1:0 Introduction
Attention Deficit Hyperactivity Disorder (ADHD) is a neurological condition that involves problems with inattention and hyperactivity-impulsivity that are developmentally inconsistent with the age of the child. We are now learning that ADHD is not a disorder of attention, as had long been assumed. Rather, it is a function of developmental failure in the brain circuitry that monitors inhibition and self-control. This loss of self-regulation impairs other important brain functions crucial for maintaining attention, including the ability to defer immediate rewards for later gain. Behaviour of children with ADHD can also include excessive motor activity. The high energy level and subsequent behaviour are often misperceived as purposeful noncompliance, when, in fact, they may be a manifestation of the disorder and require specific interventions. Children with ADHD exhibit a range of symptoms and levels of severity. In addition, many children with ADHD often are of at least average intelligence and have a range of personality characteristics and individual strengths.
Children with ADHD typically exhibit behaviour that is classified into two main categories: poor sustained attention and hyperactivity-impulsiveness. As a result, three subtypes of the disorder have been proposed by the American Psychiatric Association (Fourth edition of the Diagnostic and Statistical Manual of Mental Disorders) –
Predominantly inattentive
Predominantly hyperactive-impulsive
Combined types
A child expressing hyperactivity commonly will appear fidgety, have difficulty staying seated or playing quietly, and act as if driven by a motor. Children displaying impulsivity often have difficulty participating in tasks that require taking turns. Other common behaviours may include blurting out answers to questions instead of waiting to be called and flitting from one task to another without finishing.
The inattention component of ADHD affects the educational experience of these children because ADHD causes them to have difficulty in attending to detail in directions, sustaining attention for the duration of the task, and misplacing needed items. These children often fail to give close attention to details, make careless mistakes, and avoid or dislike tasks requiring sustained mental effort.
Although these behaviours are not in themselves a learning disability, almost one-third of all children with ADHD have learning disabilities. Children with ADHD may also experience difficulty in reading, math, and written communication. Further, ADHD commonly occurs with other conditions. Current literature indicates that approximately 40-60 percent of children with ADHD have at least one existing disability. Although any disability can coexist with ADHD, certain disabilities seem to be more common than others. These include disruptive behavious disorders, mood disorders, anxiety disorders, tics and Tourette’s syndrome, and learning disabilities. In addition, ADHD affects children differently at different ages. In some cases, children initially identified as having hyperactive-impulsive subtype are subsequently identified as having the combined subtype as their attention problems surface.
These characteristics affect not only the academic lives of students with ADHD; they may affect their social lives as well. Children with ADHD of the predominantly hyperactive-impulsive type may show aggressive behaviours, while children of the predominantly inattentive type may be more withdrawn. Also, because they are less disruptive than children with ADHD who are hyperactive or impulsive, many children who have the inattentive type of ADHD go unrecognized and unassisted. Both types of children with ADHD may be less cooperative with others and less willing to wait their turn or play by the rules. Their inability to control their own behaviour may lead to social isolation. Consequently, the children’s self-esteem may suffer.
2:0 What Causes ADHD
ADHD has traditionally been viewed as a problem related to attention, stemming from an inability of the brain to filter competing sensory inputs such as sight and sound. Recent research, however, has shown that children with ADHD do not have difficulty in that area. Insead, researchers now believe that children with ADHD are unable to inhibit their impulsive motor responses to such input.
It is still unclear what the direct and immediate causes of ADHD are, although scientific and technological adavances in the field of neurological imaging techniques and genetics promise to clarify this issue in the near future. Most researchers suspect that the cause of ADHD is genetic or biological, although they acknowledge that the child’s environment helps determine specific behaviours.
Imaging studies conducted during the past decade have indicated which brain regions may malfunction in patients with ADHD, and thus account for symptoms of the condition.
3:0 How Do we Identify ADHD ?
Although toddlers and preschoolers, on occasion, may show characteristics of ADHD, some of these behaviours may be normal for their age or developmental stage. These behaviours must be exhibited to an abnormal degree to identification as ADHD. Even with older children, other factors (including environmental influences) can produce behaviours resembling ADHD. The criteria set forth by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders are used as the standardized clinical definition to determinie the presence of ADHD. A person must exhibit several characteristics to be clinically diagnosed as having ADHD:-
· Severity: The behaviour in question must occur more frequently in the child than in other children at the same developmental stage.
· Early onset: At least some of the symptoms must have been present prior to age 7.
· Duration: The symptoms must have been present for at least 6 months prior to the evaluation.
· Impact: The symptoms must have a negative impact on the child’s academic or social life.
· Settings: The symptoms must be present in multiple settings.
4:0 Characteristics:
The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (APA, 1994), USA gives the following characteristics of children with ADHD. Children with ADHD have difficulty focusing their attention and concentration on tasks. Described as rash, driven, easily distracted, they tend to race from one idea to another. The threee primary characteristics of ADHD are:
· Inattention
· Impulsivity
· Hyperactivity
5:0 Symptoms of ADHD:
· Often fidgets with hands or feet or squirms in seat (in adolescence may be limited to feeling of restlessness)
· Has difficulty remaining seated when required to do so.
· Is easily distracted by extraneous stimuli.
· Has difficulty awaiting his turn in games or group situations.
· Often blurts out answers to question before they have been completed.
· Has difficulty following instructions from others, e.g. fails to finish chores.
· Has difficulty paying sustained attention to teaching or playing activities.
· Often shifts from one uncompleted activity to another.
· Has difficulty playing quietly.
· Often talks excessively.
· Often interrupts or intrudes on others (e.g. butts into other children’s games)
· Often does not seem to listen to what is being said.
· Often loses things necessary for tasks or activities without considering possible consequences (not for the purpose of thrill-seeking), e.g. runs into street without looking.
The above items are listed in descending order of discriminating power.
Symptoms of Inattention:
· often fails to give close attention to details or makes careless mistakes in school work, 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 instructions and fails to finish schoolwork, chores, or duties in the workplace 9not due to oppositional behaviour or failure to understand instructions).
· Often has difficulty organizing tasks and activities.
· Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as school work or homework)
· Often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books , or tools)
· Is often easily distracted by extraneous stimuli.
· Is often forgetful in daily activities.
Symptoms of Hyperactivity:
· Often fidgets with hands or feet or squirms in seat.
· Often leaves seat in classroom or in other situations in which remaining seated is expected
· Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
· 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
Symptoms of Impulsivity:
· often blurts out answers before questions have been completed
· often has difficulty awaiting turn
· often interrupts or intrudes on others (e.g. butts into conversations or games)
Symptoms must have persisted for at least 6 months. Some of these symptoms need to have been present as a child, at 7 years old or younger. The symptoms also must exist in at least two separate settings (e.g., at school and at home). The symptoms should be creating significant impairment in social, academic or occupational functioning or relationships.
According to DSM-IV of American Psychological Association (1994), there are three subtypes of ADHD:-
(1) Children can display symptoms primarily of inattention
(2) Children can exhibit behaviours’ that are primarily hyperactive-impulsive.
6:0 How does ADHD affect school performance ?
The school experience can be challenging for students with ADHD. Students usually are identified only after consistently demonstrating a failure to understand or follow rules or to complete required tasks. Other common reasons for referral include frequent classroom disruptions and poor academic performance.
Studies found that students with ADHD, compared to students without ADHD, had persistent academic difficulties that resulted in the following: lower average marks, more failed grades, more expulsions, increased dropout rates, and a lower rate of college undergraduate completion. The disruptive behaviour sometimes associated with the disorder may make students with ADHD more susceptible to suspensions and expulsions. A study by Barkley and colleagues found that 46 percent of their student study group with ADHD had been suspended and 11 percent had been expelled.
ADHD’s core symptoms – inattention, hyperactivity, and impulsivity – make meeting the daily rigors of school challenging. Difficulty sustaining attention to a task may contribute to missing important details in assignments, daydreaming during lectures and other activities, and difficulty organizing assignments. Hyperactivity may be expressed in either verbal or physical disruptions in class. Impulsivity may lead to careless errors, responding to questions without fully formulating the best answers, and only attending to activities that are entertaining or novel. Overall, students with ADHD may experience more problems with school performance than their non-disabled peers.
7:0 Treatment:
Attempts to enhance the academic and behavioural functioning of children having ADHD have included a variety of strategies. Some of these include:
· Stimulant medication or pharmacotherapy
· Educational intervention
The main objective of children with ADHD and their parents should be not to cure or eliminate their ADHD problem, but to learn methods of coping with and compensating for this ongoing learning and behavioural disability.
Stimulants Medication:
Psycho-stimulant medication has been the most extensively studied therapy for ADHD and related disruptive behaviour symptoms. Over 70% of children with ADHD taking these medication exhibits behavioural, academic and attention improvements. But no drug should be used without the prescription of a competent physician.
Positive Effects of Stimulants:
· Redduction in disruptive out-of-seat behaviour
· Increase compliance
· Responsiveness to social interaction with parents/teachers/peers
· The amounts of commands, criticism and punishment and censure directed children by adults are often reduced as well.
Side Effects of Stimulants:
The side effects of the stimulants usually include:
*Decreased appetite
* Insomnia
* Increased Tension
* Growth inhibition
* Somatic symptoms, e.g. headaches and stomach-aches
* Increase in heart rate or blood pressure.
To avoid the harmful side effects of tranquillizers, educational strategies should be devised. These are described in the following section.
Educational Interventions:
Cruikshank (1961) noted that four elements comprise the essentials in a good teaching environment for brain-injured children with hyperactivity. These elements put forward by Cruikshank were:
· Reduction in environment stimuli
· Reduced space
· A structured school programme and life plan
· Increased stimulus value of teaching materials (organized stimulation to call attention to specific teaching or learning materials).
Considerable success has been reported both with the child’s use of verbal self directions and a combination of modeling and verbal self-direction. The success of these methods consists in having the children talk themselves through tasks and/or use verbal commands such as STOP, LOOK, LISTEN and THINK.
Children can then gain proficiency in using a strategy that makes them self-reliant and the one which can be generalized beyond the classroom setting. Many believe that ADHD children can overcome the absence of spontaneous controls, if they are taught to direct their own behaviours’. Remedial strategies to reduce hyperactivity.
Lerner, Lowenthal and Lerner (1995) in their book, Attention Deficit Disorders: Assessment and Teaching suggest the following remedial strategies to reduce hyperactivity.
Modifications:
The following modification in the instruction help the students suffering from ADHD.
· Alterring the way information is presented
- Textbook recorded on audiotape
- Highlighted reading
· Altering the way information is assessed
- alternative test formats (matching instead of essay, for example)
- shorter tests
- oral presentations and responses
- redesigned tests
· Managing academics and behaviour
- specifically prescribed classroom alterations for certain students (seating, individual instruction, and so on)
- behaviour management techniques (positive reinforcement, students conferences, behaviour contracts, and so on)
- student partners/mentors
8:0 Creating a Stimulating Learning Environment
Students with ADHD respond well to novelty. Students with ADHD benefit from increased stimulation and novelty on easy and repetitive tasks, but not on new or difficult ones. Simple modification can increase the novelty and stimulation of tasks presented to students with ADHD. For example, adding shape, colour, or texture to an activity increases its novelty value. With a stimulating learning environment, students attend better to the learning activity. The other relatively simple modification that make activities more stimulating:
· Eliminating unnecessary repetition of tasks.
· Adding action to the task (for example, having the student work with other, talk to others and more materials)
· Shortening the assignments.
· Developing routines aimed at completing the task (for example, establishing a specific place to put finished material)
Increased Sustained Attention:
Students with ADHD are likely to have a short attention span. They may initially attend to task, but their attention soon begins to wander. Teachers can take suitable steps to prolong students’ concentration on the tasks at hand. These include shortening the task, making tasks more interesting and increasing the novelty of the task.
Shortening the Task:
Teachers can accommodate students with attentional problems by shortening tasks. Some ways of achieving this are: break one task into smaller parts to be completed at different times; allow quiet talking during work; give two tasks to the student with the more preferred task to be completed after the less preferred task; assign fewer words when explaining tasks, give concise verbal directions; use distributed practice rather than massed practice for rote tasks; that is, set up more short, spaced practice sessions and give fewer and shorter assignments.
Making Tasks More Interesting:
When students are intensely interested in something, their attention span can be amazingly long. For example, a child will spend hours at a favourite hobby. Remember that obtaining “on-task” behaviour is not in itself a useful goal. Attention should be a natural result, not a goal to be reached, so change the nature of the task or the learning environment as needed. The following strategies make tasks more engaging.
· Encourage children to work with partners, in small groups, or at interest centres.
· Alternated highly interesting and less interesting tasks.
· Use visual aids (such as an overhead projector) when teaching.
Increasing the Novelty of the Task:
Task that are new, unique, or unusual are inherently more likely to capture a child’s attention. For longer tasks or tasks that are necessarily repetitive, increasing the novelty value is especially important. To add novelty, try using a game format for the task. Games add fun and novelty to learning, especially when material must be overlearnt to develop automaticity (such as with word recognition or math facts).
Curriculum Adaptation:
Many parts of the curriculum can be readily changed, modified, or adapted, without sacrificing the integrity of the basic curriculum. In many cases, even small changes will greatly benefit students suffering from ADHD who, in general, need a stimulating active curriculum that will captivate their attention and motivate them to complete the activity at hand. General guidelines for an adaptive curriculum are:
· Use high-interest curriculum materials.
· Check the difficulty level of the reading material and texbooks to make sure that they are appropriate to the child’s reading level. A level that is too easy leads to boredom and a level that is too difficult leads to frustration.
· Select manipulable, hands-on materials whenever possible.
· Establish a solid, concrete experimental base before teaching abstract concepts.
· Demonstrate how new information related to material already learnt.
· Introduce new vocabulary before beginning a lesson
· Use visual aids to supplement oral and written information
· Use learning aids to structure learning and increase motivation
· Create curriculum activities that require active participation, such as talking through problems and acting out steps.
· Use multiple modalities when presenting information. For example, combining a visual-tactile approach with verbal information.
· Modify curriculum worksheets such that there is less material on each page.
· Use colour coded worksheets to attract attention and increase the novelty of the task.
· Give feedback on each task immediately.
· Avoid pressures of speed and accuracy.
Improving the student’s ability to listen:
Students with ADHD frequently miss important instructions and information because of their inattention. Often, they are even unaware that instructions have been given. When teachers ask students to listen, they want them not only to hear or recognize the words that are spoken but also to comprehend the message. The following classroom strategies can help students acquire better listening skills.
· Use short, simple sentences when speaking to the child.
· Make certain that the vocabulary used is developmentally appropriate.
· Give one instruction at a time. Slow the rate of presentation.
· Repeat as often as necessary.
· Prompt the student to repeat instruction after he/she has listened to them.
· Alert the student by using key phrases, “Listen carefully,” and the like.
· Write a short outline or summary of the directions on the chalkboard for easy reference.
· Write a short outline or summary of the directions on the chalkboard for easy reference.
· Use visual aids (such as charts, pictures, graphs) to illustrate and support verbal information.
· Make certain that the student is sitting near the teacher when oral instructions are given.
· Place the student in the least distracting location in the window. This may be in front of the window, away from high-noise or activity areas.
· Eliminate extraneous noise and visual stimuli whenever possible.
· Reduce emphasis on competition in the class. Competition may over-stimulate the students; distract him/her from listening to information they have just heard to build listening and memory skills.
9:0 Behavioural Management:
Behavioural modification is especially useful in coping with the problem of children with attention deficit hyperactivity disorders. The advantage of using these modification tecniques is that they can increase an ADHD child’s on-task behaviour, help/her complete a given assignment and make him/her more compliant. Thus, these methods are useful in helping the child to be more compliant and even building acceptable social skills. Behavioural modificationmethods are also used to decrease hyperactivity, aggressive behaviour and even increase attention.
Behavioural modification is usually undertaken with the help of some of the following conditioning techniques.
(a) Reinforcement: Using reinforcers or rewards enhance the likelihood of desirable behaviour being emited.
(b) Aversive conditioning: In simple words, it means punishment which should, as fas as possible, be non-corporal. It should be borne in mind that while using aversive conditioning techniques, corporal punishment of any kind should be avoided. Apart from being socially inacceptable, it is banned by law and could possibly result in a severe reaction from the child making his’her condition worse.
(c) Shaping: This means breaking the desired behaviour into small steps. Each step that is close to the target behaviour is reinforced.
(d) Dealing with interpersonal conflicts.
Attention Deficit Hyperactivity Disorder (ADHD) is a neurological condition that involves problems with inattention and hyperactivity-impulsivity that are developmentally inconsistent with the age of the child. We are now learning that ADHD is not a disorder of attention, as had long been assumed. Rather, it is a function of developmental failure in the brain circuitry that monitors inhibition and self-control. This loss of self-regulation impairs other important brain functions crucial for maintaining attention, including the ability to defer immediate rewards for later gain. Behaviour of children with ADHD can also include excessive motor activity. The high energy level and subsequent behaviour are often misperceived as purposeful noncompliance, when, in fact, they may be a manifestation of the disorder and require specific interventions. Children with ADHD exhibit a range of symptoms and levels of severity. In addition, many children with ADHD often are of at least average intelligence and have a range of personality characteristics and individual strengths.
Children with ADHD typically exhibit behaviour that is classified into two main categories: poor sustained attention and hyperactivity-impulsiveness. As a result, three subtypes of the disorder have been proposed by the American Psychiatric Association (Fourth edition of the Diagnostic and Statistical Manual of Mental Disorders) –
Predominantly inattentive
Predominantly hyperactive-impulsive
Combined types
A child expressing hyperactivity commonly will appear fidgety, have difficulty staying seated or playing quietly, and act as if driven by a motor. Children displaying impulsivity often have difficulty participating in tasks that require taking turns. Other common behaviours may include blurting out answers to questions instead of waiting to be called and flitting from one task to another without finishing.
The inattention component of ADHD affects the educational experience of these children because ADHD causes them to have difficulty in attending to detail in directions, sustaining attention for the duration of the task, and misplacing needed items. These children often fail to give close attention to details, make careless mistakes, and avoid or dislike tasks requiring sustained mental effort.
Although these behaviours are not in themselves a learning disability, almost one-third of all children with ADHD have learning disabilities. Children with ADHD may also experience difficulty in reading, math, and written communication. Further, ADHD commonly occurs with other conditions. Current literature indicates that approximately 40-60 percent of children with ADHD have at least one existing disability. Although any disability can coexist with ADHD, certain disabilities seem to be more common than others. These include disruptive behavious disorders, mood disorders, anxiety disorders, tics and Tourette’s syndrome, and learning disabilities. In addition, ADHD affects children differently at different ages. In some cases, children initially identified as having hyperactive-impulsive subtype are subsequently identified as having the combined subtype as their attention problems surface.
These characteristics affect not only the academic lives of students with ADHD; they may affect their social lives as well. Children with ADHD of the predominantly hyperactive-impulsive type may show aggressive behaviours, while children of the predominantly inattentive type may be more withdrawn. Also, because they are less disruptive than children with ADHD who are hyperactive or impulsive, many children who have the inattentive type of ADHD go unrecognized and unassisted. Both types of children with ADHD may be less cooperative with others and less willing to wait their turn or play by the rules. Their inability to control their own behaviour may lead to social isolation. Consequently, the children’s self-esteem may suffer.
2:0 What Causes ADHD
ADHD has traditionally been viewed as a problem related to attention, stemming from an inability of the brain to filter competing sensory inputs such as sight and sound. Recent research, however, has shown that children with ADHD do not have difficulty in that area. Insead, researchers now believe that children with ADHD are unable to inhibit their impulsive motor responses to such input.
It is still unclear what the direct and immediate causes of ADHD are, although scientific and technological adavances in the field of neurological imaging techniques and genetics promise to clarify this issue in the near future. Most researchers suspect that the cause of ADHD is genetic or biological, although they acknowledge that the child’s environment helps determine specific behaviours.
Imaging studies conducted during the past decade have indicated which brain regions may malfunction in patients with ADHD, and thus account for symptoms of the condition.
3:0 How Do we Identify ADHD ?
Although toddlers and preschoolers, on occasion, may show characteristics of ADHD, some of these behaviours may be normal for their age or developmental stage. These behaviours must be exhibited to an abnormal degree to identification as ADHD. Even with older children, other factors (including environmental influences) can produce behaviours resembling ADHD. The criteria set forth by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders are used as the standardized clinical definition to determinie the presence of ADHD. A person must exhibit several characteristics to be clinically diagnosed as having ADHD:-
· Severity: The behaviour in question must occur more frequently in the child than in other children at the same developmental stage.
· Early onset: At least some of the symptoms must have been present prior to age 7.
· Duration: The symptoms must have been present for at least 6 months prior to the evaluation.
· Impact: The symptoms must have a negative impact on the child’s academic or social life.
· Settings: The symptoms must be present in multiple settings.
4:0 Characteristics:
The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (APA, 1994), USA gives the following characteristics of children with ADHD. Children with ADHD have difficulty focusing their attention and concentration on tasks. Described as rash, driven, easily distracted, they tend to race from one idea to another. The threee primary characteristics of ADHD are:
· Inattention
· Impulsivity
· Hyperactivity
5:0 Symptoms of ADHD:
· Often fidgets with hands or feet or squirms in seat (in adolescence may be limited to feeling of restlessness)
· Has difficulty remaining seated when required to do so.
· Is easily distracted by extraneous stimuli.
· Has difficulty awaiting his turn in games or group situations.
· Often blurts out answers to question before they have been completed.
· Has difficulty following instructions from others, e.g. fails to finish chores.
· Has difficulty paying sustained attention to teaching or playing activities.
· Often shifts from one uncompleted activity to another.
· Has difficulty playing quietly.
· Often talks excessively.
· Often interrupts or intrudes on others (e.g. butts into other children’s games)
· Often does not seem to listen to what is being said.
· Often loses things necessary for tasks or activities without considering possible consequences (not for the purpose of thrill-seeking), e.g. runs into street without looking.
The above items are listed in descending order of discriminating power.
Symptoms of Inattention:
· often fails to give close attention to details or makes careless mistakes in school work, 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 instructions and fails to finish schoolwork, chores, or duties in the workplace 9not due to oppositional behaviour or failure to understand instructions).
· Often has difficulty organizing tasks and activities.
· Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as school work or homework)
· Often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books , or tools)
· Is often easily distracted by extraneous stimuli.
· Is often forgetful in daily activities.
Symptoms of Hyperactivity:
· Often fidgets with hands or feet or squirms in seat.
· Often leaves seat in classroom or in other situations in which remaining seated is expected
· Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
· 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
Symptoms of Impulsivity:
· often blurts out answers before questions have been completed
· often has difficulty awaiting turn
· often interrupts or intrudes on others (e.g. butts into conversations or games)
Symptoms must have persisted for at least 6 months. Some of these symptoms need to have been present as a child, at 7 years old or younger. The symptoms also must exist in at least two separate settings (e.g., at school and at home). The symptoms should be creating significant impairment in social, academic or occupational functioning or relationships.
According to DSM-IV of American Psychological Association (1994), there are three subtypes of ADHD:-
(1) Children can display symptoms primarily of inattention
(2) Children can exhibit behaviours’ that are primarily hyperactive-impulsive.
6:0 How does ADHD affect school performance ?
The school experience can be challenging for students with ADHD. Students usually are identified only after consistently demonstrating a failure to understand or follow rules or to complete required tasks. Other common reasons for referral include frequent classroom disruptions and poor academic performance.
Studies found that students with ADHD, compared to students without ADHD, had persistent academic difficulties that resulted in the following: lower average marks, more failed grades, more expulsions, increased dropout rates, and a lower rate of college undergraduate completion. The disruptive behaviour sometimes associated with the disorder may make students with ADHD more susceptible to suspensions and expulsions. A study by Barkley and colleagues found that 46 percent of their student study group with ADHD had been suspended and 11 percent had been expelled.
ADHD’s core symptoms – inattention, hyperactivity, and impulsivity – make meeting the daily rigors of school challenging. Difficulty sustaining attention to a task may contribute to missing important details in assignments, daydreaming during lectures and other activities, and difficulty organizing assignments. Hyperactivity may be expressed in either verbal or physical disruptions in class. Impulsivity may lead to careless errors, responding to questions without fully formulating the best answers, and only attending to activities that are entertaining or novel. Overall, students with ADHD may experience more problems with school performance than their non-disabled peers.
7:0 Treatment:
Attempts to enhance the academic and behavioural functioning of children having ADHD have included a variety of strategies. Some of these include:
· Stimulant medication or pharmacotherapy
· Educational intervention
The main objective of children with ADHD and their parents should be not to cure or eliminate their ADHD problem, but to learn methods of coping with and compensating for this ongoing learning and behavioural disability.
Stimulants Medication:
Psycho-stimulant medication has been the most extensively studied therapy for ADHD and related disruptive behaviour symptoms. Over 70% of children with ADHD taking these medication exhibits behavioural, academic and attention improvements. But no drug should be used without the prescription of a competent physician.
Positive Effects of Stimulants:
· Redduction in disruptive out-of-seat behaviour
· Increase compliance
· Responsiveness to social interaction with parents/teachers/peers
· The amounts of commands, criticism and punishment and censure directed children by adults are often reduced as well.
Side Effects of Stimulants:
The side effects of the stimulants usually include:
*Decreased appetite
* Insomnia
* Increased Tension
* Growth inhibition
* Somatic symptoms, e.g. headaches and stomach-aches
* Increase in heart rate or blood pressure.
To avoid the harmful side effects of tranquillizers, educational strategies should be devised. These are described in the following section.
Educational Interventions:
Cruikshank (1961) noted that four elements comprise the essentials in a good teaching environment for brain-injured children with hyperactivity. These elements put forward by Cruikshank were:
· Reduction in environment stimuli
· Reduced space
· A structured school programme and life plan
· Increased stimulus value of teaching materials (organized stimulation to call attention to specific teaching or learning materials).
Considerable success has been reported both with the child’s use of verbal self directions and a combination of modeling and verbal self-direction. The success of these methods consists in having the children talk themselves through tasks and/or use verbal commands such as STOP, LOOK, LISTEN and THINK.
Children can then gain proficiency in using a strategy that makes them self-reliant and the one which can be generalized beyond the classroom setting. Many believe that ADHD children can overcome the absence of spontaneous controls, if they are taught to direct their own behaviours’. Remedial strategies to reduce hyperactivity.
Lerner, Lowenthal and Lerner (1995) in their book, Attention Deficit Disorders: Assessment and Teaching suggest the following remedial strategies to reduce hyperactivity.
Modifications:
The following modification in the instruction help the students suffering from ADHD.
· Alterring the way information is presented
- Textbook recorded on audiotape
- Highlighted reading
· Altering the way information is assessed
- alternative test formats (matching instead of essay, for example)
- shorter tests
- oral presentations and responses
- redesigned tests
· Managing academics and behaviour
- specifically prescribed classroom alterations for certain students (seating, individual instruction, and so on)
- behaviour management techniques (positive reinforcement, students conferences, behaviour contracts, and so on)
- student partners/mentors
8:0 Creating a Stimulating Learning Environment
Students with ADHD respond well to novelty. Students with ADHD benefit from increased stimulation and novelty on easy and repetitive tasks, but not on new or difficult ones. Simple modification can increase the novelty and stimulation of tasks presented to students with ADHD. For example, adding shape, colour, or texture to an activity increases its novelty value. With a stimulating learning environment, students attend better to the learning activity. The other relatively simple modification that make activities more stimulating:
· Eliminating unnecessary repetition of tasks.
· Adding action to the task (for example, having the student work with other, talk to others and more materials)
· Shortening the assignments.
· Developing routines aimed at completing the task (for example, establishing a specific place to put finished material)
Increased Sustained Attention:
Students with ADHD are likely to have a short attention span. They may initially attend to task, but their attention soon begins to wander. Teachers can take suitable steps to prolong students’ concentration on the tasks at hand. These include shortening the task, making tasks more interesting and increasing the novelty of the task.
Shortening the Task:
Teachers can accommodate students with attentional problems by shortening tasks. Some ways of achieving this are: break one task into smaller parts to be completed at different times; allow quiet talking during work; give two tasks to the student with the more preferred task to be completed after the less preferred task; assign fewer words when explaining tasks, give concise verbal directions; use distributed practice rather than massed practice for rote tasks; that is, set up more short, spaced practice sessions and give fewer and shorter assignments.
Making Tasks More Interesting:
When students are intensely interested in something, their attention span can be amazingly long. For example, a child will spend hours at a favourite hobby. Remember that obtaining “on-task” behaviour is not in itself a useful goal. Attention should be a natural result, not a goal to be reached, so change the nature of the task or the learning environment as needed. The following strategies make tasks more engaging.
· Encourage children to work with partners, in small groups, or at interest centres.
· Alternated highly interesting and less interesting tasks.
· Use visual aids (such as an overhead projector) when teaching.
Increasing the Novelty of the Task:
Task that are new, unique, or unusual are inherently more likely to capture a child’s attention. For longer tasks or tasks that are necessarily repetitive, increasing the novelty value is especially important. To add novelty, try using a game format for the task. Games add fun and novelty to learning, especially when material must be overlearnt to develop automaticity (such as with word recognition or math facts).
Curriculum Adaptation:
Many parts of the curriculum can be readily changed, modified, or adapted, without sacrificing the integrity of the basic curriculum. In many cases, even small changes will greatly benefit students suffering from ADHD who, in general, need a stimulating active curriculum that will captivate their attention and motivate them to complete the activity at hand. General guidelines for an adaptive curriculum are:
· Use high-interest curriculum materials.
· Check the difficulty level of the reading material and texbooks to make sure that they are appropriate to the child’s reading level. A level that is too easy leads to boredom and a level that is too difficult leads to frustration.
· Select manipulable, hands-on materials whenever possible.
· Establish a solid, concrete experimental base before teaching abstract concepts.
· Demonstrate how new information related to material already learnt.
· Introduce new vocabulary before beginning a lesson
· Use visual aids to supplement oral and written information
· Use learning aids to structure learning and increase motivation
· Create curriculum activities that require active participation, such as talking through problems and acting out steps.
· Use multiple modalities when presenting information. For example, combining a visual-tactile approach with verbal information.
· Modify curriculum worksheets such that there is less material on each page.
· Use colour coded worksheets to attract attention and increase the novelty of the task.
· Give feedback on each task immediately.
· Avoid pressures of speed and accuracy.
Improving the student’s ability to listen:
Students with ADHD frequently miss important instructions and information because of their inattention. Often, they are even unaware that instructions have been given. When teachers ask students to listen, they want them not only to hear or recognize the words that are spoken but also to comprehend the message. The following classroom strategies can help students acquire better listening skills.
· Use short, simple sentences when speaking to the child.
· Make certain that the vocabulary used is developmentally appropriate.
· Give one instruction at a time. Slow the rate of presentation.
· Repeat as often as necessary.
· Prompt the student to repeat instruction after he/she has listened to them.
· Alert the student by using key phrases, “Listen carefully,” and the like.
· Write a short outline or summary of the directions on the chalkboard for easy reference.
· Write a short outline or summary of the directions on the chalkboard for easy reference.
· Use visual aids (such as charts, pictures, graphs) to illustrate and support verbal information.
· Make certain that the student is sitting near the teacher when oral instructions are given.
· Place the student in the least distracting location in the window. This may be in front of the window, away from high-noise or activity areas.
· Eliminate extraneous noise and visual stimuli whenever possible.
· Reduce emphasis on competition in the class. Competition may over-stimulate the students; distract him/her from listening to information they have just heard to build listening and memory skills.
9:0 Behavioural Management:
Behavioural modification is especially useful in coping with the problem of children with attention deficit hyperactivity disorders. The advantage of using these modification tecniques is that they can increase an ADHD child’s on-task behaviour, help/her complete a given assignment and make him/her more compliant. Thus, these methods are useful in helping the child to be more compliant and even building acceptable social skills. Behavioural modificationmethods are also used to decrease hyperactivity, aggressive behaviour and even increase attention.
Behavioural modification is usually undertaken with the help of some of the following conditioning techniques.
(a) Reinforcement: Using reinforcers or rewards enhance the likelihood of desirable behaviour being emited.
(b) Aversive conditioning: In simple words, it means punishment which should, as fas as possible, be non-corporal. It should be borne in mind that while using aversive conditioning techniques, corporal punishment of any kind should be avoided. Apart from being socially inacceptable, it is banned by law and could possibly result in a severe reaction from the child making his’her condition worse.
(c) Shaping: This means breaking the desired behaviour into small steps. Each step that is close to the target behaviour is reinforced.
(d) Dealing with interpersonal conflicts.
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