ATTENTION DEFICIT – HYPERACTIVITY DISORDER: Definition and Symptoms
Attention Deficit-Hyperactivity Disorder has received a lot of attention in the past 20 years, and while this has been good when translated to research, there is still a lot of confusion about the condition. One source of trouble is that ADHD often occurs with other exceptionalities such as learning disabilities, or emotional disorders (Johnson, 1991). Similarly, ADHD often looks like other conditions, such as depression, or bipolar disorder (Lerner et el, 1995). As well, many characteristics of ADHD are similar to those displayed by people in general, especially children (Barkley, 1991). Adding to these problems, the expression of symptoms can vary: while inattentiveness is a trait of ADHD, some children can be attentive for long periods of time on certain activities (Cherkes-Julkowski et al, 1997); or, barring hyperactivity, some ADHD children have below normal levels of activity (Fiore et al, 1993). Further, symptoms express themselves differently at different life stages (Lerner et al, 1995), and even within an age cohort, an ADHD child may be cheerful and social, withdrawn and moody, spacey or constantly moving (Johnson, 1991).
What then, is ADHD? The majority of research agrees about its neurological basis, its likely genetic ties, that it affects every aspect of a person’s life, and that it occurs across cultural, racial, ethnic, and socio-economic groups. Lerner et al’s definition is standard: “ADHD constitutes a chronic neurobiological condition characterized by developmentally inappropriate attention skills, impulsivity, and, in some cases, hyperactivity” (1995:4). A final area of agreement among the research is despite the fact that Ritalin is effective, such treatment is not a long-term solution for those with ADHD (Abikoff, 1987) (www.chadd.org, 2002) (Smith, et al, 2001).
The three primary characteristics of ADHD of inattentiveness, impulsivity, and hyperactivity translate into a vast array of classroom behaviors. Inattentive children often make careless mistakes, have difficulty sustaining attention, do not seem to listen, have difficulty finishing work, lose things, and are forgetful. Impulsive children often burst out answers, have difficulty waiting turns, and interrupt others. Hyperactive children often fidget, have difficulty remaining seated, move about a lot, have difficulty being quiet, and often talk excessively (DSM-IV, 1994). The resulting poor school performance, reprimands from teachers, social exclusion, and failures in learning can all lead to hypersensitivity, low self esteem, and a sense of inadequacy (Weaver, 1994).
For clarity, one could say that there are two methods to help any student: accommodations, defined as methods to work around a difficulty by offering alternative approaches to teaching, assessment, etc., and; strategies, defined as research based methods designed to strengthen or weaken symptoms (www.pbs.org, 2002). Some common methods of helping those with ADHD include social skills training, group management, and teaching study tactics (Smith et al, 2001). Predictably, none of these methods is suitable for all students; in general, “most experts recommend a multi-modal treatment approach for ADHD, consisting of a mix of medical, educational, behavioral, and psychological interventions” (www.chadd.org, 2002). For depth, this report will focus on accommodations and strategies that are based on the philosophies and/or methods of cognitive psychology. The author is aware that not all of the methods are exclusive to cognitive psychology, but feels that similarities at the philosophical or goal level suffice to place such methods under the same heading.
Cognitive Psychology: philosophies and methods:
The philosophy of cognitive training includes the centrality of thoughts, beliefs, and attitudes (cognitions), the view that cognitions mediate and are influenced by behavior, and that self-perceptions and self-guidance strategies can and should be direct targets for change (Whalen, 1986). The most characteristic methods of cognitive training are modeling/rehearsing, self-verbalizations, self-monitoring, and re-attribution techniques (Fiore, 1993). The goal in cognitive psychology is to assist people in acquiring their own skills in dealing with problematic areas, and to generalize these skills to other areas. What is unique about the cognitive approach is the process: the methods used are the skills that the person will acquire; the goals are not on improvement per se but rather on the use of the skills taught; and the locus of change resides within the individual (Abikoff, 1987) (Whalen, 1986). All of the following methods can be used for all students, and for those experiencing great difficulty individualized and more specialized forms can be used,
Modeling
- Rehearsing:
In a general sense, teachers should always model and rehearse skills, ideas, and problem solving techniques for children. Modeling and rehearsing provide practice with problem areas, and create an anticipatory reservoir of likely reactions and outcomes to make the world more predictable (Johnson, 1991). In order to do so effectively, modeling and rehearsing imply breaking tasks, assignments, and everyday challenges into manageable parts, which are recommended tactics when dealing with ADHD (Abikoff, 1987). Children with ADHD often have trouble finishing their work, or understanding directions because they are inattentive, and thus unable to manage too many instructions or too much work simultaneously (Edwards et al, 1995). The teacher, as if thinking about a lesson herself, should model effective methods of breaking up activities, or configuring a problem into simple and clear parts (Buchoff, 1990). An example, adapted from Lerner et al (1995), would be like this:
Self-Verbalization:
ADHD students have difficulty with “executive” (prioritizing - planning) attention, often being distracted by extraneous stimuli (Vineyard Video, 1997). Thus, they have difficulty staying on-task, or impulsively rush to finish their work without a clear plan in mind. Self-verbalization, the process of speaking out loud, or within one’s mind, provides a way to shut out external stimuli (Lerner et al, 1995), and a way of literally talking through a strategy. As well, considering the value of re-phrasing and re-explaining in memory and understanding, such tactics imply being aware of, and practicing the stages of a task (Abikoff, 1987). As the teacher finishes a class, or completes a stage in a process, explicit self-verbalization of these actions should be modeled for the children, and they should encourage students to verbalize on their own. Self-verbalization like techniques can be practiced and reinforced by a “buddy system”: after giving an assignment, pair up students, with one re-telling the instructions, and the other clarifying them (Buchoff, 1990).
Self-Monitoring:
The method of self-monitoring, or explicitly checking one’s behavior, is a method that helps ADHD students to keep on-task, to check the efficacy of strategies, and to slow down reaction times (Lerner et al, 1995). For students having trouble staying on task, or remembering information, self-monitoring can be practiced with a signal system, in which at the signal of a tone students are required to write down whether or not they are doing their work, or whether their chosen method of problem solving is working. Similarly, the use of acronyms is an excellent method of self–monitoring for not only do such mnemonic devices assist memory, but as well provide a guide from which to work. Further, this method can be used to help slow down the reaction time of an impulsive or hyperactive child: “STOP-THINK”, cited by Johnson (1991) is one such method; here, children prone to impulsivity are trained to stop before acting, think about the situation, review possible solutions, and to choose the best one.
Re-Attribution – Translation:
Re-attribution is another way of saying that a teacher should always be positive, concentrate on a child’s good aspects, and to never focus on the bad, embarrassing or insulting (Johnson, 1991). Many ADHD students suffer years of failure in both the academic and social realm often leading to low self-esteem. To help facilitate a student’s self-esteem, one method is for teachers to not only mark papers, but to highlight the correct parts (Buchoff, 1990). Another method would be encouraging ADHD students to keep a daily journal, in which they write down an event that made them feel good (Buchoff, 1990). This type of activity encourages students to look at the day as a whole and to take a new look at it, or to look at aspects in the day that may have been bad, and then to turn it around by translating the bad into the good. Teachers can assist those students having trouble turning their days around.
ADHD is not so much a disorder (within the individual) as a set of dysfunctional
that generates certain expectations, demands, and reactions
(Weaver, 1994:5).
Teachers must find ways to help all of their students, while trying to maintain order in the class, as well as to providing an enriching learning environment. Many of the strategies just mentioned often seem obscure, or fairly common sense, but I found that the philosophical stance of cognitive training helped me to focus, and was appealing as well by making the child responsible for their own therapy, which in turn would lead to better skills and self-esteem.
Too often, though, the strategies we use are teacher focused, with an interest in control and ease. Like all students, ADHD children have their strengths and weaknesses. Some suggest that such children are good at seeing holistically (Johnson, 1992), or the arts, or movement activities (Nelson-Burford, 1985). Considering that teaching to skills and interest is a part of good teaching, rather than focusing on changing what often are behaviors or styles of thinking that are not really desirable to change, accommodations on our parts as teachers are often just as effective in managing students and facilitating their learning (Whalen, 1986). With this in mind, it seems that integrated curriculum would be intrinsically better for such students; not only does a holistic perspective fit the thinking style of many ADHD students, current research suggests that this type of curriculum is good for anyone (Earl & Cousins, 1995), in that it allows for new ways of putting information together, and to see connections more clearly (Nelson-Burford, 1985). More specifically to ADHD students, because curriculum would be integrated, with, for example, science class vocabulary being similar to that being studied in languages, it would allow more time to be spent on ideas, interrelationships, and more difficult areas rather than on discrete facts or lists (Vineyard Video Productions, 1997). There is an apparent contradiction of ADHD students that they “see” holistically, yet require step by step instruction, yet it could be said that the difficulty to teach holistically merely reflects the problems than any child, whether or not having ADHD has: to connect the big and the small, the general with the specific. The need to split up tasks, to make the connections, and to teach clearly and simply is a need for all students, and is a duty for all teachers to provide this.
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