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10. ATTENTION DEFICIT DISORDER
Attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD) is a common co-occurring condition of children with learning difficulties.
The DSM-IV devotes distinguishes two main and one additional varieties of the disorder:
- Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type (ADD)
- Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type (ADHD)
- Attention-Deficit/Hyperactivity Disorder, Combined type
The core symptoms of AD/HD are developmentally inappropriate levels of inattention, hyperactivity, and impulsivity.
Inattention is the inability to concentrate on tasks. With AD/HD, there are three common areas of inattention problems:
- sustaining attention long enough, especially to boring, demanding or repetitious tasks;
- resisting distractions, especially to things that are more interesting;
- not paying sufficient attention, especially to details and organization.
Impulsivity can be characterized as a tendency to respond quickly without thinking. DSM-IV-TR lists the following symptoms of impulsivity:
- often blurts out answers before questions have been completed;
- often has difficulty awaiting turn;
- often interrupts or intrudes on others (e.g., butts into conversations or games).
And finally hyperactivity refers to behaviour described as constant, driving motor activity in which a child quickly changes one activity for another. Symptoms of hyperactivity, as listed in the DSM-IV-TR, are:
- often fidgets with hands or feet or squirms in seat;
- often leaves seat in classroom or in other situations in which remaining seated is expected;
- often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness);
- often has difficulty playing or engaging in leisure activities quietly;
- is often "on the go" or often acts as if "driven by a motor;"
- often talks excessively.
These problems are persistent and usually cause difficulties in one or more major life areas: home, school, work, or social relationships.
American Psychiatric Association set the following criteria for a diagnosis of ADD/ADHD:
- severity - the symptoms must be more severe and frequent that in other children of the same age,
- early onset - at least some of the symptoms must manifest themselves before the age of 7,
- duration - the symptoms must persist for at least 6 month prior to the diagnosis.
Treatment of ADD/ADHD
ADD/ADHD is a complex condition requiring a complex treatment approach. One of the possibilities is a multimodal treatment plan containing:
- effective instruction,
- behaviour management strategies (âcatching child being goodâ, the aim is to reinforce positive and eliminate negative behaviour positive attention, a system of rules and consequences),
- family and child counseling (therapy and counselling for the whole family),
- home management (strategies and accomodations to help the child with AD/HD),
- medication (AD/HD is a neuro-biochemically-based problem, cooperation with a physician is neccessary).
Educational Approaches
One of the most critical settings where offering help is crucial is in the school environment. Among the most frequent symptoms of ADD/ADHD in school arena belong problems with: starting tasks, staying on task and completing them, making transitions, interacting with others, following directions, producing work at consistent levels, and/or organizing multi-step tasks, time management, note taking, study skills, completing multiple-tasks, etc.
Behaviour problems, which usually get the most attention usually occur when tasks are too long, too hard, or lack interest. Many of them can be avoided or lessened by adapting the school setting to fit the needs of the student.
Lerner proposes the following strategies:
- limit distractions (seat near the teacher, away from noisy places, keep routines simple and direct),
- increase attention (shorten tasks and homework, make tasks more interesting and new),
- improve organization (clear classroom rules and communication, establish routines for placing objects in the classroom, use a different coloured folder for each subject, use guided-notes, note-takers),
- help students manage time (set up routines, make a list to help with time management, use behaviour contracts)
- provide opportunities for moving (alternate activities, permit students to move, allow students to stand while working, project work, use of PC).
Modification of behaviour can be supported by providing:
- supervision and discipline (state infraction of the rule, avoid debating or arguing with the student, administer consequences immediately, monitor proper behaviour, avoid ridicule criticism, enforce classroom rules consistently) and
- encouragement (reward more than punish, praise immediately and all good behaviour, change rewards, teach the child to reward itself).
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