"Effective practice with students with attention deficit disorder requires knowledge about how to match school requirements to the student's characteristics. It also requires an understanding of relevant medical issues such as whether the student is taking medication and what effects that might have on his or her classroom performance. Combine this knowledge with a solid grounding in instructional strategies, applied behavioral management techniques, and a commitment to building family relationships and you have the basics for a strong educational program (OSEP, 1994, p.5)."
ADD /ADHD (Attention Deficit Disorder/ Attention Deficit with Hyperactivity Disorder) is the term used to describe children who have attentional difficulties, who are often impulsive, and who are frequently also overactive for their mental and chronological age. Originally viewed as a disruptive disorder of childhood, AD/HD is now seen as a cluster of cognitive impairments that may or may not be accompanied by hyperactive or impulsive behavior (Brown, 1997). AD/HD children are the ones who challenge our best classroom practices because their behaviors often interfere with learning and instruction. These children also tend to experience disappointments in social situations, as their peers often find them difficult to get along with.
Typical characteristics of AD/HD children include:
- Chronic difficulties in maintaining alertness or "staying tuned" when listening or reading:
- staying focused on the right information for the right amount of time;
- filtering out distractions;
- poor attention to detail or coping with a series of instructions;
- staying on-task;
- Patterns of procrastination, disorganization and underachievement:
- activating and organizing for work;
- choosing the right piece of information on which to concentrate;
- accessing short-term memory;
- responding accurately to tasks and completing work;
- planning and monitoring work and behavior;
- Behavior management issues, such as:
- leaving one's seat without permission;
- making noises;
- seeming not to listen;
- requiring close supervision;
- talking out during quiet time.
There are some children with AD/HD who also display non-compliant and disruptive behavior, and who may behave aggressively towards other children and adults. Goldstein (1997) differentiates between incompetence (non-purposeful problems that result from the child's inconsistent application of skills leading to performance and behavioral deficits) and non-compliance (purposeful problems which occur when children do not wish to do as they are asked or directed) (p.49). According to Goldstein, AD/HD is principally a disorder of incompetence rather than non-compliance. As teachers, we need to learn to differentiate between the two and treat the behaviors differently.
Children with AD/HD have concerns, too!
In a school setting, children with AD/HD may feel:
- worried that they will not be able to follow instructions;
- scared that they cannot finish their work;
- embarrassed about the quality of their work;
- concerned that they are unable to transfer ideas from their minds onto paper;
- frustrated that they are unable to control their behaviors and moods;
- afraid that teachers and peers will be annoyed with them; or
- anxious about losing track, day dreaming, checking out and needing to move around (Comfort, 1997, p. 30).
At this time, there is no single instrument that is adequate to the task of diagnosing AD/HD, but classroom teachers do have a key role to play in a collaborative student assessment. By learning about the disorder and by gathering student-specific knowledge through file reviews and through keen observations, teachers can offer valuable information to parents and to other diagnosticians and consultants working with the child. If you have an AD/HD child on medication, it is important to monitor the dosage and administration time of the medication and to monitor the effects. Stimulant medication is sometimes administered in order to enable these children to focus their attention and behavior; medication such as Ritalin will reach its peak in effectiveness approximately two hours after it is taken, and wear off in four hours. If medication is administered late, teachers should be aware that it will take approximately 30 minutes before any effect is seen.
Strategies for working with other LD children will work successfully with an AD/HD child. Other tips that deserve special mention include:
- establish a predictable and orderly classroom environment;
- accept that sustained concentration is difficult for the AD/HD child, and therefore keep lesson objectives clear and simple. Deliver instruction at a brisk pace using a varied tone of voice;
- prepare the child for what will happen next;
- reduce the amount of materials present during work time by having the student put away unnecessary items;
- provide structure and planned programs that help children to organize and monitor their behaviors;
- write directions down as well as giving them orally; ask the child to repeat the instructions back to the person giving them;
- offer choice and allow for flexibility within the structure;
- establish schedules that build in frequent and physically active breaks;
- develop a personal code system between teacher and child for monitoring in-class or social behaviors;
- model and tell the child what he should be doing rather than what he shouldn't be doing;
- avoid statements like, "You could do this if you tried harder."
- intervene and support the child so that he/she is prevented from becoming humiliated at school.
It is true that AD/HD children can try a teacher's patience. But we are reminded of Rick Lavoie's (1990) sage advice on the issue of fairness in the F.A.T. City Video: "Fairness is not treating every child in the same way; fairness is giving each child what he/she needs." These children are worth the effort.