inclusive instruction and collaborative practices.  (Available from National Professional Resources, Inc., 25 S. Regent St., Port Chester, NY 10573).

Authors:

Russell A. Barkley

Michael Goldstein

Sam Goldstein

Barbara Ingersoll

Harvey C. Parker

Thomas Phelan

Paul Wender

. . . and many others!