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Attention Deficit Hyperactivity Disorder: Judith Axelrod, M.D. Developmental-Behavioral Pediatrician
Attention Deficit Hyperactivity Disorder: Judith Axelrod, M.D. Developmental-Behavioral Pediatrician
Disorder
Judith Axelrod, M.D.
Developmental-Behavioral Pediatrician
Attention Deficit
Hyperactivity Disorder
(ADHD) is a chronic
neurodevelopmental
disorder
Attention Deficit Hyperactivity
Disorder
The diagnosis of Attention Deficit Hyperactivity
Disorder is given to individuals who have frequent
failure to comply in an age appropriate fashion
with situational demands for inhibition of
impulsive responses and resistance to distracting
influences. These behaviors interfere with the
individual’s performance in social and academic
settings.
ADHD: Current Working Theory
Psychological evaluation
Medical evaluation
Treatment
Education
Behavior Management/Family Counseling
Medication
Consultation with school personnel
Behavior Management/Family
Counseling
Effective in teaching ways to be consistent
Teaching problem solving techniques
Support
Breaking cycles of learned behavior
Help in the Classroom
• Be sure you are dealing with ADHD
• Seek assistance to clarify diagnosis
• Communicate with teachers/parents
• Include the child in making a plan
• Ask the child what will help
• Help the child to take ownership
Help in the Classroom
• Avoid being punitive
• Set positive goals
• Attempt to reinforce effort and not just
accomplishment of goals (sometimes these
children try their best and still don’t meet
basic goals for behavior)
• Remember all ADHD is NOT alike
Help in the Classroom
• Use a “firm-flexibility” approach with the
child – combination of support,
accommodations, clear limits, and
expectations
• Daily schedules may help - visual
• Use visuals when possible
• Be cognizant of “high risk” times (e.g.,
unstructured, less supervised times)
Help in the Classroom
• Keep in mind that many behaviors may
reflect coping with frustration/anxiety
• Structure and clear expectations are vital
for success
• Need for cues, reminders, and repetition
• Be aware of and avoid “helping” strategies
that may humiliate the child
Help in the Classroom:
• ANY approach one takes should strive to
minimize penalizing the student for
struggles that are a direct result of ADHD.
That is, attempt to differentiate behaviors
that are much harder for the child due to
ADHD versus those that may occur by
choice
Help in the Classroom
• Initiate communication with parents and
ask about:
– Homework time
– Student’s understanding of tasks
– Time and effort spent with routine homework
Help in the Classroom
• If the child is clearly falling behind, take the
initiative to notify parents
• Be careful not to assume that problem
behaviors are intentional
• Try to stay positive
• Work with the student to set goals (but not
too many at once)
Help in the Classroom: Distraction
• Remember a child may be “listening” to you
but not attending to what you are saying
• Provide extended time as needed
• Emphasize quality over quantity with
assignments and homework
Help in the Classroom: Distraction
• Have the student repeat directions and/or
demonstrate understanding
• Monitor student’s progress in completing
work so it doesn’t pile up
• Provide cues to help the child stay on task
(e.g., agree on “secret” cues)
Help in the Classroom: Disorganization
• Consider allowing the student to have a
second set of books at home
• Make sure the child has correctly recorded
homework assignments
• Specifically request their homework and/or
find a system that works
• Suggest simple ways to organize papers
• Work with the child to organize locker
Help in the Classroom:
Hyperactivity/Impulsivity
• Provide adequate breaks and opportunities
to move or “reset”
• Use visual cues to help the child remember
to “STOP & THINK”
• When entering into a “high risk” situation,
talk through successful behavior with the
student beforehand
Help in the Classroom:
Working Memory
• A skill learned today is not necessarily
remembered tomorrow
• Note taking is often harder – be sure they
have relatively complete notes
• Suggest strategies that help the child
compensate for this weakness
ADHD Treatment
Multimodal Treatment Study of ADHD (n = 579)
Investigated effects of various treatment modalities on children
with ADHD, combined type over 14 month period
Results
Medication alone most effective treatment of core symptoms of ADHD
Medication with psychosocial treatments was superior to other
treatments for non-ADHD areas of functioning – i.e. aggressive
behaviors, parent-child relations, teacher-rated social skills
Medication Classes
Stimulants
Antidepressants
Antihypertensives
Wake-promoting agent used in narcolepsy
Stimulants
First line medication treatment of ADHD
Approximately 70% of children will respond to
the first stimulant prescribed
Up to 90% respond to the first or second
stimulant attempted
Mechanism of Action
Increase dopaminergic and noradrenergic
activity in frontal cortex
Stimulants
Three types of stimulant formulations
Short-acting
Duration of action 2-4 hours
Must be given 2-4 times per day
Intermediate-acting
Duration of action 6-8 hours
Long-acting
Duration of action 10-12 hours
Current accepted practice is to initiate treatment
with an intermediate or long-acting preparation
Methylphenidate Class
Short-acting
Methylphenidate (Ritalin, Methylin)
Focalin
Intermediate-acting
Ritalin LA/Ritalin SR
Metadate CD/Metadate ER
Long-acting
Focalin XR
Concerta
Daytrana patch
Amphetamine Class
Short Acting
Adderall
Abused in adolescent population
Dexedrine/Dextrostat
Desoxyn (Methamphetamine HCl)
Intermediate-acting
Dexedrine spansules
Long Acting
Adderall XR
Vyvanse
Prodrug – cleaved by stomach enzyme (less abusable)
Support
• CHADD (Children and Adults with Attention
Deficit Disorders)
8181 Professional Place, Suite 201
Landover, MD 20785
http://www.chadd.org/.
800-233-4050
ADHD Parent Support Group
• LDA of Kentucky
– www.ldaofky.org
Educational Intervention
• www.ed.gov
ADHD Recommeded Reading
For Parents
• Barkley, Russell. Taking Charge of ADHD: The Complete Authoritative Guide for Parents,
• Fowler, M.C. (1990). Maybe You Know My Kid: A Parent’s Guide to Identifying,
Understanding, and Helping Your Child with Attention-Deficit Hyperactivity Disorder.
New York: Carol.
• Hallowell. Edward and Ratey, John, Driven to Distraction: Recognizing and Coping with
Attention Deficit Disorder From Childhood through Adulthood. Patheon Books.
• Hallowell. Edward and Ratey, John, Delivered from Distraction: Getting the most out of
Life with Attention Deficit Disorder. Patheon Books.
• Jensen, Peter. Making the System Work For Your Child with ADHD. Guilford Press.
• Ingersoll, B. (1988). Your Hyperactive Child. New York: Doubleday.
• Ingersoll, B. and Goldstein, S. (1993). Attention Deficit Disorder and Learning Disabilities,
New York: Doubleday.
• Nadeau, K. A Survival Guide for High School and College Students with ADHD, New York:
Magination.
• Honos-Webb, Lara. The Gift Of ADHD: How To Transform Your Child's Problems Into
Strengths. Oakland: New Harbinger.
• Taylor, Blake. ADHD and Me: What I Learned from Lighting Fires and the Dinner Table.
New Harbinger: 2008.
ADHD Recommended Reading
For Adults