Shellie Sims

Exceptionality Project

Education 580

06/29/04

Project Topic

Understanding ADD/ADHD; Teaching Children with ADD/ADHD in the Classroom

The topic of Attention Deficit Disorder (ADD, or ADHD when you add the component of hyperactivity) has become very popular due to political and controversial arguments over: how to classify ADD, how to diagnose ADD/ADHD, whether or not to medicate, which kinds (and amounts) of medications should be used, how to teach children with ADD/ADHD in schools, and whether or not to give it a special label under the IDEA (Individuals with Disabilities Education Act). To complicate matters even more, while many scientific organizations recognize ADD/ADHD, some critics deny the existence of this “disorder” at all.

ADD, which has “changed names at least 25 times in the past 120 years” (Armstrong, 1), can be defined as a:

”neurological condition that involves problems with inattention and hyperactivity-impulsivity that are developmentally inconsistent with the age of the child. …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.”(Department of Education, 1).

Parents or children with ADD are 24 times more likely to suffer from the disorder according to the American Academy of Child and Adolescent Psychiatry. Other studies have found that ADD is genetically transferred, mostly from the father. The question of whether this syndrome is inherited or not is still up for debate as is the issue of diagnosis.

Health professionals who, along with their own testing, use information from teachers and parents to form their opinions usually diagnose Attention Deficit Disorders. Unfortunately, some studies have found that a first grade teacher “may rate as many as 50% of the boys in the class as having ADHD.” (Healthyplace.com, 1) Other studies have shown that many teachers overlook the signs of ADD. Also, many physicians have complained of persistent parents coming into their practices demanding Ritalin and other drugs for their children when the doctors were not convinced that the children truly had ADD/ADHD. Since brain scans, blood tests, or other definite medical measures are not available for diagnosis at this time, and many of the symptoms could have other causes, coming up with an accurate analysis is often tricky. Several of the symptoms of ADD/ADHD can overlap with symptoms from other origins. For example, 94% of hyperactive children have had three or more episodes of ear problems and 68% have had 10 or more. Often, signs of ADD/ADHD can be confused with learning disabilities, or even giftedness. “How behavior is interpreted , dreamy vs. imaginative, has everything to do with the orientation of the interpreter.” (Ruenzel,12) Experts who don’t buy in to the existence of ADD claim that since no medical test can pinpoint the supposed neurobiological disorder there is no such thing as ADD/ADHD:

”The reason I speak of a hoax in the case of “attention deficit disorder” is that there is no such “mental disorder” to “diagnose” and “treat.” And the reason I speak of a great hoax is that the less competent medical practitioners use this phony “diagnosis” as a warrant to “treat” millions of school children (over 5,000,000) per year by intoxicating them with brain-disabling narcotics. (Kiersey, Hoax,2)

In order to help children with ADD/ADHD better cope in the classroom, one must first come to an understanding of the different symptoms and types of ADD. (For the sake of this paper, the symptoms discussed will be limited to those found in school-aged children). ADD is “a generic term for a group of heterogeneous, pervasive, and long-term characteristics believed to have a neurological etiology. The characteristics fall into three areas (a) an inability to attend, (b) impulsivity and (c) inappropriate overactivity (hyperactivity).” (Gearheart, Gearheart, Weishahn, 335) Hyperactivity is the most associated feature of ADD/ADHD because it is the most easily recognized. When the term ADD entered textbooks in the 80’s, it was divided into two categories ADD and ADD with hyperactivity (ADHD). ADHD is most prevalent in boys.

It is important for teachers to be able to identify the signs of ADD/ADHD in order to help a student get the correct diagnosis, treatment and extra help that they may need. According to the Diagnostic and Statistical Manual of Mental Disorders criteria for ADD/ADHD, one must have six or more of the following symptoms of inattentiveness:

  1. fails to give close attention to details/ makes careless mistakes
  2. difficulty maintaining attention during tasks
  3. problems listening
  4. doesn’t follow instructions/failure to complete tasks
  5. difficulty with organization
  6. avoids/dislikes tasks requiring ongoing mental effort
  7. loses things often
  8. easily distracted
  9. forgetful in daily activities

Or, for a diagnosis of ADHD, one must have six or more of the following symptoms of hyperactivity and/or six or more of the symptoms for inattentiveness:

  1. fidgets or squirms in seat
  2. leaves seat when sitting is required/expected
  3. runs/climbs in inappropriate situations
  4. difficulty playing quietly/leisurely
  5. endless energy/always “on-the-go”
  6. excessive talking
  7. blurts out answers before questions are finished
  8. difficulty waiting for his/her turn
  9. interrupts others often

Symptoms for either ADD or ADHD must be present for six or more months and cannot be related to a diagnosis for any other condition such as a mood, anxiety, mental, or developmental disorder (to name a few).

It is interesting to note, the wide variation of instances of ADD/ADHD from culture to culture, for example “in China there was a greater likelihood of an ADD diagnosis than in a country such as the United States. On the other hand, in some countries, such as England, a diagnosis of hyperactivity is much less likely (one study on the Isle of Wight identified only two children out of 2,199 as hyperactive).” (Armstrong, 1) To put this into context, some experts suggest that ADD affects 3-10% of the U.S. school-aged population; others predict that as many as 20% of American children have ADD/ADHD. Unfortunately there is no completely accurate percentage available due to the obvious discrepancies in testing procedures. Perhaps in the future testing will become more standardized.

Although there are arguments about treating ADD/ADHD with special, restrictive diets, or other alternative methods (many which have been proven to work well for various individuals), the specific treatments we will look at the effects of behavioral modification and prescribed drugs. Most professionals agree that behavior modification should be used either alone or combined with drugs. In other words, everyone with ADD/ADHD should incorporate some form or forms of behavior modification into their lifestyle. Some experts argue that drugs merely mask the problems and that behavior modification alone can handle problems associated with ADD/ADHD. Some behavior modifications include: breaking projects into smaller chunks in order to tackle bigger jobs, setting goals/deadlines for projects, keeping a day planner, writing down important information, keeping a pad and pencil handy, keeping daily “to-do” lists, and using flash cards, outlines and notes for study. In general behavior modifications for ADD/ADHD mainly consist of honing organizational skills -which are usually lacking in most ADDers.

In 1996, 4.3 million children in the U.S. were taking Ritalin -that number is double the amount of children who consumed Ritalin in 1990. Whether or not to medicate has become quite controversial. One principal, who strongly endorses the use of Ritalin (his school has 10% of its kids on the drug), claims that without Ritalin, some kids couldn’t focus at all. At the same time, many people strongly oppose the use of drugs such as Ritalin, Strattera, and Concerta, which can have side effects including: lack of appetite, drowsiness, sleeplessness or “zoning out”.

“Now, it’s true that zapping the disruptive child with stimulants has a zombying effect in that it does cut down on forbidden activity, and the zomby effect gives both teacher and classmates relief. But the advocates of stimulants for disruptive children are unable to claim that such children get to work. They stop playing but don’t start working. And they don’t win friends either. (Keirsey, “Too Much Dope”, 3)

Many experts who are worried that our society is overmedicating children, will still admit, however, that if some of the kids miss a pill they simply cannot get their work done. In response to the dissenters of medication who think that it is a way to control children, one mother says:

“I tell them that it’s not a control thing, if people are using Ritalin to control their kid’s behavior that is wrong… if your child has a disability, say cerebral palsy, you’re not going to sit there and watch him starve to death because he cannot feed himself. You’re going to provide him with the means to help himself so that he can survive. And that’s exactly what Ritalin does.” (Ruenzel, 14)

For Brent, who was diagnosed with ADHD at age 5, Ritalin has been not been an option, but a necessity. He is a generally well-liked boy who makes honor roll half the time (when he applies himself) and irritates other children occasionally with his rude, spontaneous outbursts. He has always had trouble controlling his impulses and though he is a gifted athlete, breaks into spontaneous misbehavior if not stimulated. Brent, who doesn’t know why he misbehaves; claims that ADD is like “a hundred people are running in my head”. (Ruenzel, 3)

In the case of Susan Fuller, who was diagnosed with ADHD her Junior year of high school (1994), Ritalin helped her focus and made it a lot easier to get tasks done. “My grades were dropping and my teacher said that I was not focusing in class. I also have never tested well on standardized tests, so mother took me to a specialist.” (Fuller, interview) On the downside, Ritalin left her feeling uneasy, unable to relax, spaced out, and as if she “needed to be doing something”. As a result, Susan stopped taking the medication and decided to rely solely on behavior modification methods such as the ones mentioned above.

Although Susan’s teacher was quick to recommend testing for ADHD, she didn’t seem to alter her teaching style at all. In fact, none of Susan’s high school teachers took different learning styles into consideration. “It was hard to learn at school” said Susan. Now, due largely in part to her experiences as a student with ADHD, Mrs. Fuller incorporates all three styles of learning: visual, auditory, and kinesthetic into her lesson plans. “Last year, when I taught the seven functions of marketing to my classes, I divided them into groups and had them write scripts and create puppets geared towards teaching the lesson to first graders. It sounds silly, but my kids really enjoyed putting on their puppet shows. They learned a lot.” (Fuller Interview)

The best teachers try to take in consideration that there are three basic types of learning: auditory, or hearing based, kinesthetic, or “hands-on”, and visual, by sight. Incorporating all three ways whenever possible is the best approach. This approach is necessary for children with ADD/ADHD. Some general strategies for helping these students in the classroom lie within the fields of classroom activities, behavior modification, and learning environment.

When introducing lessons, the instructor should provide an advanced outline or a syllabus, review previous lessons, set learning expectations, and state needed materials and resources. While conducting lessons, a teacher should maintain structure and consistency, support ADHD students’ participation by helping them stay on task, check the students’ performance, ask frequent questions, perform ongoing evaluations, and help students to correct their own mistakes.

Helping students to get organized can help put their concentration on learning. Since organizational skills do not usually come naturally, or easily to students with ADD/ADHD, a teacher’s help will often be necessary. Good organizational skills can be fostered by teaching children to keep their areas tidy, helping children maintain planners, showing children how to keep their papers organized, and how to keep their thoughts in order with study methods are incredibly useful.

Effective behavior modification rests heavily on the use of praise. Children with this ADD/ADHD tend to be sensitive and often need more positive attention than other children. Never refer to a child’s ADD/ADHD publicly. Encouraging acceptable behavior can first be found through defining appropriate, expected behavior and then giving immediate, consistent and sincere praise. When rules are broken, it is important to remain calm and avoid arguing with the student. Consequences should be administered immediately. Selectively ignoring inappropriate behavior is another effective tactic in the cases of children who are desperately seeking constant attention of any variety. When children get overly excited or emotional, teachers can settle them down by sending them on an errand in the school. Whatever your rules, it is important to stay consistent. Make sure that children understand what the rules and keep them simple.

Reward systems such as tangible reward s, token systems and self-management systems are particularly useful. Reward systems use immediate rewards, such as stickers, for good behavior. In toke systems, behavior is rewarded, or penalized, by giving or taking away tokens. Once the tokens reach a predetermined number, an award, such as a party, is brought about. Self- management systems train students to monitor their own behavior in which points are awarded. Eventually the points are exchanged for a reward. Visual cues can reinforce good behavior (or notice bad behavior) as well. If a child is acting in an unacceptable manner, a signal from his teacher will let him know to straighten up. It is much easier to get the “inattentive” child to attend to the teacher's agenda than it is to get the “hyperactive” child to stop bothering his teacher and his classmates. In both cases, however, the solution is essentially the same: take away the abused privilege whenever it is abused.

An inviting and non-distracting learning environment is particularly important to ADHD students since they often have problems adjusting to the structure of a classroom and focusing on their assigned work. These children benefit from a classroom that helps them to get focused and stay on task. Some helpful ways in which teachers can aid in the learning of ADD/ADHD students are: seating children near the teacher, placing children near positive role models, providing low-distraction work areas, and taking extra clutter out of the classroom. It might also be necessary to allow fidgety children to move around or stand while doing seatwork.

There are limitless options for creating a fun atmosphere for learning. Gone are the days of boring lectures; days of being taught “at”. Because of their wiring, children with ADD/ADHD tend to need more interaction to keep them interested. One of the many ways to do this is through theater games. One of the creators of theater games is Viola Spolin. In her book “Theater Games for the Classroom; A Teacher’s Handbook, Ms. Spolin gives her philosophy behind why these games work, and how they can be integrated into classrooms of all ages.
Theater games “are designed not as diversions from the curriculum, but rather as supplements, increasing student awareness of problems and ideas fundamental to their intellectual development.” (Spolin, 2) These games stimulate action, relation, spontaneity and creativity of individuals in a group setting. I have found, through my personal experiences as a drama teacher that these games do, indeed work. As teachers, we are aware that everyone has a need for approval. Games are an excellent way to promote self-esteem, teamwork, socialization skills, listening, and focusing skills. Since children with ADHD often have extra energy games can be a terrific way to help them deal with extra energy, frustration, and/or express their creative side. It is very easy to incorporate theatre games into lesson plans. Following are some examples of theater games for the classroom with instructions and occasions for use.

Zip, Zap, Zop (focus/concentration/connecting)

Players get into a standing circle. One person will start by jumping up, clapping and pointing to someone else while saying , “zip”. The person who was being pointed to repeats the action and clapping and says “zap”. Actions are repeated with “zop”. Speed up the pace and repeat. The person who breaks the sequence is out, continue playing until there are only two people left.

Mirroring (focus/team-building/connection)

Have classmates pair off and face each other. One will be designated as the leader in each group; the other will follow everything the leader does.

Start gradually by using hands only. Eventually have the pairs join up to form a group until the whole group is doing the same thing.