Author: Kelley E. Keenan

Attention Deficit
Hyperactivity Disorder

Kelley Keenan

April 2015

What is Attention Deficit Hyperactivity Disorder?
According to the DSM-V, ADHD is characterized by persistent patterns of inattention and/or hyperactivity and impulsivity that interferes with functioning and development and are present in multiple settings.
There are three subtypes of ADHD
Predominantly hyperactive-impulsive
Six or more symptoms are in the hyperactivity-impulsivity category and less than six symptoms are in the inattention category
Predominantly inattentive
Six or more symptoms are in the inattentive category and less than six symptoms are in the hyperactivity impulsivity category
Combined hyperactivity-impulsive and inattentive
Six or more of symptoms from the inattentive category and six or more symptoms from the hyperactivity-impulsivity category are present
Most common subtype

“The average age of diagnosis for ADHD is age 7, however symptoms often appear between ages 3 and 4”

In This Packet
Glossary
Symptoms
Quick Facts
Case Study
Challenges for Students with ADHD
Tips for Teachers
Additional Resources

Symptoms
Inattention
Failure to give close attention to details
Trouble sustaining attention
Does not follow through on instructions
Does not seem to listen
Easily distracted
Forgetful in daily activities
Trouble organizing tasks or activities
Avoids task requiring sustained mental effort
Loses things necessary for tasks
Hyperactivity and Impulsivity
Fidgets with or taps hands or feet or squirms in seat
Leaves seat during situations when expected to remain in seat
Runs or climbs in inappropriate situations
Difficulty playing quietly
Is “on the go” or “driven by a motor”
Talks excessively
Blurts out answers before questions are completed
Has difficulty waiting his/her turn
Interrupts or intrudes on others

Glossary
ADHD- Attention Deficit Hyperactivity Disorder
Comorbid- Occurring alongside something else
Deficit- Lacking or shortage
Diagnostic and Statistical Manual, Fifth edition or DSM-V- Classification and diagnostic tool for mental disorders
Hyperactivity- Constant activity
Impulsivity- Displaying behaviors characterized by little or no forethought
Inattention- Failure to carefully think about, listen to watch; distraction
Prevalence- Degree to which something occurs

ADHD Quick Facts
ADHD is one of the most common childhood disorders and the affects can continue into adolescents and adulthood. There is no confirmed cause of ADHD however many researchers believe that genes play an important role
Approximately 11% of children aged 4-7 have been diagnosed with ADHD since 2011
Diagnoses have been steadily increasing from 7.*% in 2003 to 11.0% in 2011
ADHD affects 4.1% adults each year
ADHD is often comorbid with other disorders such as oppositional defiant disorder, conduct disorder, anxiety and depression, or bipolar disorder
Medicine and psychotherapy are the most common treatments for ADHD

Case Study
Chad is a 12 year old boy in 6th grade who lives with his mom, dad, and two younger siblings, Grace (8) and Jordin (4). Chad’s father is a hotel manager and his mother is a pediatric nurse. Chad’s father has ADHD, persistently hyperactivity-impulsivity. Both of Chad’s parents are fully supportive of their children and work to provide them with whatever possible and want them included in multiple extracurricular activities.
Chad has always been extremely active, since his early childhood. He would find it difficult to sit still during family gatherings and would move from one activity to the other activity. As a child Chad often would fidget with his hand or tap his feet constantly. He struggled to play games with his family, often jumping out of turn and getting upset at having to wait his turn. At age eight, Chad was officially diagnosed with ADHD after a referral from his pediatrician and assessment by the school psychologist. The school psychologist monitored Chad’s behaviors periodically and used interviews to collect home data. Chad was below his grade level in reading and writing. After initial assessment the school psychologists agreed with the pediatrician for an outside evaluation to observe his home setting and an official diagnosis was confirmed.
Chad currently is taking a trial medication for ADHD, however sometimes Chad still struggles to pay attention to classroom details. He often gets out of his seat or has to move around a lot and adjust his posture. During long discussion Chad turns his head around and looks out the window or around the classroom at bulletins and papers. During small groups, Chad struggles to keep his voice down and talk in an inside manner. At the beginning of the year Chad would blurt out answers without raising his hand.
Chad’s teacher and parents worked to create an intervention and behavior plan that suited Chad’s personal needs. Chad and his teacher have worked to increase Chad’s attention and organizational skills and decrease his impulsive behaviors. Chad has recently been transferred to a self-evaluating method of his behaviors. Chad has a laminated index card on his desk which helps remind of things he needs to have and do to be successful in school each day. At the end of each week if Chad is able to remain in his seat during class periods, keep his assignments organized and turned in on time, and talk in a quiet voice he will earn tallies to buy a prize from the classroom prize jar. So far Chad’s behavior plan has been effective, and the more success he finds the more his plan will improve so he can continue his self-improvement skills.

Challenges Students With ADHD Face at School
Difficulty paying attention, focusing on schoolwork, and listening to directions. A child with ADHD may be easily distracted by peers, sounds, or even artwork on classroom walls.
Problems organizing schoolwork and remembering tasks. Multiple-part verbal directions, such as requesting a student “turn to page 133 in your math book, complete problems 1-6, then begin reading pages 20-25 in your history book,” may be confusing. Homework assignments and textbooks may be forgotten or misplaced frequently, and papers and notebooks may be quite cluttered.
Inability to sit still and remain seated. Children with ADHD may not know why it is difficult for them to sit still. They may be unable to sit quietly, despite frequent reminders to do so.
Difficulty waiting their turn in line, waiting to give an answer during class, or waiting their turn during games. These children may appear impatient or may insist upon being first. These behaviors can be misunderstood and can easily annoy others.
Learning disorders are common in people with ADHD. A child’s difficulties in school should not be presumed to be due entirely to ADHD. If the child still has academic difficulty after ADHD symptoms are treated, an educational evaluation for a learning disorder should be considered. A child’s repeated reluctance to attend school may be an indicator of an undiagnosed learning disability.
Other mental health conditions, compounding any learning and behavioral challenges. Having one mental health condition does not “inoculate” the child from having other conditions as well. Children with ADHD commonly have co-existing mood and anxiety disorders.
Speech and language problems that may need evaluation by specialists
Side effects from medications. Medications may have cognitive or behavioral effects or physically uncomfortable side effects that interfere with school performance. After a child begins receiving medical treatment for symptoms, any mood changes or new behaviors should be discussed with parents, as they can reflect medication side effects.

Tips for Teachers
Assign the child a seat that limits distractions. Sit children near the teach or near the front of the room.
Have clear expectations for classroom behaviors. Keep rules simple and concise, repeating them as often as necessary.
Make instructions clear. Write instructions on the board or provide clear instructions in a large poster.
Ask the child to repeat instructions before carrying them out.
Check in with students frequently. Provide necessary assistance for children that may need extra help.
Use visual cues. Visuals can provide another way for students to understand directions or for teachers to get points across.
Help the child remember and keep track of assignments and important class materials. Mail home documents. Provide folders. Help guide children to be successful.
Minimize distracts. Give children a squeeze ball or fidget toy
Design interventions that interrupt the behaviors. Provide students with specified help; specific spots in line, amount of time to clean up
Develop a behavior plan that is a true incentive to the student. Make sure that incentives motivate the student and that the student understands the necessary steps needed to gain an incentive and to follow the behavior plan. Use self-monitoring when necessary.
Reward a child’s efforts. Praise! Praise! Praise!

Additional Resources
Here are some websites that you may find beneficial
http://www.dsm5.org/documents/adhd%20fact%20sheet.pdf
-DSM-V ADHD fact sheet
http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
-National Institute of Mental Health ADHD page
http://www.helpguide.org/articles/add-adhd/teaching-students-with-adhd-attention-deficit-disorder.htm
-Non-Profit Website that provides information on ADHD, specifically some resources for teachers to use in the classroom
http://www.cdc.gov/ncbddd/adhd/index.html
-CDC ADHD website
Here are some books that you may find beneficial to share with your class
I Can’t Sit Still: Living with ADHD by: Pam Pollack
Does Everyone have ADHD: A Teen’s Guide to Diagnosis and Treatment by Christine Petersen
My friend has ADHD by Amanda Doering Tourville
Stuck in The Middle (of Middle School): A Novel in Doodles by Karen Romano Young

Contact Us
If there is anything you would like to use from this or to reproduce a copy of these pages please contact the author:
Kelley Keenan
kek117@pitt.edu
The University of Pittsburgh