I have come to a frightening conclusion That I am the decisive element in the classroom.

Its my personal approach that creates the climate. Its my daily mood that makes the weather. As a teacher, I possess a tremendous power To make a childs life miserable or joyous. I can be a tool of torture Or an instrument of inspiration. I can humiliate or humor, hurt or heal. In all situations, it is my response that decides whether a crisis will be escalated or de-escalated and a child humanized or dehumanized. --Haim Ginott Teacher and Child. (New York: The Macmillan Co., 1972), p.15

Attention Deficit Hyperactivity Disorder ADHD

Why?
To provide BASIC information from credible sources supported by independent, thorough research To help staff reach a common level of understanding ADHD affects students across their school day, including specialist classes

What is ADHD?
A neurobiological disorder characterized by
Inability to regulate behavior Poor self-monitoring skills

Hereditary Not usually outgrown, although symptoms can become manageable

What ADHD is NOT

A problem caused by poor parenting skills An emotional disorder A learning disability (although LDs coexist in 1/3 of all ADHD students) Overdiagnosed only 2% of an affected 5-8% receive treatment A problem that only boys have Although controversial, currently there is no independent scientific research showing that ADHD is caused by food allergies, food additives or environmental toxins

Behaviors linked to ADHD

Executive Functioning Difficulties these skills are critical for success at school Working memory and recall Activation, arousal and effort Control of emotions Internalizing language Complex problem solving

Behaviors linked to ADHD

(continued) Forgetfulness and disorganization Variability in school work Not learning from mistakes Impaired sense of time Sleep disturbances Difficulty with transitions and changes in routine A need for stimulation

Prevalence
A conservative estimate is that between 5-8% of school aged children are affected At ASH, middle school enrollment is approximately 360 students, 6% = approximately 22 students A conservative estimate is that each middle school grade level could anticipate 5-6 students with ADHD Found in all intelligence levels Occurs in all socioeconomic, cultural and racial backgrounds

Types of ADHD 1. Hyperactive/impulsive (ADHD) 2. Inattentive (ADD) 3. Combined (both hyperactive and inattentive)

Co-existing Conditions
If undiagnosed and untreated, coexisting disorders frequently develop
Depression Anxiety disorder Conduct disorder

A diagnosis helps to reduce the likelihood of these by explaining behavior with brain science rather than by moral failure

Consequences of no diagnosis
Lack of self understanding School failure and drop out Failed relationships (peers, family) Underachievement in the workplace Substance abuse

Girls and ADHD

Girls and women are more likely to be misunderstood and under diagnosed because they are usually inattentive rather than hyperactive Social rewards usually modulate behavior toward social acceptability Around late 3rd grade, may slide academically and socially Impulsivity may be limited to interrupting social conversations or not raising hands, so go undiagnosed Anxiety or depression may become major

Diagnosis
There is no test for ADD/ADHD A diagnosis is confirmed by a medical professional using:
DSM-IV criteria Behavior rating scales A childhood/family history Description of school performance Psychological evaluations

The basis of the diagnosis of ADHD is not the mere presence of these symptoms, but their severity, duration and the extent to which they interfere with everyday life

What does current brain research show?

 Functioning magnetic resonance imaging (fMRIs) have shown that brain volume is slightly smaller in subjects with ADHD Quantitative elecroencephalogram (qEEG) is a brain-wave test that is 90% accurate in identifying ADHD through brain wave differences Single Photon emission computed tomography (SPECT) brain scanning shows notable differences in brain activity

Medication
National Institute of Mental Health held the Multi-Modal Treatment Study of Children with ADHD (579 ADHD students for 14 months) four groups: Medication management Behavior treatment Combination of behavior treatment and medication management Usual community care

Results
Carefully monitored medication alone was more effective than behavioral treatment Carefully monitored medication alone was almost as effective as the combined treatment of medication plus behavioral treatment Those without medication and those with community care (medication not monitored closely) showed the least improvement of ADHD symptoms

More about medication

It is effective for 80% of those diagnosed with ADHD in reducing symptoms Stimulant medications have been used safely since 1937, but we dont know about long term effects It is not the only answer to ADHD symptoms It is short-lived and not addictive (it actually helps avoid future addictions) The decision to trial a medication must be well thought out and comfortable to the family Optimum results require frequent communication between doctor, family and school

Most Effective Approach Multi-modal

Education Support Exercise Nutrition Medication

Sources
National Institute of Mental Health. (1999). Multi-Modal Treatment Study of Children with ADHD. http: //www.nimh.gov Hallowell,E. & Ratey, J. (2005). Delivered from Distraction. New York: Ballantine Books.

Nadeau, K., Littman, E. & Quinn, P. (1999). Understanding Girls with AD/HD. Silver Spring : Advantage Books.
Zeigler-Dandy, C. (2000). Teaching Teens with ADD & ADHD. Bethesda: Woodbine House.