ADHD & SID Research

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The Need for Increased Teacher Awareness of

ADHD & Sensory Integration Dysfunction

EDA6061

By Bernadette Harris


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November 22, 2008

ADHD and SID are real and present in classrooms across America, but it doesnt

seem that institutions and educator programs have prepared our teachers sufficiently in

methods and interventions, or even an in depth understanding of what these challenges

are. Universities prepare educators in classroom management, curriculum presentation

and a minute introduction to educational psychology of standard students. Some

programs go the extra mile and add training for working with non-English speaking

students. Few, if any, address effective training for meeting the needs of a vast number

of what will make up their classrooms when they enter the field of education. As leaders,

it is time that we took measures to fill the learning gap for our educators, and arm them

with the tools they need to ensure success of these students in their classrooms.

Background / History of ADHD

The term ADHD (Attention Deficit Hyperactivity Disorder) is not novel to

teachers and school administrators across the nation. It has become almost epidemic in

elementary age student populations, as, according to Honos-Webb (2005), 3 to 5 percent

of all school aged children have been diagnosed with ADHD (p.1). Its rates have

increased by 400 percent since 1988 (Stein 1999 p. 3), but it is said to be confined to the

United States! As Furman (as cited in Honos-Webb, 2005, p. 1) in Germany, Italy,

France and England combined, only one child is diagnosed for every 250 diagnosed in

the United States.

For the benefit of those who are less familiar with ADHD, its two major

dimensions, according to the American Psychiatric Association (as cited by Honos-

Webb, 2005, p.2), are inattention and hyperactivity/impulsivity. This is characterized by

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easy distractibility, frequent careless mistakes, talkativeness, organizational problems,

difficulty focusing on a single isolated task, and difficulty following directions. Those

with a great deal of impulsivity and hyperactivity often find it difficult to stay seated or

still for extended periods of time and may leave their seat often, fidget with items in their

hands, tap, or even have to work standing up! It should also be noted that ADHD can be

just ADD, with the aforementioned symptoms with regard to inability to focus, organize,

stay on task and follow directions, but without the tendency toward hyperactivity and

impulsivity behaviors (Wheeler & Carlson, 1994).

Many children with ADD/ ADHD often also find it difficult to participate in

sports and seem to often have lower athletic ability than those without ADHD.

According to the National Institute of Mental Health, because so many of the

behaviors prevalent in ADHD children appear deliberate, (such as not following

directions, impulsivity and excessive talking, inability to focus and complete tasks) they

are often a source of frustration to their parents and educators.

Interestingly, unlike other physiological and psychological problems, such as

learning disabilities, low I.Q, speech pathology, etc, there does not exist a test for ADHD.

Instead, physicians rely on parents and educators to complete surveys addressing

behavioral tendencies of children with ADHD and the frequency that the child

demonstrates these tendencies. The child might also be seen by a psychologist for a

battery of testing to eliminate other possible disorders such as bipolar personality

disorder, low IQ, processing deficits, as well as a battery of other possible physical and

psychological problems. It is identified by a difference in the frontal lobes of the brain.

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Once the child is diagnosed, they are usually prescribed one or more of a variety

of medications designed to help the child control their behaviors and focus more

effectively. According to the American Academy of Pediatrics, the most effective of

these medications seem to be the stimulants such as Ritalin, Dexedrine and Adderall.

Pharmaceutical companies in recent years have also discovered some natural non-

stimulant medications that are effective in some children as well, such as Strattera.

Although the medication alone can provide amazing results for children, it is often a hit

and miss in finding the correct one that the child responds to. In addition, behavioral

modification plans and psychological counseling are recommended as a comprehensive

form of treatment and found to be much more effective than just medication alone.

So what does that all have to do with me, the educator? I think it is important for

teachers to have a better understanding of the disorder as well as some other interesting

facts about students with ADD/ADHD.

In addition to the very frustrating constraints that ADHD has on a students ability

to focus, organize themselves, and therefore learn, many brain image tests of children

with ADHD have found that they have a heightened intuitiveness and creativity (Honos-

Webb 2005, p. 95). Unfortunately, due to the fact that they usually have a series of

negative experiences and conflicts in their school setting year after year, they tend to lose

their self-esteem and motivation to succeed. They will then try to deflect attention to

their shortcomings by becoming increasingly distractive to those around them. This is

why it is critical that educators avoid reacting negatively to these students and instead

find creative ways of increasing their motivation and keeping them striving to achieve.

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Many of these students are not qualified for special services in the education

system because they do not have learning disabilities or processing deficits of the

conventional sense. Therefore, they do not come to our classrooms and schools with

Individual Education Plans that give us a framework for knowing what types of

modifications and accommodations we should make for these children. This is where the

need for increased training and information comes in. Teachers need to be educated in

the intricacies of the most effective methods for helping these students achieve their

goals. Pulling them away from the group and sitting them in the most remote corner of

the classroom where they cant disturb the rest of the students who are there to learn is

just not enough! These children deserve the same opportunities, the same reinforcement

and the same energy and attention from their teachers; in fact, they need more!

Background/ History of Sensory Integration Dysfunction

The second piece of this research is a less widely known disorder called SID

(Sensory Integration Dysfunction). It affects childrens behavior, ability to learn, move,

relate to others and their self-esteem (Kranowitz 1998, p.3). It can come with either

major or minor symptoms, depending on the child, and is interestingly similar in many

ways to ADHD!

SID is defined as the inability to process information received through the

senses (Kranowitz 1998, p.8). It was discovered by A. Jean Ayres, PH.D., an

occupational therapist in the 1950s and 60s. It begins in the central nervous system,

which controls our ability to analyze, organize and integrate messages from our senses.

A dysfunction here means that the child cant respond to sensory messages consistently,

therefore affecting their ability to learn! In the term learning, we are referring to

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learning to follow directions and expectations, motor skill learning, and academic

learning. One of the most prevalent facets in the learning dysfunction is the childs

inability to read verbal and nonverbal cues. They also may be able to interpret or

read the cues, but cannot change their behavior or stop themselves!

**This is where I have found the greatest connection between SID and ADHD to

exist. A very wise physician once gave me the following analogy to explain the inability

for self control in an ADHD child:

Two children are sitting in their third grade classroom and the teacher has her

back turned and is writing on the board. Child #1, who has ADHD, and Child #2 who

does not, have both created elaborately crafted paper airplanes that they badly want to see

soar across the classroom to one anothers desks. Child #2 picks up his airplane to throw

it, realizes that the teacher will probably turn around at any moment and catch him

releasing the airplane into the air, and even if she doesnt, the other students will react in

some way that will draw her attention to it. He decides it would not be the best choice

and puts the plane away. Child #1s plane is already out of his hand and has hit the

teacher in the back of the head as he comes to his same realization!

SID follows the same rules, and to add even more complexity to the picture, the

SID child may be able to read cues, organize and respond appropriately one day, but not

the next! In order to make a diagnosis of SID in a child, they must exhibit sensory

dysfunctions such as avoiding touch, movement unbalance or lack or coordination,

motion sickness, body rigidity, over-excitability, inattentiveness, sensitivity to sounds or

smells or tastes. They may exhibit some, few or many of the symptoms, but must exhibit

them with frequency, intensity and duration in order for a diagnosis to be made.

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What I found most interesting about these symptoms in my research is that most

physicians do not address or test for these symptoms in their diagnosis of ADHD! There

is not a place on the ADHD survey questionnaire that addresses these types of

dysfunction, and instead only looks at the impulsivity and inattentiveness symptomology,

although those are symptoms of BOTH ADHD and SID! Another interesting fact that I

discovered is that most of the SID children seem to be diagnosed in their infancy and

preschool years, and are identified mostly by dysfunction in fine motor skills and

heightened sensitivity to sound, smell and touch, rather than the other symptoms

associated with SID. It seems that in school aged children, all children exhibiting

impulsivity and inattentiveness are being diagnosed and treated for ADHD, without

exploring the possibility of SID.

Mixed Syndrome Kids

And who are the kids in the syndrome mix? Take a real live childAdd a

double helping of ADHD and any one of the following and you have you have a

syndrome mix child (Kutscher 2005, p.15).

Learning disability

Sensory Integration Dysfunction

Anxiety/ obsessive-compulsive disorder

Bipolar depression

Auditory processing disorder

Children in the syndrome mix have as compounded disadvantage, since many of

these problems, when paired together, exacerbate each other. SI dysfunction,

ADHD, autism and learning disabilities are separate but often coexisting disorders of

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the syndrome mix, which frequently elicit similar symptoms. A child might exhibit

characteristics of ADHD or learning disabilities, but actually be suffering from SI

dysfunction, and vice versa (Kutscher 2005, p. 16).

Screening and testing for SID must be done by an occupational therapist, rather

than a physician or psychologist. This can attribute to why there may be a lack of

diagnosis of one piece of the puzzle for many children, since pediatricians and

psychologists are not trained or qualified to identify SID, and occupational therapists

are not trained or qualified to identify ADHD, learning disabilities and psychological

disorders.

Interventions for SID Children

Depending on the type of dysfunction the child is found to have, there are many

interventions that can be made in the classroom environment to help these students learn.

Tactile dysfunction, for instance, can be helped with the use of hand fidgets, textured

seating pads, textured paper such as sandpaper for the child to trace figure eights and xs

across with their fingertip, sand/ water tables, and rocking chairs for when students are

reading. To develop vestibular integration, a student can sit and read on a therapy or

balance ball, or spend time on a swing each day. To develop fine motor skills

integration, the children should form things out of clay, use scissors, buttons, beads, or

work with puzzles. The ADHD child is extremely disorganized and merely owning a

planner is not going to be enough (Hallowell & Ratey 2005, p. 49). The teacher will

need to go the extra step of daily planner checking and signing, and other organizational

interventions like creating a simplified system for turning in assignments.

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Mixed Interventions & Teacher Creativity

Finding the right mix of modifications is where the true need for educator training

and creativity on come into play. In the classroom, there are limits to how many different

modifications can be made in a given day and setting. However, with some creative

thought and ingenuity, this can be done.

Picture the classroom with group seating for all students. Desks are in groups of

four or five throughout the room. On three of the chairs there are sensory integration

seating pads, with specific textures as recommended by occupational therapists, for three

students who have tactile dysfunction along with ADHD. These are the students that are

very impulsive and frequently out of their seat without the seat pads.

Inside another students desk is an array of four or five different hand fidgets for

him to hold onto when he does his math or writing, whatever is the most difficult for him

to complete. He is a child who is very fidgety, has trouble focusing especially on

auditory instruction, and always has something in his hands.

Another student has two large pieces of sandpaper taped to his desk. One has a

figure eight and one has a curvy x on it. This child has dysgraphia dysfunction, and is

also inattentive when he is asked to do any writing or any classwork that extends beyond

five minutes. When he gets frustrated or tired of doing his work, he must run his

fingertip across one of the shape at least three or four times and then return to his work.

In the rear of the classroom is a Language Experience Work center, which is a

group of four tables. In the center of the tables there is a caddy holding a small bag of

dry beans, a container of playdough, and some dry pasta, small squares of construction

paper, glue and scissors. At any time throughout the day, such as during literacy centers,

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the teacher assigns certain students to go to this table and complete an activity such as

using the dry pasta to spell out their spelling words, form letters out of playdough, cut out

small shapes of construction paper and glue them in patterns on a sheet of paper, etc.

These activities as well as many others are taught at teacher workshops across the

nation throughout the year. Often times they are presented by occupational therapists and

experts in the study of ADHD and SID, along with other common disorders and learning

disabilities.

We are no longer of the belief that students with these types of syndromes should

be self-contained and locked away from their peers. They have gifts, talents and special

needs. Educators have to expand their knowledge and understanding and be willing to

adjust the setting and scope of their classrooms in order to motivate, stimulate and

accommodate the variety of differences these children bring into their world.

Application to Florida Principal Leadership Standards

Standard 2 of the FPLS is Instructional Leadership. Some of the benchmarks

under this standard include making provisions in your instructional program for students

with special needs, identifying curriculum needs for different student populations, and

ensuring that teachers get the help (training) that they need to improve teaching and

learning. Part of meeting this standard as a leader means providing teachers with the

resources they need to know how to prepare effective instruction for the population of

students they will face that have so many of these problems. With the large percentage of

students entering our schools in America with these disadvantages, we cannot assume

that using only conventional methods and materials is going to achieve success. It is our

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job as leaders to create a school climate that embraces and is well prepared and educated

in the formulation of success of students with special needs such as ADHD and SID.

References

DSM-IV-TR Workgroup. (2006).Attention deficit hyperactivity disorder.National

Institute of Mental Health, Publication 3572.

Furman, R. A. (2002). Attention deficit / hyperactivity disorder: an alternative

viewpoint.Journal of infant, child and adolescent psychotherapy 2, 125-144.

Hallowell, E. M. & Ratey, J. J. (2005).Delivered from distraction.New York: RandomHouse.

Honos-Webb, L. (2005). The gift of ADHD. California: New Harbinger.

Kranowitz, C .S. (1998). The out of sync child.New York: The Berkley Publishing

Group.

Kutscher, M. L. (2005).Kids in the syndrome mix of ADHD, LD, Aspergers, Tourettes,Bipolar & more. London, UK: Jessica Kingsley.

Pelman, W. E. & Jensen, P. (2001). Clinical practice guideline: treatment of the school-

aged child with attention deficit hyperactivity disorder.Journal of American

Academy of Pediatrics, 108, 4, 1033-1044.

Stein, D .B. (1999).Ritalin is not the answer: a drug-free, practical program for childrendiagnosed with ADD or ADHD. San Francisco: Jossey-Bass.

Still, G. F. (2003). Some abnormal physical conditions in children: the Goulstonianlectures. available at http://www.nimh.nih.gov.

Wheeler, J. & Carlson, C. L. (1994). The social functioning of children with ADD with

hyperactivity and ADD without hyperactivity.Journal of emotional and

behavioral disorders, 2, 1, 2-12.

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ADHD & SID Research