Berryville School District
Berryville, AR
Health Management for School Series

   Web Page 3: Attention-Deficit/Hyperactivity Disorder

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What is Attention-Deficit/Hyperactivity Disorder?

      ADHD is one of the more common behavioral/ psychiatric disorders of childhood.  In this disorder, children and teens can demonstrate inappropriate degrees of: inattention, impulsiveness, and hyperactivity.
     ADHD affects between 3 to 5% of children.  Boys are affected more often than girls.  A number of children with ADHD have additional disorders, such as depression, anxiety, Tourette syndrome, oppositional defiant disorder (ODD), speech and language delays, and learning disabilities.  A diagnosis qualifies a child for special education services under the Individuals with Disabilities Education Act (IDEA).  For an audio presentation on Attention-Deficit/Hyperactivity Disorder click here.

 


 

     Types of ADHD

      Although some children can have both inattention AND hyperactivity, other children can present with one predominant symptom pattern.  As a result, three (3) subtypes, based on symptom patterns, are recognized:

  1. Attention-Deficit/Hyperactivity Disorder, Combined Type (ADHD-C).
  1. Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type (ADHD-IA)

  2. Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type (ADHD-HI)
     

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What Causes ADHD?

 ADHD is thought to result from abnormalities of neurotransmitters (dopamine and norepinephrine) in areas of the brain that regulate motor and attention behaviors.   The precise etiological mechanism is unknown, but psycho-social, biologic, and genetic factors are thought to play a role.   Currently, there is no cure.  Fortunately, even though people do not outgrow ADHD, they can learn to adapt and enjoy productive lives.

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     What are the Characteristics of ADHD?

      ADHD can be characterized by problems with sustained attention, concentration, task persistence, impulsivity, and/or hyperactivity.  Diagnosis is based on the following criteria:

  • The individual must demonstrate at least 6 symptoms of inattention and at least 6 symptoms of hyperactivity/impulsivity for more than 6 months in two (2) settings.
  • There must be evidence that symptoms significantly impair social, academic, or occupational functioning.
  • Some of the symptoms causing impairment were present before the age of 7 years.
  • Symptoms can NOT be attributed to illness or other disorders.

Source: American Psychiatric Association, 2000)

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What are Symptoms of Inattention, Hyperactivity, and Impulsivity?

Symptoms of Inattention:

  • Does not pay attention to details or makes careless mistakes in school assignments, work, or other activities.
  • Has trouble paying attention in task and play.
  • Does not appear to listen when spoken to directly.
  • Does not follow through on instructions and fails to complete school work, chores, or workplace duties (the reason can NOT be attributed to oppositional behaviors or failure to understand the instructions).
  • Has problems organizing tasks and activities.
  • Avoids, dislikes, or is reluctant to engage in tasks requiring sustained mental effort.
  • Loses items necessary for tasks or activities.
  • Is easily distracted by extraneous stimuli.
  • Often forgetful in daily activities

Symptoms of Hyperactivity: 

  • Fidgets with hands or feet or squirms in seat.
  • Leaves seat in class or other areas where individuals are expected to remain seated.
  • Runs and climbs excessively in inappropriate situations.
  • Has difficulty playing quietly in leisure activities.
  • Talks excessively
  • Is frequently “on the go” or acts as if “driven by a motor.”

Symptoms of Impulsivity: 

  • Blurts out an answer before question has been completed.
  • Has difficulty waiting for own turn.
  • Interrupts or intrudes on other’s conversations or games.

 Source: American Psychiatric Association (2000)

Implications: Teachers often are the first to recognize that a child is hyperactive or inattentive. Report observations and concerns to parents and appropriate school staff (i.e., the student staffing team). Symptoms of other health problems can be mistaken for symptoms of ADHD (middle ear infections, petit mal seizures, depression, and anxiety disorder). Thus, referral to the school nurse or to the child’s physician is helpful.

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How is ADHD Diagnosed and Treated?

      Diagnosis is made by a qualified professional, such as a pediatrician, family physician, neurologist, psychologist, or psychiatrist.  Criteria set forth in the DSM – IV is used to establish a diagnosis. Sometimes, blood tests or other diagnostics are performed to rule out other health problems.  If ADHD is suspected, children may be screened for learning problems, speech/language delays, and depression, anxiety, or behavior disorders.   

      Treatment can include medicine or a combination of medicine and therapy. Family education also is an important part of total treatment. Medications commonly used in the treatment of ADD/ADHD include: 

  • Stimulants (i.e., Ritalin, Cylert, Dexedrine, Adderal)

  • Non-stimulants (Strattera)

  • Less commonly used medications (i.e., Wellbutrin, Clonidine)

   Medications can cause significant side effects.  Therefore, parents, teachers, and child care providers must learn about the medications used to treat ADHD, their potential side effects, and necessary precautions to take when administering the medicines to a child.   

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Impact of ADHD on the Individual 

  1. Students often have difficulty making and keeping friends because of inappropriate behaviors.
  2. Frustrations associated with the disorder may be released in inappropriate and socially unacceptable ways (fighting or vandalizing property).
  3. Frustrations may be turned inward, leading to low self-esteem or an increase in somatic complaints (headache/stomach aches).
  4. Impulsivity and hyperactivity may strain family relationships.
  5. Individuals are more prone to accidents and injuries.
  6. Poor academic performance may affect self-esteem and place the individual at-risk for dropping out of school.
  7. Individuals with this disorder are at greater risk for drug abuse.
  8. Individuals also are at greater risk for poor weight gain (with or without stimulant medicines).
  9. Families may spend considerable time, effort, and money on fad treatments for the child. 

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Management Strategies
 for Parents

 
  1. Consider using stress management techniques to increase your tolerance.
  2. Be open to parenting skills training. Such training may give you the tools you need to manage your child’s behavior (i.e., behavior modification techniques).
  3. Consider joining a support group.  Sharing successes and failures with other parents can be helpful.
  4. Stay current on the most recent, evidence-based treatment for ADHD.  Visit your local library often, contact a national association, and maintain on-going communication with your medical care provider.
  5. Structure your child’s environment in ways that promote success (i.e., help your child break a large task into smaller steps).
  6. Spend quality time with your child every day.   Use the time to share an enjoyable, relaxing activity.
  7. Encourage your child to engage in athletics, if appropriate.
  8. Look for opportunities to identify what your child does well, and BE LIBERAL with your praise.
  9. Remember: your child’s behavior is related to a disorder – it is not deliberate.
  10. Be consistent, patient, and supportive.  Do your best to stay calm when your child experiences setbacks.  Be an advocate for your child until your child can become his/her own advocate.
  11. Be active in the development of the IEP and 504 Plan at school

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Management for Teachers and School Staff

 
  1. Consider seating the child in front of the class near your desk (this keeps other students out of view).  Arrange seating so that the child is away from a window or door, the pencil sharper, the air conditioner or heater, and any area of “high traffic.”
  2. Surround the child with strong student role models.
  3. Consider the use of peer-tutoring.
  4. Use a secret “signal” when a child is “off-task.”  This signal can prevent embarrassing the child in front of peers.
  5. Keep a classroom routine and avoid major changes.  This can be upsetting to the child with ADHD. Alert students to events (i.e., assemblies, fire drills) as soon as possible. 
  6. Whenever possible, reduce extraneous stimuli.
  7. Create a quiet work area in your classroom to which ALL students have access.   
  8. Communicate with parents on a regular basis.  Encourage them to review their child’s work each day.  Explain the importance of having a quiet study space for their child at home.
  9. Provide the child with verbal AND written directions/instructions whenever possible.
  10. Assign one task at a time.
  11. Use a variety of instructional activities to facilitate learning. Consider using role play, games, and videos to enhance learning.  Students, especially those with hyperactivity, respond well to lessons incorporating movement.
  12. Allow student to complete work on a computer if handwriting is a problem.
  13. Encourage the student to use a daily planner.  Assist the students as needed and monitor its use.
  14. Consider having the child keep a duplicate set of books at home.
  15. Reward positive behaviors in the classroom.
  16. Avoid punishing behaviors related to the disorder.
  17. Incorporate color-coded bins, cubbies, or student mailboxes in the classroom to help students with organization.
  18. Evaluate academic strategies set forth in the student’s IEP or 504 Plan and communicate regularly with the staffing or resource team.

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Management for School Nurses

 

 
  1. Rule out hearing and visual problems with appropriate screening methods. 
  2. Be active in the development of the IEP or 504 Plan.
  3. Administer prescribed medications and monitor for side effects.
  4. Monitor growth (height and weight) in students taking
  5.  medicines that suppress growth or appetite.
  6. Encourage an increase in daily calories if weight gain is slow.
  7. Consult with teachers, parents, and physicians to evaluate the efficacy of the child’s medication regimen.
  8. Provide education to students, staff, and parents about ADHD and current treatments.
  9. Serve as a liaison between the school and medical communities.
  10. Monitor for accidents and injuries and provide necessary first aid.
  11. Serve as a child advocate. Be supportive and non-judgmental.

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Online Resources

References

ADHD or ADD: Treatments and coping strategies. (2004). Retrieved October 28, 2004, from http:www.helpguide.org.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders  (4th ed.). Text Revision. Washington, DC: Author.

Carbone, E. (2001). Arranging the classroom with an eye (and ear) to students with ADHD. Council for Exceptional Children, 34 (2), 72-81.

DeStefano-Lewis, K., & Bear, B. J. (2002). Manual of school health (2nd ed.). St. Louis: Saunders.

Salend, S.J., & Rohena, E. (2003). Students with attention deficit disorders: An overview. Intervention in School and Clinic, 38 (5), 259-266.

Varcarolis, E.M. (2002). Foundations of psychiatric mental health nursing: A clinical approach (4th ed.). Philadelphia: W.B. Saunders Company.

Written: October 29, 2004
Last Updated: February 8, 2005
Written by: S. Verwey, R.N.
Graduate Student
Southwest Missouri State University
Springfield, MO

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Disclaimer: This page was created for the staff of the Berryville School District for informational purposes only.  The information provided on this page should NOT be a substitute for evaluation and treatment by a qualified medical care or mental health care provider.