There seems to be one in almost every classroom. That student that just can’t get it together. Maybe it’s the homework that never gets turned in or the desk that resembles a pigpen. Possibly the student is disruptive, blurting out inappropriate remarks or just can’t stop tapping her pencil even when you have asked her a million times to stop.
As teachers, we know its normal for students to forget their homework or daydream and get fidgety from time to time. But how do we distinguish between “normal” kid behavior and ADHD behavior? Are we too quick to diagnose and medicate in hopes that these behaviors simply disappear? Is ADHD being over diagnosed when kids are just really being kids? And if it really is ADHD, how do we accommodate these students so they succeed in our classroom?
The 3 Sub-Types of ADHD
Here are a few facts to consider about ADHD, also known as Attention Deficit Hyperactivity Disorder.
- ADHD is the most commonly studied and diagnosed psychiatric disorder in children. It is considered a neurobehavioral developmental disorder.
- ADHD affects approximately 3-7% of all children globally with symptoms typically presenting before the age of 7.
- Boys are 2 to 4 times more likely than girls to be diagnosed with ADHD.
- Scientists are not sure exactly what causes ADHD, although many studies suggest that genetics and brain chemistry play a large role. It is thought that ADHD may result from a combination of factors including genetics, brain injuries, nutrition, environmental factors and/or social influences. (NIMH, National Institute of Mental Health).
To make the disorder even more confounding, ADHD has three subtypes according to the DSM-IV. A child who is diagnosed with ADHD will fall into one of the following categories:
ADHD- Predominantly Inattentive (also known as ADD)
A child with this diagnoses presents symptoms that are more inattentive in nature. They are easily distracted, forgetful, have trouble with organizing and completing a task, become bored easily, struggle to follow directions, have difficulty focusing on one thing, daydream and/or have trouble completing or turning in homework assignments. Children with this subtype are less likely to act out or have difficulties getting along with other children. In fact, they tend to be very quiet and are often overlooked. Parents and teachers may not notice that he or she has ADHD.
ADHD- Predominantly Hyperactive-Impulsive
Students who are diagnosed with this type of ADHD may display symptoms such as talking nonstop, fidgeting and squirming in their seats, having difficulty doing quiet tasks, are very impatient, blurt out inappropriate comments and act without regard for consequences.
ADHD- Combined Hyperactive-Impulsive and Inattentive
These students have the symptoms of hyperactivity, impulsivity and inattention. Most children who are diagnosed with ADHD fall into this category.
Diagnosing ADHD Is Not a Simple, Single Event
ADHD, and other mental illnesses, do not allow for a blood test to provide a definitive diagnoses. Instead, diagnosing the disorder is based upon the observations of the student by parents, teachers and other caregivers.
Questionnaires regarding behaviors in the classroom and at home help a mental health professional or doctor determine if a child is indeed suffering from the disorder. Professionals also look at how long the symptoms have been present and whether the behaviors are excessive or not age appropriate.
What To Do As Teachers and Parents If We Suspect ADHD?
Erin’s son, Matt, started having trouble once he began Kindergarten. He was placed on a behavior chart for inattentive behaviors. Every year, Erin would get the same email from his teacher. “Matt has trouble focusing, so we are going to start him on a behavior chart.” Erin became so sick of the smiley face, frown face chart, as they just didn’t seem to work.
Matt’s 3rd grade teacher realized that his inattentive behaviors were something that Matt couldn’t help, so she asked if she could have him observed by the Vice Principal. From there, Erin and Matt saw his pediatrician who suggested a psychologist for a diagnosis as well.
Once Matt was officially diagnosed with ADHD-Inattentive type, Erin and the school professionals wrote a 504 Plan. Erin honestly didn’t think it worked well, if at all, because the teacher didn’t follow it. She was not a good communicator and didn’t check Matt’s backpack like what was written in the plan.
At home, Erin tried a no sugar diet and found that didn’t help either. What does help is making sure to check Matt’s backpack every night and talking to him about school, pointing out the positives. Erin also has Matt repeat back to her directions given at home.
After about 10 months and no success using the 504 Plan, Erin decided to start Matt on ADHD medicine. Matt began on a low dose and the teacher reported seeing a difference right away, much more participation, attention and interest in math. Matt takes a low dose in the morning with the school nurse on the days he is at school. There has been a real positive change in Matt since beginning the medicine.
Is ADHD Over Diagnosed?
Are we too quick to label a student as ADHD just because he can’t sit still or because a student’s grades are slipping? A recent study conducted by the CDC (Center for Disease Control) showed that 11% of school-age children in the United States have received a diagnosis of ADHD.
What has alarmed many is that in which the rate has climbed. According to the study, the rate has skyrocketed 16% since 2007. The rise was most dramatic among boys, with an estimated 1 in 5 boys of high school age diagnosed with ADHD.
Like most mental health disorders, ADHD is not black and white.
Like most mental health disorders, ADHD is not black and white. It is a perplexing condition that can affect the academic and social lives of affected children, possibly into adulthood. A few points to consider about the rising rates of ADHD: Family doctors, who aren’t always adequately trained in providing the detailed evaluation that a reliable diagnosis requires, are diagnosing many children with ADHD when there really may be another condition going on, or in fact, nothing at all.
This problem may lie in the detail that doctors are required to sort out a very complex condition in a short amount of time. Just because a child is showing a few symptoms does not necessarily point to a positive diagnosis. The symptoms must be present every day for a long period of time and must lead to an impairment on the child’s life.
20 Ways To Support Students With ADHD
Regardless of the how’s and why’s of ADHD, as teachers it is vital that we support our students on their academic journey. How do we support parents and students who are affected by ADHD?
- Learn about which subtype of ADHD the student has been diagnosed with. Get to know the individual student and be mindful of his or her uniqueness.
- Seat the student away from doors and windows that may distract him or her. The student may work best closest to the teacher.
- Allow physical activity breaks (stretching) and incorporate movement activities into a lesson. If possible, allow for outdoor instruction time.
- When possible, provide academic instruction to these students with ADHD in the morning. Evidence suggests that on-task behaviors of a student with ADHD worsen over the course of a day.
- Write important information down where the student can easily reference it, most likely at their desk.
- Divide large assignments into small segments. Write these segments down. Have the student cross the items off as they are completed.
- Provide frequent breaks for the student to get a drink or walk around the room.
- Allow the student with ADHD to run errands for you (take a note to the office) or have them be in charge of sharpening the classroom pencils.
- Provide the student with a stress ball or other object for the student to play with discreetly at their seat, especially when they need a break.
- Write the schedule of the day on the student’s desk and allow him or her to cross off each item as it is completed.
- Recognize and praise aloud all good behaviors. Be specific in what the student is doing correctly.
- Provide an assignment book for the student to keep track of homework and daily work. Encourage this book to be signed by parents so parents know what is going on in the classroom. Communicate with the parent as much as possible.
- Form small groups for students with ADHD to work in so as not to get distracted and lost in a large group.
- Allow the student with ADHD to work in a quiet zone within the classroom. This should be a place in the room that is quiet and free from visual stimulation.
- Establish a secret signal with the student to use as a reminder when he or she is off task.
- When giving directions, make eye contact with the student and be as brief as possible.
- Use visuals. Highlight words in colored chalk or bright ink. Underline and circle important things to remember.
- Use auditory cues. Set a timer and encourage the student to work uninterrupted until the timer goes off. Allow the student a break following the work period.
- Provide specific, well-defined rules to the student with ADHD. Write these rules down and tape them to the student’s desk. These rules should have clear consequences.
- Most importantly, students need guidance, compassion and understanding from their parents and teachers as they navigate the path of dealing with ADHD. It isn’t their fault that they have been diagnosed with ADHD.