This article was written by a wonderful school psychologist who also happens to be an amazing friend. She works primarily in student assessment and is a wealth of knowledge on many different areas of student needs both in the classroom and at home. Her ideas truly offer us ways to bridge the gap between home and school. This is my longest post yet…and while I thought about breaking it into two sections, I didn’t want to make my readers wait to read the second half. Yes, it is long but it is informative and sends a message of hope to all of us out there working with children who have been diagnosed with ADHD.
What’s the deal with A.D.H.D? by, Emma Savino, M.A., C.A.S, NYS Certified School Psychologist
We’ve all heard someone self-diagnose themselves with ADHD; “I can’t focus today! I’m so ADHD!” The truth is, we are all inattentive or become restless at times. Most of us have the self-awareness and cognitive control to bring ourselves back to reality when this occurs. However, about 10% of the population struggles with maintaining focus and conforming to environments that require controlled behavior on a daily basis. Imagine how tiring that would be for someone who has limited control over their impulses, attention, organization and ability to remain still. Now imagine that person as a child stuck in a classroom for 6 hours each day behind a desk. This is a daunting task for many children in our classrooms. Some feel that ADHD is over-diagnosed (which it probably is), however, it does exist! What separates those with true ADHD from those with attention difficulties depends on the frequency, severity and length of time behaviors have been present. For these individuals, there is hope! We can treat ADHD just as we treat medical disorders, through various modifications and behavior management systems in home and school settings. This helps create a better and more productive work environment for everyone involved.
What is ADHD? Attention-Deficit Hyperactivity Disorder (ADHD) is a neurobiological disorder characterized by inattentive and hyperactive behaviors that are developmentally inappropriate. These behaviors tend to interfere with daily life, impacting school performance, social relationships and productivity.
When do children display these behaviors? ADHD can manifest at an early age. Be sure to rule out developmentally appropriate behaviors. Kids are inattentive! That’s just a fact of life. My professional opinion is to seek help if behaviors persist through 1st grade. I do not feel comfortable assessing a child in pre-K or kindergarten for ADHD. First grade is where students usually begin to be required to function in more structured settings. If you (parent or teacher) are actively teaching self-control through the use of a structured routine and other direct teaching strategies in which the child is not responding, further investigation into ADHD may be warranted. Be sure that these behaviors are impacting your child across various environments. If behaviors are specific to one setting (i.e. the classroom) modifications in that particular setting may be all that is needed to see improvements in behavior.
*It is also important to rule-out learning disabilities or any medical problems that may contribute to inattention/hyperactivity. If you have concerns about your child’s performance, contact your school district to find out how you can refer your child for evaluation to assess these areas.
Who can diagnose ADHD? School districts can use screening tools to determine frequency and significance of behaviors, however, cannot diagnose. Once this information is gathered, school districts will typically recommend you share the data with an outside medical professional.
Although your general pediatrician can diagnose ADHD, I recommend follow-up with a neurologist, clinical psychologist or psychiatrist. These individuals have more training in this area and may be able to conduct additional assessments to determine whether a diagnosis is warranted.
Guidelines for Diagnosis The Diagnostic & Statistical Manual for Mental Disorders (DSM-IV-TR) is the mental health professional’s bible. This manual outlines behaviors associated with various disorders. Individuals must meet a specific number of criteria, occurring for a pre-determined length of time. For ADHD, symptoms must be present for 6 months and be disruptive to daily life or are considered developmentally inappropriate. They also must be present across at least two settings. There are three different ADHD diagnoses (the term ADD is no longer used):
a. Predominately Inattentive Type: This describes the child who is inattentive and does not display significant hyperactive behaviors.
- Inattentive symptoms can include:
- Trouble organizing activities.
- Trouble keeping attention on tasks or play activities.
- Is often easily distracted.
- Does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
- Loses things needed for tasks and activities.
b. Predominately Hyperactivity Type: This describes the child who is hyperactive and does not display significant inattentive behaviors.
- Hyperactive/Impulsive symptoms can include:
- Fidgets with hands or feet or squirms in seat.
- Runs about or climbs when and where it is not appropriate.
- Has trouble playing or enjoying leisure activities quietly.
- Is often “on the go” or often acts as if “driven by a motor.”
- Trouble waiting one’s turn.
- Interrupts or intrudes on others.
- Blurts out answers before questions have been finished.
c. Combined Type: This describes the child who displays both inattentive and hyperactive symptoms.
Recommendations for Teachers and Parents
- Be patient with your children with ADHD. The calmer and more collected you are, the more they will respond to you and follow directions within the classroom or household.
- Provide these children with visually stimulating and interesting material such as maniuplatives, to help catch their attention. You can also allow a student to hold an object in their hand while working (i.e. stress ball, play-doh, etc.). This can sometimes help increase focus. However, this technique should only be used if the item itself does not become a distraction.
- Students with ADHD often suffer from deficits in working memory or “immediate memory.” This is where we initially process information and then store the information into our short or long-term memory. When we repeat a phone number in our head in order to remember it as we get to the phone, we are using our working memory. Individuals with attention problems may struggle with using their working memory. Therefore, always break up instructions into individual steps. Writing down these steps on paper can also act as a visual reminder.
- Teach organization! If your home and classrooms are organized, the more likely your child will be organized. At home, organize toys into categories and colored bins. You can also label these bins and put pictures on them displaying what’s inside. For school books, color code folders and binders into separate subjects.
- Attention to task and school performance for a child with ADHD can fluctuate. Some days you may notice this child is “on point” or they may score high on a test. This is normal for these children so it is important to expect patterns of fluctuating performance and attention. Again, be patient.
Recommendations specific to teachers:
- Have the student sit in close proximity to you. A simple tap on the students’ desk may be enough to redirect them to task.
- Reward this student when they are focusing.
- Provide them with movement breaks throughout the day.
- DO NOT take away recess as a punishment or for the student to catch up on work. These children (wait a tic; all children) NEED recess. Recess is not a significant amount of time to keep the student from participating. What is recess nowadays, anyway? Fifteen to thirty minutes? Let the kid play!
- Use visual schedules so the student knows what to expect each period during the day. This can be posted on the child’s desk or in the front of the classroom.
- Rules should be clear, concise and their implementation should be consistent. The student will eventually learn your expectations and this leaves no room for surprises.If and when you have the time, work one-on-one or in a small group with these children. Attention can significantly increase with less distraction in a smaller setting.
- Expressive tone of voice when teaching will help keep your student’s attention.
Recommendations specific to parents:
- Homework can be challenging to finish with any child. Create a homework routine. Complete homework at the same time each day. Have a “homework box” near where your child completes their work to avoid disorganization and interruptions during homework time. This box should include ANYTHING that your child could possibly need to complete homework and small projects.
- Medications: Medicating your child is a big decision and is solely your decision. I’m not going to speak too much on this matter because the truth is if you are considering medication, you really must speak to a medical professional about benefits and side-effects.
- Encourage healthy eating! You are what you eat, right? Good foods that act as fuel are the healthy ones! These foods can help improve focus and productive energy. Therefore, avoid sugary foods that are going to make your child MORE hyper. Have a healthy snack waiting for them when they get home from school.
- Limit video game time. Many parents think their child does not have ADHD because their child can play video games for hours! However, the intense stimulation provided by video games is making your child’s brain happy, but is not necessarily good for them. Although a child can partake in a healthy amount of video game playing, try to get them to do something more productive like build a sculpture out of blocks, play with a friend, create artwork or help you with chores around the house.
- Let your child play! Take them to the park and let them play outside. Use play time as a reward for your child. As long as all of their school responsibilities are fulfilled, they should be playing, running and jumping to release that energy, particularly after being cooped up in school all day.
- Keep open communication with your child. Do not keep their ADHD a secret from them. Many children with ADHD have average to above average intellectual abilities. Therefore, there is a good chance they know they’re different! Educating your child about their strengths and areas for growth, and working with them to determine what works best to manage inattention and impulsive behaviors will only benefit them.
In closing, remember this when working with these children:
- There is no cure for ADHD, but managing the disorder is possible.
- Be sure that inattention/hyperactivity is significantly impacting your child before searching for a diagnosis.
- Ignore behaviors that are not causing disruption to others or are not jeopardizing safety for anyone. If you try to correct each and every problematic behavior, you will go crazy.
- Use every opportunity to teach your child. Teachable moments occur everyday and many of the skills that children with ADHD lack can be taught directly with repeated practice.
- Take a deep breath. Remember, you are working with a child and they need your help; and hey, they keep you on your toes, right? Accept the challenge and do all you can to create enriching experiences and environments for your child.
Resources: http://www.chadd.org/ – This website is a great resource to learn about ADHD and connect with other parents or adults who have been diagnosed. They also offer a bi-monthly magazine that you can subscribe to so you can stay informed.
Emma also highly recommends this book for parents and teachers that are working with children with ADHD:
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