This blog took me a little longer to write than most, not because I got OFF TASK or anything, but because I am so passionate about teaching and learning about Attention Deficit Hyperactivity Disorder (ADHD). I want to make sure I get the right points across to my readers since one of my goals with the MOTIVATED TEACHER blog is to bring awareness to disabilities that our students may have, and ADHD is a disABILITY. In this blog I will define ADHD, discuss treatment options, and give some TIPS for helping students with ADHD be successful in the classroom and later in life.
This is how the DMV most recently defined ADHD:
The DSM-5TM defines ADHD as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, has symptoms presenting in two or more settings (e.g. at home, school, or work; with friends or relatives; in other activities), and negatively impacts directly on social, academic or occupational functioning. Several symptoms must have been present before age 12 years.
ADHD in my Opinion:
ADHD can be a blessing or a curse, and we as teachers have to teach our students how to make it a blessing and that ADHD is an ABILITY not a disABILITY.
A Little about ADHD:
ADHD is the most common childhood disorder seen in schools today. ADHD, in my opinion, is a very broad term and can look very different from one student to the next. The Center for Disease Control and Prevention estimates 6.4 million children in the U.S. have a diagnosis of ADHD. Link to Centers for Disease Control: If a student is diagnosed with ADHD it is important to know which type of diagnosis they are assumed to have. The three types of ADHD are:
Three Diagnosis of ADHD:
- Inattentive ADHD-which was formerly known as ADD. Yes teachers this means you have to stop saying “Johnny has ADD and he daydreams all day”.
- Hyperactivity-Impulsive ADHD– The kid that popped in your head, yes he probably had this one.
- Combined ADHD- If I was to diagnose myself in school or today I feel I would fall under this one, and a lot of your under-performing students will too.
What the three types of ADHD may look like in the CLASSROOM:
Inattentive or Inattention ADHD– Like previously stated, Inattentive ADHD has taken place of what was formerly known as ADD, but looks the same in the classroom. Teachers, things you may notice in the classroom.
- Off task or easily distracted by the littlest things that happen.
- Struggles getting back on task when something out of ordinary happens. (Fire drill, assembly, etc.)
- Makes mistakes that to you seem careless but to them seem normal (Like forgetting to put name on paper)
- Can easily ignore you and others even when speaking directly to them
- Multi-task activities are a struggle.
- Lack of organization in desk or locker
- Can not keep up with needed material (e.g., pencil, books, folders)
Hyperactivity and Impulsivity ADHD:Below are some common behaviors that a student may CONTINUOUSLY do if they truly have ADHD. As stated these are just signs, and all students may do this from time to time. Remember, you collect as much information as you can if you suspect ADHD, then consult with administration so they can consult with guardians which would then seek medical advice and further evaluation from a Doctor.
- Struggles during silent reads or quiet times
- Can not sit still at all
- Talks constantly, interrupts others before they can finish
- Doesn’t listen to verbal directions, because they are too busy thinking what they want to say
- Always has hands on something. Constantly telling them, don’t touch that, don’t pick that up, etc.
- Patience is a word they do not understand
Combined ADHD is exactly that. It combines all of the symptoms of ADHD, inattention, hyperactivity, and impulsiveness. Teachers, you have to be the doctors and parents’ eyes in the classroom. If you suspect any of the three types of ADHD please start collecting data so a medical professional can make the correct diagnosis and interventions can begin to determine what is best for each particular student.
Teachers, please remember HIGH-ENERGY does not mean a child has ADHD. The behaviors listed above must be EXTREME. Doctors will want data for 6 months, so if you seriously suspect ADHD start collecting data now and give your reasoning WHY you suspect ADHD. Data can be anything from jotting down notes in a notepad with dates and times, or printing a DATA collection chart that you like and will use (key word USE). You will be surprised what you learn by doing this, about yourself and your students.
Once a diagnosis has been given by a physician for your child or student, the next step is to determine the appropriate treatment. I am not going to go in detail about how physicians determine if a child has ADHD, but I do want to say to make sure the physician knows any outlying information that may be spiking certain behaviors. Outlying information could be things like depression from problems at home, anxiety from new school, or substance abuse. I want to start out by saying EVERY CHILD’s plan will be and should be different. The suggestions I am giving is some that have worked for myself personally or I have seen and researched to be successful for students and adults with ADHD.
Who can TREAT and Diagnose ADHD:
Before you choose what professional to go to for advice or a diagnosis of ADHD, know a little about what they do first. Like stated previously every diagnosis of ADHD will be different so plan to research who you visit first. Make sure they have experience with ADHD and don’t just flip out the prescription pad.
Healthcare Professionals who can help with ADHD Diagnosis
A psychiatrist is a Medical Doctor M.D. who is trained in diagnosis and can prescribe medication or other treatments to address ADHD behaviors.
A psychologist is not a M.D., but has studied how the mind works and can better explain chemical imbalances that may be taking place. A psychologist cannot prescribe medications, but if they feel medicine is needed they can refer patients to either a medical doctor or a psychiatrist. Psychologist are trained in diagnosis and in counseling.
Family doctors can prescribe medications, and can be a great resource if they have seen the child for a number of years. Most will be familiar with ADHD but will want to look for other sources of information to help with appropriate medication and diagnosis.
A Neurologist is a doctor that’s primary focus is the central nervous system and treatments for the brain. This allows them to determine things the others listed can not, such as seizures disorders, etc. While an EEG is not necessary to diagnose ADHD many believe that it should be used to rule out other medical conditions and the neurologist would be the one to determine this.
Master Level Counselor:
To be considered a master level counselor, a master’s degree in psychology or counseling must be completed from an accredited university. With this they can do initial assessments for ADHD and provide counseling services and behavior management plans to use at home and in the classroom. They can not prescribe medication and must refer patient to a M.D. or other professional listed above.
A Licensed Clinical Social Worker (LCSW) are trained to support behavior issues that students and adults with ADHD may face. If they feel the need for further evaluation they must refer to a M.D. or other professional for diagnosis and other medical treatment options.
Medication as a treatment
The first treatment most doctors will try is a low dose of medication. I have seen medicine work wonders for students with a diagnosis of ADHD. I have also seen the flip side of this where medicine makes students so sick at their stomach they can not function. I do think it is a good starting point and that the benefits outweigh the side effects in most cases. I feel sometimes for students it is simply a mental thing. A doctor tells a child this is going to help you focus in school, and this gives the student the MOTIVATION and belief that they can learn. All kids should have this feeling, so why not try medication as a treatment? If this is the decision the parents and doctors make, a MedWatch is a must to determine any change in behavior. I have parents ask me almost everytime. I tell them that I was diagnosed with ADHD as a child and they say, “Did you take medicine?” The answer I used to give was I really don’t know. I know now that I did, but it was only for short periods in my youth and I really do not know how it affected me as a child. I do as an adult, but that will be for another blog. My grandfather was a pharmacist and tried a few different stimulant drugs when I was very young, but due to outlying factors that I had during my diagnosis, I stopped taking medication to treat my ADHD. All kids have outlying factors, and that is why it is so important for parents, teachers, and doctors to be on the same page and communicate effectively with one another. For me I stopped taking ADHD medications when I was very young. I often wonder what my academic career would have been like if the correct medicine was found for me. Then I think I would not be where I am today if it was. So, I am thankful my life played out like it did. I will talk more about my ADHD in a future blog.
If I was a parent, stimulant drugs would sound scary, especially if my child had a diagnosis of Hyperactive or Impulsive ADHD. Actually, stimulant drugs, despite their name don’t excite kids, they calm them down and help with focus. A few common ADHD medications currently being used are:
- Dextroamphetamine/amphetamine (Adderall)
- Dexmethylphenidate (Focalin)
- Methylphenidate (Concerta, Quillivant, Ritalin)
- Lisdexamfetamine (Newer ADHD Medicine known as “Prodrug”)
There is only one non-stimulant drug that is approved by the FDA to treat ADHD. This medication is Atomoxetine (Strattera).
Something my mother would always say about her dad went something like this. “Pharmacist only fill prescriptions from the doctor’s recommendations. It is the patient, parents, and in our case the TEACHER’S job to determine if the medicine is an accurate intervention.” How do we determine if medicine is having a positive impact addressing ADHD behaviors is by collecting DATA.
PARENTS and TEACHERS document everything you can before medication and once even the child is on medication. This is called an AB design. We know what A is in the design. That is the child’s ADHD behaviors. We may have to play with B until we determine the correct treatment, which could be trying different types of medicines, different dosages, or in some cases no medicine at all. My suggestion on medication is this, give it a try and see what happens. Depending on the child’s age there are different forms in all the above medicines: pills, capsules, liquids, and now even patches. The last thing I want to add on medication is this. If the above medications do not work, what I have seen doctors do is try antidepressants and antihypertensives. I am not going to elaborate on these because these are used after the initial diagnosis of ADHD, but as you now know depression and anxiety are commonly associated with ADHD and medication for depression, anxiety, and Obsessive-Compulsive Disorder (OCD) are typically added later and data is collected much in the same way.
Other Non-medication treatments for ADHD:
Behavior therapy, also known as behavior modification, should be used once the targeted behaviors have been identified. Meaning, a functional behavior assessment (FBA) has already been completed or some other type of behavior assessment. The basis of a good behavior modification program should start with building student rapport. This RELATIONSHIP should revolve around mutual respect and clear expectations from both the teacher and student or parent and child. Also, for behavior therapy to be effective it is a must to teach self-monitoring, self-management, and individual coping skills and social-emotional skills. Lastly for behavior therapy to be effective teachers, parents, and school administration must understand the therapy and all of them must be communicating together.
Cognitive Behavioral Therapy:
Cognitive therapy is used with both medication and behavior therapy. It uses the defined problem behaviors to develop plans that can actually be used in the classroom and in other areas. My favorite part about this therapy is that it explains that if something doesn’t work document it, move on, and try something else.
Diet and supplements:
Some research recommends diet changes and states that a balanced diet that consist mostly of protein and complex carbohydrates. A dietitian will also put an emphasis on limiting sugar, artificial preservatives, and food coloring. These diet changes are believed to reduce hyperactivity and help the brain function so that it can control swings in behavior.
This is my favorite! For students and adults with a diagnosis of ADHD, research supports that exercise will not only keep your metabolism in check and weight off, it will also improve attention, working memory, and other executive functioning skills such as organization, impulsive behaviors and focus. I know it can be hard to get them off the video games, but if you make it a habit to walk three to four times a week for 30 minutes before homework or screen time, the time benefits will outWEIGH the time of exercise, no pun intended.
My wife does not believe me when I tell her I need to go to the woods, hopefully after reading this she will. Studies have shown that a daily dose of mother nature such as; gardening, hiking, canoeing, and pretty much anything that can be done in mother nature improves behaviors associated for both students and adults with ADHD.
ADHD Coach or Accountability Partner :
An accountability partner or coach is someone that is aware of ADHD tendencies and can help develop the mindset and skills to overcome setbacks someone with ADHD may face. This person will play the role of enforcer, cheerleader, praiser, taskmaster, teacher and much more. Finding a coach that a student clicks with is difficult, but when you do it is magic, and parents you are going to have a hard time playing the role of coach and parent. As much as you want to help it just does not work that way.
Choosing the right ADHD Treatment:
Choosing the correct approach to treat ADHD symptoms is very difficult. The only way you know if something is better or worse is to keep track and log certain behaviors listed above. Do not try something one day and give up on it because of one bad day. Remember there are always outlying factors that we may be missing and change takes time. Always consult with a professional and have others assess behaviors with new treatments in place. Don’t give up, keep adjusting and constantly logging behaviors and outcomes from whatever treatment you are currently trying.
ADHD in The Classroom
Interventions to use in the classroom:
- CHICO Folder- with specific expectations listed and followed up on at specific times of the day.
- Classroom design – set in room with the least amount of distractions: distractions being other students, windows, doors, clock, etc.
- Make To do lists for the students:
- Give one assignment at a time.
- Scheduled break time and physical activities.
Restraints students with ADHD can have:
- Students not staying on a routine schedule taking medicine everyday.
- Students not having clear expectations in school or home.
- Teachers not giving student something to work for, only taking away.
- Students not being taught executive functioning skills to help them cope with ADHD. Specifically in the areas of organization.
- Teachers taking away P.E. and recess. (Seriously, this is DUMB) If you do this at least make them get some type of physical activity in, like walking around gym or black top.
Teachers, administrators, and parents we have to be the ones that help turn this disability into an ability. Students and adults that have ADHD honestly have a super power if they can learn how to use it. For me, I struggle and strive with it daily, but I know that, and it helps me cope and intervene MOST of the time. The sooner we can start teaching coping skills and finding treatments, the sooner students with ADHD can start using their super power. If we wait around and just wait for these students to move on to the next grade we are not doing our job. If this happens, students with ADHD will be like me and struggle and have to cheat all the way through school. Teachers, we both know that some students will never have the label or get the medicine they MAY need, for this reason TEACH your class like you have students with ADHD because you probably do, and if you are not noticing it then it is probably the inattentive type and I am sure you can tell by their grades. You never know when an organizational skill or a to-do list is going to change a student’s life. I do not claim to be a doctor and hate labels and stereotypes. I just write about what I have seen work for me and my students. I do know that if you are a teacher, you will have students with ADHD and it is REAL. It can also REALLY be a struggle, and students with ADHD are AT RISK if not treated and taught accordingly. Teachers and Parents please help students before they become at risk. Not all of your students will be as lucky as me and have a mother that was a teacher, and a grandfather that was a pharmacist. YOU have to help your kids and your students the way they helped me. Young students do not know how to cope with their ADHD yet, so you must teach them and constantly monitor and adapt everyday.
Let’s go MOTIVATE and change our STUDENTS’ lives!
Michael Todd Clinton