From the Publisher

Sandra Rief offers myriad real-life case studies, interviews, and student intervention plans for children with ADD/ADHD. In addition, the book contains best teaching practices and countless strategies for enhancing classroom performance for all types of students.

This invaluable resource offers proven suggestions for:

• Engaging students' attention and active participation
• Keeping students on-task and productive
• Preventing and managing behavioral problems in the classroom
• Differentiating instruction and addressing students' diverse learning styles
• Building a partnership with parents
• and much more.

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Table of Contents

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How To Reach And Teach Children with ADD/ADHD

John Wiley & Sons

Chapter One

Understanding Attention-Deficit/ Hyperactivity Disorder

As mentioned in this book's introduction as well, many people continue to use the two distinct terms of ADD (Attention-Deficit Disorder) and ADHD (Attention-Deficit/Hyperactivity Disorder). Some use the two terms interchangeably, and others specifically use ADD when referring to those who do not have the symptoms of hyperactivity. However, the most current and official term or acronym is ADHD (with or without the slash). This is the umbrella term or acronym under which all three types of the disorder are included:

* The predominantly inattentive type of ADHD (those without hyperactivity)

* The predominantly hyperactive/impulsive type of ADHD (those without a significant number of the inattentive symptoms)

* The combined type (the most common type of ADHD-those with a significant amount of symptoms in all three core areas-inattention, impulsivity, and hyperactivity)

In the first edition of this book (1993) I had used ADD/ADHD, and it remains as such in the title of this new edition. However, throughout the remainder of this text I choose to use the most current terminology of ADHD; and this will include all three types of attention-deficit disorders.

Definitions and Descriptions of ADHD

There are several descriptions ordefinitions of ADHD based on the most widely held belief of the scientific community at this time. The following are some of those provided by leading researchers and specialists in the field:

* ADHD is a neurobiological behavioral disorder characterized by chronic and developmentally inappropriate degrees of inattention, impulsivity, and, in some cases, hyperactivity (CHADD, 2001c).

* ADHD is a brain-based disorder that arises out of differences in the central nervous system (CNS)-both in structural and neurochemical areas.

* ADHD is a dimensional disorder of human behaviors that all people exhibit at times to certain degrees. Those with ADHD display the symptoms to a significant degree that is maladaptive and developmentally inappropriate compared to others that age.

* ADHD is a developmental disorder of self-control, consisting of problems with attention span, impulse control, and activity level (Barkley, 2000b).

* ADHD is a chronic physiological disorder that interferes with a person's capacity to regulate and inhibit behavior and sustain attention to tasks in developmentally appropriate ways.

* ADHD is a neurobiological behavioral disorder causing a high degree of variability and inconsistency in performance, output, and production.

* ADHD refers to a family of related chronic neurobiological disorders that interfere with an individual's capacity to regulate activity level (hyperactivity), inhibit behavior (impulsivity), and attend to tasks (inattention) in developmentally appropriate ways (National Institute of Mental Health, 2000; National Resource Center on AD/HD, 2003a).

* Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood. ADHD is also among the most prevalent chronic health conditions affecting school-aged children (American Academy of Pediatrics, 2000).

* ADHD is a neurobehavioral disorder characterized by differences in brain structure and function that affect behavior, thoughts, and emotions (CHADD, 2001c).

* ADHD is characterized by a constellation of problems with inattention, hyperactivity, and impulsivity. These problems are developmentally inappropriate and cause difficulty in daily life (Goldstein, 1999).

Behavioral Characteristics of ADHD

The fourth edition of the Diagnostic and Statistical Manual (DSM-IV), published by the American Psychiatric Association [APA] in 1994, is the source of the official criteria for diagnosing attention-deficit/hyperactivity disorder. The DSM-IV and more recently the DSM-IV-TR (text revised) lists nine specific symptoms under the category of inattention and nine specific symptoms under the hyperactive/impulsive category. Part of the diagnostic criteria is that the child or teen often displays at least six of the nine symptoms of either the inattentive or the hyperactive/ impulsive categories. The lists below contain those symptoms or behaviors found in the DSM-IV (1994) and DSM-IV-TR (2000). Below are the symptoms specifically listed in the DSM (which are indicated in italics), as well as additional common and related behaviors (Rief, 2003).

The Predominantly Inattentive Type of ADHD

This type of ADHD (what many still call ADD), refers to those with a significant number of inattentive symptoms that occur frequently. They may have some, but not a significant number of the hyperactive/impulsive symptoms. Since they do not exhibit the disruptive behaviors that get our attention, it is easy to overlook these students and misinterpret their behaviors and symptoms (for example, as "not trying" or "being lazy").

It is common to display any of the following behaviors at times, in different situations, to a certain degree. Those who truly have an attention-deficit disorder have a history of showing many of these characteristics-far above the "normal" range developmentally-causing impairment in their functioning (at school, home, social situations, work). The nature of these inattentive symptoms tends to heavily impact academic performance and achievement. Those written in italics are the behaviors that are listed in the DSM-IV and DSM-IV-TR.

Characteristics and Symptoms of Inattention (That Occur Often)

* Easily distracted by extraneous stimuli (sights, sounds, movement in the environment)

* Does not seem to listen when spoken to directly

* Difficulty remembering and following directions

* Difficulty sustaining attention in tasks and play activities

* Difficulty sustaining level of alertness to tasks that are tedious, perceived as boring, or not of one's choosing

* Forgetful in daily activities

* Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)

* Tunes out-may appear "spacey"

* Daydreams (thoughts are elsewhere)

* Appears confused

* Easily overwhelmed

* Difficulty initiating or getting started on tasks

* Does not complete work, resulting in many incomplete assignments

* Avoids, dislikes, or is reluctant to engage in tasks requiring sustained mental effort (such as schoolwork or homework)

* Difficulty working independently-needs high degree of refocusing attention to task

* Gets bored easily

* Sluggish or lethargic (may fall asleep easily in class)

* Fails to pay attention to details and makes many careless mistakes (with math computation, spelling, written mechanics-capitalization, punctuation)

* Poor study skills

* Inconsistent performance-one day is able to perform a task, the next day cannot; the student is "consistently inconsistent"

* Loses things necessary for tasks or activities (toys, school assignments, pencils, books, or tools)

* Disorganized-misplaces or loses belongings; desks, backpacks, lockers, and rooms may be total disaster areas

* Difficulty organizing tasks and activities (planning, scheduling, preparing)

* Little or no awareness of time-often underestimates length of time a task will require to complete

* Procrastinates

* Displays weak executive functions as described below in this section

Academic Difficulties Related to Inattention

Reading:

* Loses his or her place when reading

* Cannot stay focused on what he or she is reading (especially if text is difficult, lengthy, boring, not choice reading material), resulting in missing words, details, and spotty comprehension

* Forgets what he or she is reading (limited recall) and needs to reread frequently

Writing:

* Difficulty planning and organizing for the writing assignment

* Off topic as result of losing train of thought

* Minimal written output and production

* Slow speed of output/production-taking two or three times longer to execute on paper what is typical for the average child/ teen that age or grade

* Poor spelling, use of capitalization/ punctuation, and other mechanics, ability to edit written work (as a result of inattention to these boring details)

Math:

* Numerous computational errors because of inattention to operational signs (+,-,×, ÷), decimal points, and so forth

* Poor problem solving due to inability to sustain the focus to complete all steps of the problem with accuracy

The Predominantly Hyperactive-Impulsive Type of ADHD

Those individuals with this type of ADHD have a significant number of hyperactive/impulsive symptoms; they may have some, but not a significant number of inattentive symptoms. Children and teens with ADHD may exhibit many of the following characteristics (not all of them). Even though each of these behaviors is normal in children at different ages to a certain degree, in those with ADHD, the behaviors far exceed that which is normal developmentally (in frequency, level, and intensity). Again, those written in italics are the behaviors that are listed in the DSM-IV and DSM-IV-TR.

Characteristics and Symptoms of Hyperactivity (That Occur Often)

* "On the go" or acts as if "driven by a motor"

* Leaves seat in classroom or in other situations in which remaining seated is expected

* Cannot sit still (jumping up and out of chair, falling out of chair, sitting on knees or standing by desk)

* Highly energetic-almost nonstop motion

* Runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)

* A high degree of unnecessary movement (pacing, tapping feet, drumming fingers)

* Restlessness

* Seems to need something in hands. Finds/ reaches for nearby objects to play with and/or put in mouth

* Fidgets with hands or feet or squirms in seat

* Roams around the classroom-is not where he or she is supposed to be

* Difficulty playing or engaging in leisure activities quietly

* Intrudes in other people's space; difficulty staying within own boundaries

* Difficulty "settling down" or calming self

Characteristics and Symptoms of Impulsivity (That Occur Often)

* Much difficulty in situations requiring having to wait patiently

* Talks excessively

* Difficulty with raising hand and waiting to be called on

* Interrupts or intrudes on others (butts into conversations or games)

* Blurts out answers before questions have been completed

* Has difficulty waiting for his or her turn in games and activities

* Cannot keep hands/feet to self

* Cannot wait or delay gratification-wants things NOW

* Knows the rules and consequences, but repeatedly makes the same errors/ infractions of rules

* Gets in trouble because he or she cannot "stop and think" before acting (responds first/thinks later)

* Difficulty standing in lines

* Makes inappropriate or odd noises

* Does not think or worry about consequences, so tends to be fearless or gravitate to "high risk" behavior

* Engages in physically dangerous activities without considering the consequences (jumping from heights, riding bike into street without looking); hence, a high frequency of injuries

* Accident prone-breaks things

* Difficulty inhibiting what he or she says, making tactless comments-says whatever pops into head and talks back to authority figures

* Begins tasks without waiting for directions (before listening to the full direction or taking the time to read written directions)

* Hurries through tasks (particularly boring ones) to get finished-making numerous careless errors

* Gets easily bored and impatient

* Does not take time to correct/edit work

* Disrupts, bothers others

* Constantly drawn to something more interesting or stimulating in the environment

* Hits when upset or grabs things away from others (not inhibiting responses or thinking of consequences)

Other Common Characteristics in Children and Teens with ADHD

* A high degree of emotionality (temper outbursts, quick to anger, get upset, irritable, moody)

* Easily frustrated

* Overly reactive

* Difficulty with transitions and changes in routine/activity

* Displays aggressive behavior

* Difficult to discipline

* Cannot work for long-term goals or payoffs

* Low self-esteem

* Poor handwriting, fine motor skills, written expression, and output

* Overly sensitive to sounds, textures, or touch (tactile defensive)

* Motivational difficulties

* Receives a lot of negative attention/ interaction from peers and adults

* Learning, school performance difficulties-not achieving or performing to level that is expected (given his or her apparent ability)

* Language and communication problems (sticking to topic, verbal fluency)

Criteria for a Diagnosis of ADHD

It is not just the existence of symptoms that indicate ADHD. It must be proven that there is a history of those symptoms having been evident since before age seven and lasting for a while (at least the past six months). In addition, those symptoms must be (a) more severe than in other children that same age; (b) evident in at least two settings (for example, school and home); and (c) causing impairment in the child's functioning (academically, socially).

Remember that each individual with ADHD is unique in the combination, amount, and degree of symptoms he or she exhibits, as well as that person's own set of strengths, talents, interests, personality traits, and so forth.

Positive Traits and Characteristics Common in Many Children, Teens, and Adults with ADHD

Parents and teachers must recognize, appreciate, and nurture the many talents and positive qualities our children possess. To develop their self-esteem and enable them to become resilient, successful adults, we must help our children to value their areas of competency and strengths. The following are some common positive characteristics and traits that many of those with ADHD possess (Rief, 2003):

* Highly energetic

* Verbal

* Spontaneous

* Creative and inventive

* Artistic

* Persistent/tenacious

* Innovative

* Imaginative

* Warmhearted

* Compassionate/caring

* Accepting and forgiving

* Inquisitive

* Resilient

* Makes and creates fun

* Knows how to enjoy the present

* Empathetic

* Sensitive to needs of others

* Resourceful

* Gregarious

* Not boring

* Enthusiastic

* Intelligent/bright

* Humorous

* Outgoing

* Ready for action

* Willing to take a risk and try new things

* Good at improvising

* Enterprising

* Sees different aspects of a situation

* Able to find novel solutions

* Charismatic

* Observant

* Negotiator

* Full of ideas and spunk

* Can think on their feet

* Intuitive

* Good in crisis situations

* Passionate

(Continues...)

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Excerpted from How To Reach And Teach Children with ADD/ADHD by Sandra F. Rief Excerpted by permission.
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