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Chapter 7

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Ernie Mac Kinnon

[ CHAPTER SEVEN ] ATTENTION DEFICIT HYPERACTIVITY DISORDER AND RELATED DISORDERS  Attention deficit hyperactivity disorder (ADHD) – condition of brain tht makes it difficult for children to ctrl beh’ in school and soc settings  25-40% of CWLD have co-occurring ADHD  30-65% of children w/ ADHD have co-occurring LD  2/3 of children w/ ADHD have other co-occurring conditions (LD, disruptive beh’ Ds, anxiety Ds, tics and Tourette’s syndrome)  ADHD and ADD are two diff terms for same condition CHARACTERISTICS OF ADHD  Inattention – inability to concentrate on a task  Impulsiveness – tendency to respond quickly w/o thinking t/ consequences of action  Hyperactivity – beh’ described as constant, driving motor activity in which child races from one endeavour/interest to another  Some will have only 1 or 2 of these beh’s Symptoms of ADHD 1. Severity: symptoms must be more frequent and severe than typical children at ~ dvlmptal levels 2. Early onset: at least some of symptoms appeared before age 7 3. Duration: symptoms must have persisted for at least 6 mths prior to diagnosis Symptoms of ADHD at Different Ages Young Children  Excessive gross-motor activity (i.e. running/climbing)  Unable to sit still for more than a few min at a time before beginning to wriggle excessively Elementary-Age Children  Extremely restless and fidgety  Likely to talk too much in class and may constantly fight w/ friends, siblings, and classmates Adolescents  Hyperactivity may diminish  Beh’al problems, low SE, inattentiveness, or even depression may appear Adults  Organizational problems, soc rel’nshp difficulties, job problems ASSESSMENT Types of ADHD (DSM-IV-TR) ADHD-IA Subtype: Symptoms of Inattention  Fails to give close attention to details  Has difficulty sustaining attention  dN seem to listen  dN follow t/ or finish tasks  Has difficulty organizing tasks and activities  Avoids/dislikes tasks tht req’ sustained effort  Loses things needed for tasks  Easily distracted by extraneous stimuli  Often forgetful in daily activities ADHD-HI Subtype: Symptoms of Hyperactivity and Impulsivity Hyperactivity:  Fidgets w/ hands/feet, squirms in seat  Leaves seat in classroom or in other situations  Runs abt or climbs excessively  Has difficulty playing/engaging in leisure activities quietly  Talks excessively  Acts as if ―drive by motor‖ and cannot sit still Impulsivity:  Blurts out answers before q’ns completed  Has difficulty waiting in line or awaiting turn in games/activities  Interrupts/intrudes on others ADHD-C: Combined Subtype  Symptoms of both IA and HI  Abt 5% 1’ly inattentive  Abt 15% 1’ly hyperactive and impuslve  Abt 80% combined Rating Scales  Frequently used assessment measures for students w/ ADHD  Based on reports of beh’ obsv’d by teachers and parents Eligibility of Children with ADHD for Special Services  1991: Clarification of Policy to Address the Needs of Chidlren With Attention Deficit Disorders Within General and/or Special Education  1999: The Regulations for Individuals With Disabilities Education Act of 1997 (IDEA-1997)  2004: The Individuals with Disabilities Education Improvement Act of 2004 Implications of the Law for Children with ADHD Special Education Services  May be eligible under category of ―other health impaired‖/‖LD‖/‖emo’al disturbance‖ in IDEA-2004 Section 504 Services  Mandates tht any agency receiving federal funds must provide reasonable accommodations for PWD Increase in the Number of Children Identified with ADHD  I↑ in children identified mostly due to new inclusion in ―other health impaired‖ category of IDEA-2004 Educational Settings for Students with ADHD  GEC: 50%  Resource room: 31%  Separate class: 15%  Other placements: 4% Response-to-Intervention and Eligibility of Students with ADHD  RTI = procedure or providing interventions to all students at-risk for school failure  Child w/ suspected ADHD would receive intervention w/in GE in various tiers of intervention TREATMENTS FOR ADHD Multimodal Treatment  Combines several approaches: 1.) effective edu’al instruction 2.) beh’ management strategies 3.) family and child counselling 4.) home management 5.) medication  Improvement greatest when all components present and working in conjunction w/ each other Medication  Prescribed in 96.4% of all cases  Ideally, ctrls hyperactivity, i↑’s attention span, and reduces impulsive and aggressive beh’ w/o inducing side effects Psychostimulant Medications  Most widely used; abt 75-85% improve w/ use i.e. Ritalin, Dexedrine, Adderall, and Concerta  Affect brain of children by i↑’g arousal/alertness of CNS  Thought tht insufficient NT produced, and tht psychostimulants work by stimulating production of NTs needed to send info from brain stem to parts of brain tht deal w/ attention  Appears to lengthen attention spans, ctrl impulsivity, d↓ distractibility & motor activity, and improve visual-motor integration  Side effects: insomnia, loss of appetite - usually diminish as tolerance dvlps  Serious side effect of Ritalin: trigger tics or Tourette’s syndrome  Rebound effect – child’s beh’ can significantly deteriorate in late afternoon/evening after daytime dose wears off, causing chid to temporarily exhibit more impulsivity, distractibility, and hyperactivity than previously obsv’d Strattera  Not a psychostimulant  Only needs to be given once daily Other Medications  Wellbutrin  Catepres  Tenex  Strattera American Academy of Pediatrics Guidelines for Treatment  1 care clinicians should establish trtmt program tht recognizes ADHD as chronic condition  Treating clinician, parents, and chil, in collaboration w/ school personnel, should specify appropriate target
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