Professional Documents
Culture Documents
A guide for
UK teachers
www.livingwithadhd.co.uk
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www.livingwithadhd.co.uk
While most specific treatments for ADHD will be given in secondary care, children with ADHD have behaviour
problems that, by definition, affect both the home and the school, and the teacher has a number of important
roles to play:
A
teacher may be the first person to express concern about a childs behaviour and suggest seeking medical
help or advice.
Specialists
investigating possible cases of ADHD often want to find out as much as possible about how the child
behaves and performs at school.
T
eachers sometimes play an important role in treatment, working with psychologists and other specialists to
develop approaches to the organisation of learning and classroom management that will help children improve
their behaviour.
The aim of this guide is to provide you with the sort of information you will find useful as teachers, as well as
some idea of what will happen once the child moves to specialist care. First, we provide some background to the
condition. This is followed by a discussion of the whole process of diagnosis and treatment, with a special focus
on the role of the teacher. We recognise that training for teachers in this area is limited, and this guide is a small
contribution towards improving the situation.
We hope that the information about ADHD contained in this guide will help teachers to contribute towards
improved management of this common, damaging and often misunderstood condition.
Dr David Coghill
University of Dundee
Professor Edmund Sonuga-Barke
University of Southampton
Background
to ADHD
What is ADHD?
Attention Deficit Hyperactivity Disorder (ADHD) is a
clearly defined clinical condition and not just a label for
naughty or badly brought-up children.
ADHD is diagnosed when a child exhibits abnormally
high levels of:
Inattention5 (short attention span, easily distracted,
doesnt finish things, disorganised, forgetful etc)
and/or
H
yperactivity and impulsiveness5 (fidgets, cant
sit still, always on the go, talks too much, interrupts,
cant wait their turn etc).
www.livingwithadhd.co.uk
Subtypes
Practical Point:
ADHD affects 5%
of school-age ch
ildren. 1,4
This means that
the average UK
cl
as
will include at le
sroom
ast one child wit
h
A
D
HD.
The more seriou
s cases that qual
ify as
hyperkinetic diso
rder affect abou
t 1.5%
of primar y scho
ol children. 1,4
In the UK, not al
l of these childre
n will have
been investigat
ed and diagnose
d.
Background to ADHD
Brain processes
S
tudies of twins suggest that 65%-90% of the risk
of having ADHD is associated with a persons genes.1
This means that ADHD is often inherited and tends
to run in families.
Specific genes have been linked to ADHD. People
with these genes dont all have ADHD, but they are
more likely to have it than people without these
genes. Many of these genes have to do with action
of the neurotransmitters* dopamine and
noradrenaline. The main medical treatments
for ADHD boost the function of dopamine and
noradrenaline.1
Other problems
Clumsiness.
Tic disorders.
* Neurotransmitters are substances that transmit nerve impulses from one nerve cell to another.
Tranquillizers such as diazepam and temazepam.
www.livingwithadhd.co.uk
www.livingwithadhd.co.uk
t
Practical poin
HD as it often
rst to spot AD
fi
e
th
e
b
ay
he first
Teachers m
ool success. T
h
sc
to
r
e
ri
ar
the
represents a b
m teachers is
o
o
sr
as
cl
r
fo
al
NCO)
point of referr
ordinator (SE
o
C
s
d
e
e
N
al
tion
there are
Special Educa
in areas where
t
n
e
al
iv
u
q
e
utside
(or nearest
n refer on to o
e
th
n
ca
o
h
w
rtant to
no SENCOs),
arly it is impo
le
C
.
e
at
ri
p
ro
.
p
an early stage
agencies if ap
at
rs
re
ca
r
o
ts
en
involve the par
Practical poin
Contact with
the school or
pre-school
Knowledge ab
out how the ch
ild behaves an
away from hom
d performs
e is crucial to th
e diagnosis of
With the perm
ADHD.
ission of the p
arents, the spec
may contact th
ialist team
e school (or pre
-school) to ask
Behaviour an
about:
d behavioural
problems.
The childs le
vel of develop
ment.
Social funct
ioning.
Symptoms
of other possib
le disorders.
Relationship
with the teach
er.
How the teac
her manages th
e childs proble
ms.
11
Treatment:
Advice and support
Advice, information and support for children, parents and teachers is an important
part of ADHD treatment.
Treatment options
www.livingwithadhd.co.uk
Practical poin
Structured a
d
vice, support
and behavio
ural program
ADHD isnt ca
mes
used by bad p
arents or bad
research has
te
ac
shown that st
hers, but
ructured prog
and support fo
rammes of ad
r parents and
vice
teachers can
behaviour an
improve the ch
d concentratio
ilds
n.
Psychologists
work with par
ents and teac
in groups. The
hers individual
y help them to
ly or
:
Consider cl
assroom stru
cture and task
having the ch
demands (e.g
ild seated clo
.
se to the teac
assignments,
her, brief acad
interspersing
emic
classroom lect
periods of exe
ures with brie
rcise).
f
Focus on p
articular prob
le
m
times or situat
mealtimes, ge
ions (e.g.
tting ready fo
r school, start
and track the
o
f
the lesson)
childs behavio
ur over time.
Work out in
advance what
to do when a
well or badly
child behaves
then do it con
sistently.
Develop te
chniques for
getting a child
contact, one
to listen (e.g.
thing at a tim
eye
e, what to do
not to do).
rather than w
hat
Use token
systems and co
ntracts.
Use time o
ut as a sanctio
n.
13
Medication
What specialists prescribe.
What side-effects to look out for.
Guidance on the question of drug abuse.
Main agents
The medicines licensed in the UK for ADHD are:3
Methylphenidate
Dexamfetamine
Atomoxetine
Methylphenidate and dexamfetamine belong to
the same class of medicines, called stimulants.1
Atomoxetine is a selective noradrenaline reuptake
inhibitor.3
www.livingwithadhd.co.uk
Practical point
For the child, long-acting medications
may avoid
embarrassment and increase privacy at
school,
and may make it more likely that they
will take the
medicine as prescribed. For the school,
not having
to dispense a medication is a great adv
antage.1
However, once-daily dosing may redu
ce dose
flexibility and tailoring at different time
s of the day.
Note There is no standard dose of thes
e
medicines the best dose varies from
child to
child. Normally the specialist will start
with a low
dose and gradually increase it, looking
for the best
balance between effectiveness and side
-effects.
At this stage, parents and teachers may
be asked
to monitor the childs behaviour quite
intensively
using standard questionnaires.
Treatment expectations
Length of treatment
15
Medication
Does the use of methylphenidate and dexamfetamine in childhood increase the chances that a child will become
addicted to similar drugs, or other drugs, in later life? This question naturally worries many parents, teachers and
health professionals. More research needs to be done here before we can answer this with certainty. However we
know that having ADHD increases1 the risk of substance abuse (drugs and alcohol) in later life.
Overall, the studies that have been done suggest that stimulants do more good than harm in this area. In young
people with ADHD treated with stimulants, the risk of substance abuse is almost halved compared with those not
treated with stimulants.1
As always, if you have any concerns about a childs health or medication, you should consult a specialist
or general practitioner.
Practical point
Stimulants and Drug abuse
In the UK, methylphenidate and dexamf
etamine
are controlled drugs. Taken by mouth
,
methylphenidate is no good as a recreati
onal
drug, but there are some cases of it bein
g
diverted for illicit use by intravenous inje
ction.1
Once-daily formulations mean that chil
dren
do not have to bring medications to sch
ool.
The once-daily preparations are much
more
difficult to grind up or snort.10
www.livingwithadhd.co.uk
Dietary
approaches
Parents often feel that diet plays a role in their childs ADHD.
t
n
e
m
t
a
e
r
T
*
s
n
o
i
t
a
d
n
Recomme
h
g people wit
n and youn
re
ve
ild
si
h
n
c
e
r
h
fo
re
t
en
mp
Drug treatm lways form part of a co
ioural
r
a
o
ld
gical, behav
ts
u
n
lo
o
o
re
h
a
sh
c
p
D
r
sy
H
e
p
D
ff
s
o
A
e
d
ld
lu
u
c
o
ls sh
to a
lan that in
entions.
professiona n with ADHD a referral
treatment p
e and interv
c
Healthcare
vi
e
re
d
a
lin
ild
l
ta
h
c
rs
n
l
fi
o
o
ti
e
hildren
as th
-scho
and educa
de to treat c hcare
programme
carers of pre
a
n
y
m
io
d
n
a
at
e
e
c
e
lr
u
b
a
d
s
t
o
alt
ing/e
ision ha
arers have n
h drugs, he
parent-train
When a dec
h ADHD wit
parents or c
mme has
it
e
ra
w
g
th
le
ro
if
p
p
t
o
n
e
e
e
p
th
treatm
mme or
or young
ld consider:
ch a progra
ionals shou
ss
attended su
fe
gnificant
ro
p
D without si
effect.
H
D
d
D
e
H
A
it
D
r
A
lim
fo
t
u
a
te
o
d
ab
ha
henida
ed training
methylp
have receiv
havioural
e
o
b
h
w
e
ity
duct
d
rs
id
vi
e
rb
h
ro
o
c
p
Tea
com
morbid con
nd
should
o
a
c
t
n
n
h
e
re
it
m
w
ild
e
h
D
g
c
H
a
elp
r AD
and its man
ssroom to h
henidate fo
methylp
ns in the cla
o
ti
n
e
rv
te
in
D.
disorder
te
le with ADH
hen tics,
has modera
moxetine w
young peop
D
to
t
H
a
D
r
A
o
h
te
it
a
w
on
er, stimulan
be
henid
r young pers
methylp
nxiety disord
arers should
a
c
t
,
r
n
e
o
se
m
ts
re
ro
n
p
d
e
n
ar
If the child o
ttes sy
t, the p
cation
rsion are
n
u
e
re
e
d
u
iv
d
/e
To
rm
t
g
ai
n
in
p
la
n
u
im
ai
levels of
sk of stim
up parent-tr
ied and
a group
misuse or ri
rral to a gro
has been tr
gether with
te
to
a
r
id
o
n
n
e
w
offered refe
h
y
o
p
p
s
yl
rated dose,
ioural thera
, either on it
tine if meth
aximum tole
m
e
programme ramme (cognitive behav ild or
atomoxe
th
t
a
t to low or
ffective
rog
is intoleran
g) for the ch
as been ine
n
h
o
in
n
rs
treatment p
ai
e
p
tr
s
g
n
ill
or you
r social sk
nidate.
or the child
[CBT] and/o
f methylphe
o
s
se
o
.
re
d
n
ve
o
te
h se
modera
young pers
g people wit firstn and youn
e
re
th
ild
s
h
a
c
d
e
re
g
In school-a
ould be offe
uptreatment sh ld also be offered a gro
g
ru
d
,
D
H
D
u
A
sho
nt. Parents
ramme.
line treatme aining/education prog
t-tr
based paren
* Taken from NICE Clinical Guideline 72. Diagnosis and management of ADHD in children, young people and adults. Sept 2008.
Quick reference guide pp5-6 - Available at http://guidedance.nice.org.uk/CG72/QuickRefGuide/PDF/English.
www.livingwithadhd.co.uk
Practical point
Tips for teachers
19
www.livingwithadhd.co.uk
Other useful
information
Support Group
This group provides advice, information and support to individuals and families, and also promote better
awareness of ADHD.
ADDISS - ADHD Information Services
2nd Floor, Premier House
112 Station Road
Edgware, HA8 7BJ
Phone: 020 8952 2800
www.addiss.co.uk
info@addiss.co.uk
Other resources
Website
www.livingwithadhd.co.uk
www.mentalhealth.org.uk
www.chadd.org
www.adders.org
www.teachernet.gov.uk
Book
Fintan ORegan. How to teach and manage children with ADHD. (2002) LDA, Wisbech.
21
References
1. Taylor E, et al. European clinical guidelines for hyperkinetic disorder first upgrade. European Child & Adolescent
Psychiatry. 2004; 13(Suppl 1): 7-30.
2. Scottish Intercollegiate Guidelines Network. Attention deficit and hyperkinetic disorders in children and young people.
October 2009. www.sign.ac.uk.
3. NICE. Methylphenidate, atomoxetine and dexamfetamine for attention deficit hyperactivity disorder (ADHD)
in children and adolescents. March 2006. www.nice.org.uk.
4. NICE. Attention deficit hyperactivity disorder. Diagnosis and management of ADHD in children, young people and adults.
March 2009. www.nice.org.uk.
5. Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. American Psychiatric Association, 2000.
6. Concerta XL. Summary of Product Characteristics. Janssen-Cilag Ltd. November 2009. www.emc.medicines.org.uk.
7. Equasym XL. Summary of Product Characteristics. Shire Pharmaceuticals Ltd. June 2009. www.emc.medicines.org.uk.
8. Strattera. Summary of Product Characteristics. Lilly. May 2009. www.emc.medicines.org.uk.
9. Medikinet. Summary of Product Characteristics. Flynn pharma.
Feb 2007. www.emc.medicines.org.uk.
10. A
ACAP. Practice parameter for the use of stimulant medications in the treatment
of children, adolescents and adults. J Am Acad Child Adolesc Psychiatry 2002;
41(2 Suppl): 26S-49S.
11. M
cCann, D et al. Food additives and hyperactive behaviour in 3-year-old
and 8/9-year-old children in the community: a randomised, doubleblinded, placebo-controlled trial. Lancet 2007; 370; 9598: 1560-1567.
12. R
ichardson AJ. Omega-3 fatty acids in ADHD and related
neurodevelopmental disorders. Int Rev Psychiatry 2006;
18(2): 155-172.
www.livingwithadhd.co.uk
Notes
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