2014-2015 Professional Development SeriesSpecial Education Disabilities

PD Part 2:

Understanding ADHD and Other Health Impairments (OHI)

Presented by: Melanie Garcia, Special Education Coordinator and Christina Saad, School Psychologist

Today’s Agenda1. POP QUIZ!2. What is OHI?3. ADHD- Most Common OHI in SPED4. Etiology of ADHD5. How ADHD manifests6. ACTIVITY!7. Interventions/Supports8. Vignettes/Scenarios Practice

Pick 2 Partners!

Partner A (someone you do not usually work with):_______________

Partner B (Someone that teachers/their role is different from yours): ______________

Pop Quiz!

Other Health Impairment (OHI)● 1 of 13 Special education categories● According to IDEA 2004:“Other health impairment means having

limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that--

Is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette’s syndrome; and Adversely affects a child's educational performance.”

● Not an exhaustive list ● Adversely affects are the key words● ADHD (suspected or diagnosed) is the most common OHI

ADHD Symptoms and Behaviors

Diagnosis includes ADHD indicators (according to the DSM 5 2014):● ADHD-Inattention Presentation● ADHD-Combined Presentation● ADHD-Hyperactive/Impulsive Presentation● No longer “ADD vs. ADHD”

Diagnosis:● Pediatrician will refer to child psychiatrist● Usually diagnosis happens after age 7 (best practices)● Most referrals come from school● SPED gives educational diagnosis (ADHD behaviors impacting education)● Do not need diagnosis to qualify!

Associated Behaviors: ● Low tolerance for frustration● mood swings● temper tantrums● anger management● More extreme behaviors = Often develops into Oppositional Defiant Disorder/Conduct Disorder

(frequently comorbid with ADHD)

Etiology of ADHD

1. Genetic: Children of adults with ADHD have a two to eightfold increased risk for the disorder

2. Environment: Toxins, such as exposure to lead, play a role (although a smaller one)

3. Prenatal care: Smoking and alcohol use during pregnancy that resulted in prematurity, is a risk factor for ADHD

How ADHD Manifests in SchoolADHD Checklist: Warning Signs for Educators

Developmentally Inappropriate Hyperactivity

❏ Often fidgeting with hands or feet, squirming while seated.❏ Running in halls, climbing on desks, leaving a seat in situations where

sitting or quiet behavior is expected❏ When talking, jumping from one topic to another --verbal tangents

Developmentally Inappropriate Impulsivity

❏ Blurting out answers before hearing the whole question❏ Having difficulty waiting in line or taking turns

Developmentally Inappropriate Inattention

❏ Easily distracted by irrelevant classroom activities, sights or sounds❏ On assignments and when given instructions may not pay attention to

details or makes careless mistakes❏ May display persistent difficulty following instructions carefully❏ May misplace, lose or forget pencils, books, and tools needed for a

task❏ May skip from one uncompleted activity to another. This may result in

problems with completing homework.

Other common areas of deficit

Social Skills: Problems with impulsivity and inattention often disrupts the social performance of youth. This may be in the form of interrupting peers already engaged in a game together, joining a game without asking permission first, not following rules that are often “implicit”, pay minimal attention to what they are saying to their peers, etc.

Executive Functions: Often times, children with ADHD will have difficulty planning, prioritizing, initiating and completing tasks as their typically developing peers. ADHD affects the regions of the brain associated with impulse control, working memory and organization. These have a greater impact on academic performance in school than intelligence. This is why children with ADHD appear lost, easily frustrated and struggle with turning in homework.

Symptomatology of ADHD changes throughout childhood

Activity!

https://www.youtube.com/watch?v=nLVObdlI0m0

Interventions/Supports

1.Daily Report Card/Adapted System utilizing current classroom management system a. Star Systems b. Dojoc. Paycheck

2.Contingency Contracts 3. Incorporate movement in your lesson! 4.What has worked for you?

Examples: Behavior/Reward Charts

Contingency Contracts

Functions of Behavior and Interventions

Typical function(s) of behavior

Interventions

Avoiding/Escaping task demands

Reduce Task demandsMake Task StimulatingAllow Choice of TaskAttention Breaks Contingent on Task CompletionOthers?

Obtaining Attention from peers

Reinforce Peers for ignoringUse Group ContingencyPeer TutoringOthers?

Obtaining Attention from adults

Ignore off-task behaviorTime-OutAttend to On-task BehaviorOthers?

Zones of Regulation Strategies!

More of these can be accessed on Google Drive shared folder. Don’t forget our in-house Zones expert, Dee DiGioua!

Other interventions

Teach student to take 'calm-down' break: Students who frequently become angry at peers or who may be set off by the excitement of large groups may be taught to (1) identify when they are getting too tense, excited, or angry, and (2) take a short break away from the setting or situation until they have calmed down sufficiently.Modeling (Vicarious Learning): While the target child is observing, the teacher gives specific public praise to children other than the target student when they show appropriate behaviors. When praising these behaviors, the teacher clearly describes the praiseworthy behaviors. When the target child 'imitates' the same or similar appropriate behaviors, the teacher immediately praises him or her.Over-correction: The student is required repetitively to practice a skill that will 'replace' or improve upon an inappropriate or problem behavior. For example, a student who wanders the halls without permission when taking an unsupervised bathroom break may have to stay after school one afternoon and take multiple 'practice' trips to the school bathroom. In this example, the instructor might accompany the student to monitor how promptly the student walked to, and returned from, the bathroom and to give the student feedback about how much this target behavior has improved.

Let’s Get up!

Find your Partner A and complete Scenario 1

Find your Partner B and complete Scenario 2

With Partner A: Scenario # 1Johnny is a 3rd grader who has already been identified as having learning problems and is in the process of getting tested for an IEP. His teacher has made comments to the IEP team that he has difficulty remembering to turn in his class work when he is finished. He also has a very disorganized backpack. Sometimes, he appears to be daydreaming and takes longer than his peers to finish a task. Johnny will appear fidgety and get up frequently from his desk, even though most of his peers are seated. His mother mentioned to his teacher that her husband was “exactly like that when he was little” according to her mother in law.

● Turn and talk with your partner A o What supports would you put in place for this student?

With Partner B: Scenario # 2Marie is in the 5th grade. Her teachers are very worried about her. They are in the process of setting up an SST to come up with interventions. She currently reads at about a 3rd grade level and struggles to remember to turn in her homework because she “forgets”. Her desk is unorganized and she often loses things. In class she will attempt to answer a question but gets sidetracked and will go off on tangents. She gets sent to the principal’s office frequently because she will often yell across the room at her teacher and peers, disrupting learning. Students have complained that she gets angry quickly at them, for no apparent reason. Her teachers conferenced with her parents and they too see anger issues, social problems, moodiness and apathy regarding school. ● Turn and talk with your partner

o What supports would you put in place for this student?

Questions?Comments?

References

Brock, S., & Jimerson, S. (2009). Identifying, assessing, and treating ADHD at school. New York: Springer.

DuPaul, G., & Stoner, G. (2014). ADHD in the Schools, Third Edition Assessment and Intervention Strategies. (3rd ed.). New York: Guilford Publications.

Mash, E., & Barkley, R. (2009). Assessment of Childhood Disorders, Fourth Edition (4th ed.). New York: Guilford Publications.