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What Is
Attention Deficit Hyperactivity Disorder

(Antecedent Interventions)
Classroom Interventions for Children with Attention Deficit Disorder

Attention-Deficit Hyperactivity Disorder, or ADHD, is a chronic, biologically-based disabling condition.  Over the years, there have been many different names for the disorder, including minimal brain dysfunction, hyperactivity, and Attention Deficit Dosorder (with or without the hyperactivity). The characteristics of ADHD are described below.

Primary Features:

The primary features of ADHD are inattention and/or overactivity and impulsivity.  The behaviors commonly associated with ADHD are listed in the table below.  The diagnosis of ADHD requires that these symptoms be present at a level that is excessive for the person's age and sex.  There are three types of ADHD: the Predominantly Inattentive type (at least 6 of 9 from the left column below), or the Combined Type (at least 6 from each column).
Inattentive Behaviors: Overactive & Impulsive Behaviors:

Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
*  Often has difficulty sustaining attention in tasks or play activities
*  Often does not seem to listen when spoken to directly
*  Often does not follow through on instruction and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand)
*  Often has difficulty organizing tasks and activities
*  Often avoids, dislikes, or reluctant to engage in tasks that require sustained mental effort, such as schoolwork or housework
*  Often loses things necessary for tasks or activities (for example, toys, school assignments, pencils, or books)
*  Often easily distracted by extraneous stimuli
*  Often forgetful in daily activities
*  Oftenfidgets with hands or feet or squirms in seat
*  Often leaves seat in classroom or in
other situations in which remaining iseated is  expected
*  Often runs about or climbs excessively in situations in which it is inappropriate
*  Often has difficulty playing or engaging in leisure activities quietly
*  Is often "on the go" or often acts as if "driven by a motor"
*  Often talks excessively
*  Often blurts out answers before
questions have been completed
*  Often has difficulty awaiting turn
*  Often interrupts or intrudes on others, such as butting into conversations or games.

Early onset:   Thetypical age at which children are clinically diagnosed with ADHD is between 5 and 11 years of age, or during the elementary school years.  In many children, the onset of symptoms can be traces back to the preschool years.  The diagnosis of ADHD requires that the symptoms be present prior to age 7.

Chronic:   It was commonly thought that children with ADHD would outgrow their symptoms by the adolescent years.However, the research to date indicates that ADHD is a chronic condition that will continue to be problematic through the adolescent years and into adulthood for the majority of children with ADHD.  Some children with ADHD will show a reduction in symptoms by late adolescence and early adulthood.

Inconsistent Behavior:   Fluctuations in the ability to pay attention and to control behavior are characteristic of ADHD.  This fluctuation can result in inconsistent work performance at school and inconsistent behavior at home.

Associated Problems:   While not all children with ADHD will develop associated problems, they are at greater risk than children without ADHD for developing problems in academic, behavioral, social, and emotional areas.

Academic Performance.   Children with high levels of ADHD symptoms are rated by their teachers to have significant problems in classroom performance, such as on-task behavior, work completion, and conduct.  In addition, about 25% of children with ADHD also have a coexisting learning disability.
Behavioral Problems.   Children with ADHD have a higher rate of acting-out problems than children without ADHD, including oppositional, antisocial, aggressive, and conduct disordered behaviors.  As many as 65% of children with ADHD will develop an additional diagnosis of an oppositional or cinduct disorder by the adolescent years.
Social Problems.   Research has shown that children with ADHD tend to have an intrusive, domineering, and impulsive social style.  Children with the Predominantly Inattentive type of ADHD tend to have a passive and withdrawn social style.  These social styles place them at risk for problems with social relation.
Emotional Problems.   Research studies have documented that children with ADHD display more symptoms of depression and anxiety than children without ADHD.  In addition, children with ADHD can have problems with low self-esteem and demoralization, as a result of their continued failure experiences.

How Many Children Have ADHD/ADD?

There is a general agreement that 2% to 3% is a conservative estimation of the rate of ADHD in the general school-age population.  Studies have shown that ADHD is more common in boys than in girls by a ratio of 3:1 to 6:1.

What Causes AHDH/ADD?

The available research evidence suggests that the causes of ADHD are biological.  The strongest evidence for a biological basis for ADHD comes from studies that support the role of inheritance in ADHD.  Other evidence for the biological basis for ADHD comes from studies of the brain and it's functioning in individuals with ADHD.  The evidence, abeit inconsistent to implicate deficiencies in those areas of the brain that are thought to be involved in attention and control of behavior.

Brain damage from trauma, infection, disease, and pregnancy and birth complications has been proposed as a cause of ADHD.  While brain damage from these types of problems can result in symptoms of ADHD, research evidence suggests that fewer than 5% of children with ADHD have actual evidence of brain damage.

Diet and poor parenting have also been proposed as causes of ADHD.  To date is minimal evidence that children with ADHD have unusual sensitivities or reactions to foods.  In addition, there is no evidence that ADHD is caused by poor parenting.

How Is ADHD Diagnosed?

Since there is no reliable "ADHD Test", an assessment for ADHD will need to be comprehensive in nature.  In addition to assessing for the symptoms of ADHD and any associated problems, it is necessary to assess whether other problems may be causing the ADHD symptoms.  A comprehensive assessment should involve multiple methods (for example, interviews, behavioral rating scales, objective testing, and direct observations), multiple informants (parents, teachers, child), and disciplines.

The American Acadamy of Child and Adolescent Psychiatry has developed a set of practice guidelines for the assessment of ADHD, which are listed in the table above.  A thorough assessment should consider each of these areas.

How Is ADHD Treated?

There is no cure for ADHD.  Instead, treatments are used to directly manage ADHD symptoms and their associated problems.  Standards of practice indicate that three types of treatment modes should be considered for the treatment of children with ADHD: education, behavioral interventions, and medication.

    Education     Parents, teachers, and other significant persons should be educated about the nature of ADHD.  In addition parents or a counselor should discuss the nature of ADHD with the child in an age-appropriate manner.

    Behavior Interventions     Behavioral interventions implemented at home and at school have proven to be the most promising alternative or adjunct to medication treatment of children with ADHD.  Research has established the usefulness of a variety of behavior techniques in the school setting, such as seating arrangements, task modifications,  School-Home Note programsToken Economies, Response Cost Programs.  For the home, behavioral parent training programs are one of the more commonly recommended nonmedical interventions for ADHD.  Parent training is a systematic approach to teaching parents to implement positive behavior management techniques, consistent and appropriate discipline techniques, and clear and concise communication.

    Medication Intervention     Treatment with medication is the most common intervention for ADHD.  The short-term effectiveness of the stimulant medications is well-documented.  Research studies indicate that about 75% of children treated with stimulant medications will show mild to moderate improvement.

How Can I Get Help?

For information about local support groups and information about ADHD:

        Children and Adults with Attention Deficit Disorder (CHADD)
        National Headquarters
        Suite 109
        449 N.W. 70th Avenue
        Plantation, Florida

Telephone: 1-305-857-3700

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