Exploring Attention Deficit Hyperactivity Disorder ADHD Secondaryphasespecific workshop

Exploring Attention Deficit Hyperactivity Disorder (ADHD) . . . Secondary-phase-specific workshop Concordia Education & Training LLP joematt 2000@hotmail. com

Yourselves Take some sweets please Introduce yourself to your neighbour using the sweets: Number of sweets = number of facts l Blue = family l Green = school l Yellow = friends l Red = hobbies l Brown = music/movies l Orange = wild card

Looking at: 1. 2. 3. 4. 5. Is it a thing? Signs & Symptoms Feel like? Difficulties with school? Strategies to help

1. Is it a thing? “Why have we created a medical condition to excuse our spoiled brats? ” Leo Mc. Kinstry Daily Express 2 nd March 2005 p. 12. “ADHD doesn't exist & drugs do more harm than good” Dr Richard Saul Daily Mail Online 11 th March 2014 Group Task: Discuss & Feedback! l Parents to blame? l Benefits scam – maybe eligible for allowance? l Is it a thing or an excuse?

Definitely a Thing! “ We cannot overemphasize the point that, as a matter of science, the notion that ADHD does not exist is simply wrong. All of the major medical associations & government health agencies recognize ADHD as a genuine disorder because the scientific evidence indicating it is so overwhelming …. there is no doubt that ADHD leads to impairments in major life activities, including social relations, education, family functioning, occupational functioning, self-sufficiency, & adherence to social rules, norms, & laws. ” International Consensus Statement on ADHD January 2002 in Clinical Child & Family Psychology Review, Vol. 5, No. 2, June 2002 ADHD is one of the most misunderstood disorders

Facts & figures ADHD = a neurobiological condition l No single cause yet established : strong evidence = largely genetic influence with other factors l Current thinking: imbalance of neurotransmitter chemicals e. g. dopamine & noradrenalin which control ‘executive functions’ in the prefrontal cortex may cause the core symptoms of ADHD: l Hyperactivity l Impulsiveness l Inattention At significant risk of anxiety & depression Causes particular & exceptional difficulties with: l managing frustration l restraining outbursts l planning/ organizing l problem solving l memory recall l sustaining effort l keeping focused Thought to affect around 5% of school population about 1 in 20 pupils – very likely 1 or possibly 2 in each class – not all diagnosed Evidence: 3 x as many boys v. girls l

2. Signs & Symptoms ADDISS: National Attention Deficit Disorder Information & Support Service. “The best description for ADHD is that a child who suffers from this condition shows disruptive behaviours, which cannot be explained by any other psychiatric condition & are not in keeping with those of the same-aged people with similar intelligence & development. These behaviours are usually first noticed in early childhood & are more extreme than simple “misbehaving”. Children with ADHD have difficulty focussing their attention to complete a specific task. Additionally they can be hyperactive & impulsive & can suffer from mood swings & ‘social clumsiness’ ”

Different Types & Degrees of Severity Varying degrees: mild, moderate & severe 3 main types recognized: 1. Predominantly hyperactive-impulsive 2. Predominantly inattentive – known as ADD mostly girls daydreaming/ anxious 3. Combined all of the above! = most common! Diagnosis difficult: l only by professionals usually child psychiatrist or paediatrician l no single specific test or standardised assessment but diagnostic evaluation l ADHD services underfunded & overloaded so diagnoses may be delayed Group Task: See Handbook for Diagnostic Guide

Never rains but it pours!!! Research shows: over 50% also have one or more of: (Jensen Martin & Cantwell 1997) l l l l l Specific learning difficulties Conduct disorder -repetitive & persistent pattern of antisocial behaviour Oppositional defiant disorder Affective disorder – mood disorder e. g. bipolar; anxiety disorder & depression Substance abuse Developmental language delay Obsessive compulsive disorder Asperger syndrome Tic disorder Tourette's syndrome

3. Feel like? l l Red Bull & caffeine!!! ADHD sufferers may have difficulty filtering impulses & try respond to them all Rather than failing to pay attention, they pay more attention to more cues than the average person & are unable to stop the relentless flow of information. Researchers recognize that ADHD doesn’t impair the ability to pay attention but the ability to control what you pay attention to What does this feel like? Group Task: Left to right up down & turn game & see how many objects you can remember

4. Difficulties with school? Group Task: What skills do you need to succeed in school? Space in handbooks & Feedback l Memory l Listening l Communication l Organisation & time management l Follow instructions & prioritising l Concentration l Sitting still for long periods of time l Not disrupting / shouting out l Reading & mathematical functioning l Speaking & listening l Complete work / Meet deadlines l Social skills Is it a wonder they struggle? Square peg / round hole? Not the wrong weather just the wrong clothing!

Now ……. Task: Your pupils specific difficulties? In one colour itemise their difficulties- matchstick man in handbooks Group Task: Compare with Problems: Academic & Social in handbooks N. B. Secondary school possible even harder than primary school as there is more: l demand for independent work l less structure l more pressure to multi-task l more subjects & subject teachers l more change

5. Strategies to help We can make a difference & help them overcome their challenges, raise their self esteem & reach their full potential! When people with ADHD find something that they’re passionate about-can dedicate themselves totally l Tend to relax when they know they are supported Group Task: Who am I? l Focus on their strengths – build on what they can do - help them grow as confident independent learners l Pupils with ADHD may be some of the most challenging! But also some of the most loving, caring, delightful & enthusiastic! May be: l Bright /Creative/ Imaginative/ Blue sky big picture thinkers l Articulate/ Quick to put learning into practice/ Curious l Spontaneous / Fun/ Humorous/Artistic/ Energetic Group Task: Return to matchstick pupil & add strengths in a different colour - capitalise on these? l

Vital to Make a Difference: Through: A. Medication B. Understand & Get to know them C. Management: l Behavioural intervention : STOP & START l Educational Strategies & Support

A. Medication Not major on but need to understand: l Can be highly effective but not for everyone l Not usually preschool: 1 st line = parent education l School age children - medication for severe cases l Psycho-stimulants – change levels of brain chemicals (e. g. Ritalin & Dexedrine) l Psycho-stimulants are stimulants NOT sedatives that help concentration. Have almost immediate, observable effects & wear off around 4 hours so need number of doses/ slow release form l Tricyclic antidepressants also used l If required during the school day, school’s agreed procedures must be followed. Pupils may be embarrassed – respect needed l Side effects are possible: monitor & report

B. Understand & Get to Know Them 1. Understand ADHD 2. Understand parent power – work with them inform of positive changes too! Use home-school diary l Use IEPs / IBPs - identify difficulties / set targets /devise strategies 3. Understand the pupil & how ADHD affects them – all unique Get to know them & build warm, friendly, positive, professional, respectful, safe relationships Group Task: Getting to know you alphabet game: pool things beginning with each letter of the alphabet N. B. Give them chance to talk – ask them how you can help them Group Task: Return again to matchstick pupil & add all you know e. g. personality; motivators; likes; dislikes; learning style; other special need; windows of opportunity; social; emotional in a third colour Vital to Engage & Motivate use motivators/ interests; preferred learning style – see handbook Think: Anything you need to find out?

C. Management: Behavioural intervention Behaviour & learning are linked! Pupils with ADHD need boundaries ++ l ADDISS highly recommended: 1 2 3 Magic behavioural intervention programme for ages 2 -12 but principles same for older pupils Books: l 1 2 3 Magic for Teachers l 1 2 3 Magic for Parents Divides behaviour into Stop & Start - different strategies

1 -2 -3 Magic STOP - Must decide: 1. ADHD behaviour or ‘choice’ behaviour? 2. Just annoying & can be tactically ignored 3. If tackling - prioritise & tackle systematically 1 or 2 at a time NO TALKING – NO EMOTION RULE Strategy: Counting = Simple, direct & effective Must agree & teach beforehand: A pupil stuck on a maths problem? Then – Count: l 1 give 5 seconds to comply l 2 & wait l 3 say take 5 = sanction e. g. time out / Can go straight to 3 After sanction: NO TALKING – NO EMOTION – NO APOLOGIES Needs practise for you & them! Benefits? 1. Energy saving: breath & aggravation 2. Gives time for positive: more attention/ fun 3. It works! Reaction: Immediate compliers & immediate testers START: Energy goes into this – rewards/ incentives better than sanctions – catch them being good – give them a reason to behave

C. Management: Educational Strategies & Support Group Task: See General Strategies: Proactive NOT Reactive in handbook Before look at specific problems need to think: l Respect l Have high expectations: Halperin ‘reason not an excuse’ – best that they can be! l Ownership & independence where possible – help them to help themselves l Think on your feet & keep sense of humour l Give dedicated undivided attention l Teach/ model/ praise/ practise skills that are needed to succeed e. g. listening Group Task: There’s no need to shout/ Never. .

Over to you: Group Brainstorm Give a man a fish …. Reflective practitioner Think child think problem think solution Group Task: Lucky Dip! Brainstorm: Tips & Tricks; Strategies & Games/ Activities – Head Fake! 1. Giving & Following Instructions 2. Concentration & Memory 3. Hyperactivity 4. Organisation 5. Peer problems Feedback

1. Giving & Following Instructions l l l l l Working in groups: Get them into groups before giving instructions! Stand/ sit near them Attract attention & gain eye contact Be specific & brief Communicate clearly – tell them personally Short sequences of instructions then if necessary give one instruction at a time Check understanding & ask to repeat back to you Use additional reminders e. g. Write down use colour / use recording devises e. g. talk buttons Model – walk through During tasks, make frequent checks to ensure that pupils are on task & following instructions correctly. Games/ activities: Digital scavenger hunt/ cookery / blind drawing

2. Concentration = prerequisite for memory l Actively involve / Engage & Motivate – use interests l Use variety & pace / concentration windows / attention training – personal bests / stress toy/ time out zone/ cards l Allow short breaks between tasks – rule of thumb timing – 1 minute for ever year+ 2 minutes l Share targets: WALTS & WILFS & success criteria l Set short achievable tasks: chunking & clustering 1. Chunking: whole steak at once? Tasks: manageable bits 2. Clustering: wouldn’t eat rice one grain at a time! l Develop prompt rewards for work/ homework completion l Use timers to indicate a period of concentrated work l Follow a difficult/ set task with a preferred task l Emphasize quality of work rather than quantity l Use alternative methods of recording (diagrams/ tape recorders; ICT etc)

Memory Many have working memory issues = ability to hold information long enough to accomplish a specific task l Some have problem with retrieval of stored information l Use memory tricks 1. Visualisation & Colour: Memory= enhanced by exaggeration of emotion action & colour - draw or create vivid pictures to enhance memory Researchers: Minnesota University found colour Increased motivation; willingness to learn & participation by 80% & retention by 75%+ 2. Teach strategies e. g. Mnemonics/ Acrostics /Stories/ Chunking etc. 3. Make it musical- Songs/ Rhymes/ Rap 4. Quickly review /consolidate learning l Games & activities for memory/ concentration: DVD; Where’s Wally/ A Picture paints a thousand words

3. Hyperactivity Allow movement within agreed boundaries l Plan in movement / practical tasks l Provide opportunities for movement (handing out books) l Allow alternative seating e. g. straddle chair horse-back style = more difficult to swing or tip a chair l Set shortened assignments – remember timings l Reduce distractions – seat wisely – near Teacher away from visual & auditory distractions - windows when on task & move to social seating when not l Seat near positive role models - opportunities for cooperative working & enable to learn from their peers. l Calm space - colours matter l Listen to soft music through headphones aids concentration & filters other auditory distractions l Remove unnecessary objects from desk / Use desk dividers / study carrels to reduce visual distractions l Support adult needs to be near & use respectful alerts if they are off-task l Stress toys – justify use l Be fair – injustice can lead to explosions Games/ activities: Guess 2 minutes/ Attention training – PBs l

4. Organisation Need help with organisation of resources & time management: l Teach & Model Organisation – visible thinking l Set aside special times to tidy folders etc. l Colour coding books & folders / Chunking l To do lists/ checklists/ planners/ calendars / diaries/ mind maps l Provide regular reminders of daily tasks/ print-outs of homework & course-work requirements (including submission dates) l Visual timetables l Keep worksheet/ instruction sheet format simple l Organised buddy - If possible, find something that the pupil with ADHD can help them with in return: respect & equality l Enlist help from home where possible. l Reward tidiness & organisation l Have times of amnesty when long-forgotten work can be handed in & organized without penalty l Repeat expectations each time a piece of work is set l Summarize instructions in writing/ talk button l Develop a clear system for keeping track of completed/ uncompleted work Games/ Activities: Plan a party/ Event; Order of Birthday, height etc

5. Peer problems “The children who need love the most will always ask for it in the most unloving ways” Russel Barkley Use PHSE role-play and drama to teach concepts/ skills of communication, participation, cooperation, turn-taking, listening, empathy etc. l Teach & Model social rules l Encourage/ facilitate inclusion of pupil in friendship groups l Use cooperative learning activities where tasks require all members of are required to fulfil their role to ensure group success l Reward appropriate social behaviour l Involve parents l Assign the pupil responsibility in their peer group to increase respect l Increase self esteem Games & activities: Big bad wolf freestanding newspaper shelter for group/ outfit for the races / Balloon master: sticky tape l

Useful organisations ADDISS: Registered charity providing information & resources about ADHD for parents, sufferers, teachers & health professionals – have local support groups www. addiss. co. uk/ e-mail: info@addiss. co. uk Phone: 020 8952 2800 / Fax: 020 8952 2909 l ADDitude: provides expert guidance & inspiring life stories from the experts in the field & from parents & adults offering advice & inspirational stories. Magazine: www. additudemag. com/ Expert webinars/podcasts: www. additudemag. com/webinars/ Free downloads: www. additudemag. com/resources/free-downloads/ l

Have we…. . ? ? ? 1. 2. 3. 4. 5. Is it a thing? Signs & Symptoms Feel like? Difficulties with school? Strategies to help Thank you for your time & participation