Key Strategies For Teaching and Managing Boys and Girls With ADHD Fintan J O’Regan MA Fintan J...
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Transcript of Key Strategies For Teaching and Managing Boys and Girls With ADHD Fintan J O’Regan MA Fintan J...
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Key Strategies For Teaching and Managing Key Strategies For Teaching and Managing Boys and Girls With ADHD Boys and Girls With ADHD
Fintan J O’Regan MAFintan J O’Regan MA
07734 715 378 07734 715 378
www.fintanoregan.comwww.fintanoregan.com
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Publications Publications Cooper P and O’Regan F (2001) EDUCATING children with Cooper P and O’Regan F (2001) EDUCATING children with
ADHD: Routledge Falmer PressADHD: Routledge Falmer Press
O’Regan F (2002) How to teach and manage children with O’Regan F (2002) How to teach and manage children with ADHD: LDA a division of McGraw- Hill ADHD: LDA a division of McGraw- Hill
O’Regan F (2005) ADHD : Continuum International O’Regan F (2005) ADHD : Continuum International
O’Regan F (2005) Surviving and Succeeding in SEN Continuum O’Regan F (2005) Surviving and Succeeding in SEN Continuum International International
O’Regan F (2006) Challenging Behaviours Teachers O’Regan F (2006) Challenging Behaviours Teachers PocketbooksPocketbooks
O’Regan F (2006) Troubleshooting Challenging Behaviours O’Regan F (2006) Troubleshooting Challenging Behaviours Continuum International Continuum International
O’Regan F (2008) The Small Change 2 BIG DIFFERENCE series O’Regan F (2008) The Small Change 2 BIG DIFFERENCE series
Hyperactive, Inattentive and Disorganised, Special DirectHyperactive, Inattentive and Disorganised, Special Direct [email protected] [email protected]
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What is ADHD?What is ADHD?
Three types of ADHDThree types of ADHD
Predominantly InattentivePredominantly Inattentive
Predominantly Hyperactive/ImpulsivePredominantly Hyperactive/Impulsive
Combined typeCombined type
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InattentionInattention HyperactivityHyperactivity
ImpulsivityImpulsivity
Core symptoms of ADHDCore symptoms of ADHD
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What does a child with ADHD look like ?What does a child with ADHD look like ?
Funny….. he was Funny….. he was here a minute here a minute ago…….ago…….
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The school day..through a child’s eyesThe school day..through a child’s eyes
“Everything distracts you at school. If someone drops a pen on the floor
you know about it…if someone drops a pen…in a different school,
you’d probably know about it.”
“I quite often go into daydreams because of my ADHD. I might drift off
for a few minutes and then when I come back round I realise everyone
else is two pages ahead of me.”
“We do things we don’t mean to do, like fiddling around and
fidgeting and it makes you stick out.”
“If teachers know you are ADHD as soon as
someone does something they will
blame you instantly.”
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ADHD: Through the Teachers eyesADHD: Through the Teachers eyes
“It doesn’t really matter what you call it he is real pain and even if you do understand it you still have to deal
with a class of 30 teenagers ”
There is rarely any liaison between consultant and the school. Any
communication or advice etc.. Is instigated by the school
SENCO
The whole mystery of ADHD is shrouded in
mystery and confusion as far as I am concerned.
More guidance is needed
“Their behaviour can annoy and alienate
their peers”
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Likely progression unless identified
Age 7 Key Stage 2, low Self esteem
Age 11 Key Stage 3, Disruptive Behavior, Learning Delay, Poor Social Skills
Age 14 Key Stage 4, ODD, Challenging Behavior, Criminal Behavior, School Exclusion, Substance Abuse, Conduct Disorder, Lack of Motivation, Complex Learning Difficulties
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DiscussionDiscussion
What are some of the other potential issues of ADHD What are some of the other potential issues of ADHD in a child not either being recognised or supported in a child not either being recognised or supported effectively? effectively?
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ADHDADHD
ADHD is a real condition and not the result of ADHD is a real condition and not the result of poor parenting, food allergies or excess sugarpoor parenting, food allergies or excess sugar
ADHD is considered the most commonly ADHD is considered the most commonly diagnosed psychiatric disorder in children diagnosed psychiatric disorder in children and adolescentsand adolescents
The cause is unknown but scientists classify The cause is unknown but scientists classify it as a neurological disorderit as a neurological disorder
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What we knowWhat we know
Genetic influences are very strongGenetic influences are very strong
Several changes in the DNA of chromosomes are Several changes in the DNA of chromosomes are now known to be associated with ADHD, these now known to be associated with ADHD, these changes are in the genes that control specific changes are in the genes that control specific neurotransmitters especially dopamine.neurotransmitters especially dopamine.
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Problem with neurotransmission of Dopamine
Neurobiology of ADHD
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Social clumsiness / Response Social clumsiness / Response InhibitionInhibition
Got to say Got to say it…… it……
Got to say it Got to say it now….. now…..
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QuestionQuestion
What could be some of the reasons for why a child What could be some of the reasons for why a child with ADHD might shout out answers to questions with ADHD might shout out answers to questions posed in a classroom instead of putting up their posed in a classroom instead of putting up their hand and waiting their turn? hand and waiting their turn?
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Are individuals with ADHD always Inattentive Are individuals with ADHD always Inattentive and Hyperactive ?and Hyperactive ?
Their behaviour will Their behaviour will vary according to vary according to the degree to which the degree to which rules are managed, rules are managed, the amount of the amount of structure and structure and support for support for compliance and the compliance and the degree to which the degree to which the child is interested child is interested in the activity” in the activity”
Mike Gordon 1992 Mike Gordon 1992
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Girls with ADHD
Their problems are frequently under-appreciated
May be inattentive only By adolescence may appear depressed,
to have low self –esteem and to be learning disabled
If hyperactive, may present differently
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MedicationBehaviourModification
EducationalIntervention
Mentoring/counselling
AlternativeOptions
Multi-Modal ManagementMulti-Modal Management
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ManagementManagement
Full commitment to teach and manage children with Full commitment to teach and manage children with ADHD from the SMTADHD from the SMT
All Teaching and Support staff trained in recognition, All Teaching and Support staff trained in recognition, teaching and management of these studentsteaching and management of these students
Positive and realistic academic and socialisation Positive and realistic academic and socialisation expectations within policies outlined at the start with expectations within policies outlined at the start with parents fully in the loop.parents fully in the loop.
In most cases a part individualised programme outlining In most cases a part individualised programme outlining key academic goals in core subjects, socialisation and key academic goals in core subjects, socialisation and behavioural targets. behavioural targets.
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Rules, Routines and Rituals will… Rules, Routines and Rituals will…
Reduce anxietyReduce anxiety
Enhance motivation, confidence and self esteemEnhance motivation, confidence and self esteem
Enhance concentration and reduce distractionsEnhance concentration and reduce distractions
Facilitate independenceFacilitate independence
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Application of R/R?Application of R/R?
Band 1Band 1 Band 2Band 2
Physical /Verbal abuse Distractibility Physical /Verbal abuse Distractibility
Theft Disorganisation Theft Disorganisation
Timekeeping Calling out Timekeeping Calling out
Attendance Fidgeting Attendance Fidgeting
Dress Code Engaging others Dress Code Engaging others
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Rules and Responsibilities
* Rules, Rights and Responsibilities posted clearly in classes
*Graduated Positive and Logical consequences reinforcement charts explained on a regular basis
*Set up escape hatch for certain students to sound off/diffuse …………”can’t do it in public”
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Routines and RitualsRoutines and Rituals
Have you cut out external distractionsHave you cut out external distractions
Are you aware of the danger spotsAre you aware of the danger spots
Can you arrange the seating plan to reduce Can you arrange the seating plan to reduce potential trouble spotspotential trouble spots
Can you see them at all timesCan you see them at all times
Do you control exits and entrancesDo you control exits and entrances
Is your mobility fit for purposeIs your mobility fit for purpose
Does your equipment work and do have Does your equipment work and do have your materials in advanceyour materials in advance
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Classroom layoutClassroom layout
Identify a safe haven / quiet areaIdentify a safe haven / quiet area
Sit away from door, window, corridorSit away from door, window, corridor
Sit away from resources not in useSit away from resources not in use
Sit away from resources needed by other studentsSit away from resources needed by other students
Sit near teacherSit near teacher
Sit near student with good study and attention skillsSit near student with good study and attention skills
If available use work stationsIf available use work stations
Use horseshoe layout for discussionUse horseshoe layout for discussion
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Poor attention skillsPoor attention skills
Try and work out what are the main distracters Try and work out what are the main distracters (auditory, visual, kinaesthetic, internal)(auditory, visual, kinaesthetic, internal)
Reduce expectations of seat work and use Reduce expectations of seat work and use alternative ways of task completion alternative ways of task completion
Only one or two activities per pageOnly one or two activities per page
Avoid unnecessary pictures or visual stimuliAvoid unnecessary pictures or visual stimuli
Ensure white space on each pageEnsure white space on each page
Provide alternative environments for some tasks Provide alternative environments for some tasks and activitiesand activities
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Group situationsGroup situations
Have the child sit near teacher / away from Have the child sit near teacher / away from distractionsdistractions
Pair the child with strong role models (both Pair the child with strong role models (both academic and social)academic and social)
Use ‘dead/alive headphones’ / study carrelsUse ‘dead/alive headphones’ / study carrels
Move the child ‘away from temptation’Move the child ‘away from temptation’
Use preferential seating arrangementsUse preferential seating arrangements
Take the child’s strength and group with Take the child’s strength and group with children weak in that areachildren weak in that area
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Excessive motor activityExcessive motor activity
Allow student to fiddle with an agreed object e.g. Allow student to fiddle with an agreed object e.g. stress ball, concentrators, bar magnets etc… stress ball, concentrators, bar magnets etc…
Give short breaks between assignmentsGive short breaks between assignments
Plan ahead for transition timesPlan ahead for transition times
Use alternative technology e.g. computer, musicUse alternative technology e.g. computer, music
Set variety of tasks and activities, where possible Set variety of tasks and activities, where possible include ‘hands on’ activityinclude ‘hands on’ activity
Give whole class stretching exercises midway Give whole class stretching exercises midway throughthrough
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Self esteem
Plan for success, catch them being good and praise
Recap emphasising the student’s achievement Explore what motivates student and build this into programme
If they have grasped a concept allow them to share this success with another student who is struggling (boosts self esteem and reinforces knowledge)
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Problem subject areasProblem subject areas
Tend to be subjects where:Tend to be subjects where:
There is no right/wrong answersThere is no right/wrong answers
Pupils are expected to debate/express their opinionPupils are expected to debate/express their opinion
Lots of social understanding (i.e. group work)Lots of social understanding (i.e. group work)
Lots of writing involvedLots of writing involved
Lots of listening and processing of verbal Lots of listening and processing of verbal instruction rather than visual presentation and instruction rather than visual presentation and practical involvementpractical involvement
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OrganisationOrganisation
Clearly identify certain places in the room, trays, shelves, Clearly identify certain places in the room, trays, shelves, boxes where students know where to put assignmentsboxes where students know where to put assignments
Have a daily assignment schedule booklet/sheetHave a daily assignment schedule booklet/sheet
Colour Code books folders, materialsColour Code books folders, materials
Clipboard for papers on deskClipboard for papers on desk
Use post it notes for recording information, ideas, Use post it notes for recording information, ideas, thoughtsthoughts
2nd set of key text books at home2nd set of key text books at home
Get them to use a timer/watch with alarms and set it to Get them to use a timer/watch with alarms and set it to vibrate or beep at certain intervals during the dayvibrate or beep at certain intervals during the day
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DiscussionDiscussion
Think about some of the key study skills needed to Think about some of the key study skills needed to support children with ADHD that you work with? support children with ADHD that you work with?
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Curriculum flexibilityCurriculum flexibility
Reinforcement in reading, written Reinforcement in reading, written language and language and spelling, creative language, study skillsspelling, creative language, study skills
Touch Typing, Computer, Dictaphone skills Touch Typing, Computer, Dictaphone skills
Teaching the language of Maths and Science Teaching the language of Maths and Science
Extra Extra work on Fine or Gross Motor Skillswork on Fine or Gross Motor Skills
Target strengths and weaknesses in specific non-Target strengths and weaknesses in specific non-core subjects i.e. Art, Sports, Music, Drama, DTcore subjects i.e. Art, Sports, Music, Drama, DT
Use of Headphones for independent learningUse of Headphones for independent learning
Speech and Language TherapySpeech and Language Therapy
Use of Video, Interactive Whiteboards Use of Video, Interactive Whiteboards
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ComputersComputers
Children with ADHD respond well to an individualised or 1 -1 Children with ADHD respond well to an individualised or 1 -1 settingsetting
Attention is focused on the screenAttention is focused on the screen
Multi-sensory experienceMulti-sensory experience
Non-threatening: can retry problems, constant feedback and Non-threatening: can retry problems, constant feedback and reinforcementreinforcement
Impersonal: computer doesn't yell or have favouritesImpersonal: computer doesn't yell or have favourites
Variety of presentation; attend to novel stimuliVariety of presentation; attend to novel stimuli
Student can control pace, flexible: programmed to do thingsStudent can control pace, flexible: programmed to do things
Rapid assessmentRapid assessment
Game like approach: challengeGame like approach: challenge
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HomeworkHomework
Ensure homework diary being used efficientlyEnsure homework diary being used efficiently
Reduce homework to only that which is essentialReduce homework to only that which is essential
Shorten assignments (bonus points for doing more)Shorten assignments (bonus points for doing more)
Find ways to reduce writing requirements i.e. dictate into tape Find ways to reduce writing requirements i.e. dictate into tape recorder /allow computer userecorder /allow computer use
Use chart instead of written report, mind mapping etcUse chart instead of written report, mind mapping etc
Give choices/let students design their own homeworkGive choices/let students design their own homework
Earn free homework passesEarn free homework passes
Have student stay at school to finish homeworkHave student stay at school to finish homework
Allow ‘partnering’/Build in social componentAllow ‘partnering’/Build in social component
Let student use ‘parent secretary’Let student use ‘parent secretary’
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Some personal skills could be Some personal skills could be
Listen actively to what they sayListen actively to what they say
Use assertiveness as opposed to aggressivenessUse assertiveness as opposed to aggressiveness
Bring energy and optimism into the classroomBring energy and optimism into the classroom
Eliminate Sarcasm and other forms of put downsEliminate Sarcasm and other forms of put downs
Challenge damaging talk about student’s by Challenge damaging talk about student’s by colleaguescolleagues
Use of signs and signals to prevent escalation of Use of signs and signals to prevent escalation of behaviourbehaviour
Feigning shock and surprise at the student’s choice Feigning shock and surprise at the student’s choice of actionof action
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Problem solving Problem solving
When do the problems occur (after break, When do the problems occur (after break, start/end of lesson, quiet timestart/end of lesson, quiet time
What are the triggers (interaction with What are the triggers (interaction with other students, boredom, particular tasks)other students, boredom, particular tasks)
In confrontation how does he/she reactIn confrontation how does he/she react
In what way does your response to the In what way does your response to the student affect the outcomestudent affect the outcome
What seems to have a positive affect (your What seems to have a positive affect (your approach; humour, peer pressure, change approach; humour, peer pressure, change of task)of task)
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DiscussionDiscussion
Please think or a recent incident involving a child Please think or a recent incident involving a child with ADHD and reflect on the following:with ADHD and reflect on the following:
What happened?What happened?
What did you do?What did you do?
How did it end?How did it end?
How did you feel afterwards?How did you feel afterwards?
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Other key areas to consider
• Break time/lunch time• Sports• Field trips• Assemblies/Group gatherings• End of terms
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RelationshipsRelationships
Peer understanding about ADHDPeer understanding about ADHD
BullyingBullying
Developing friendshipsDeveloping friendships
Making the class a teamMaking the class a team
Trying to get other parents to Trying to get other parents to understand the issues of ADHD understand the issues of ADHD
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Other issues
• Mentoring• Coaching• Counselling
Dealing with issues such as relationships, self esteem, anger management, appropriate interaction with others, lying, stealing, academic expectations, future options etc…
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DiscussionDiscussion
What are your own and the views of others that you What are your own and the views of others that you work with on the issue of the use of medication to work with on the issue of the use of medication to support children with ADHD in learning and support children with ADHD in learning and behaviour ? behaviour ?
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Medication Options
When ?
• Only after comprehensive evaluation
• When earnest attempts at non-medical interventions have proved insufficient
• When the child is at risk of emotional and/or academic failure
•
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Documented benefits of MedicationDocumented benefits of Medication
CognitiveImproves attention, short term memory, increase amount and accuracy of work completed
MotorReduce activity level, improve handwriting, decrease talkativeness, noisiness, disruptiveness
SocialImprove cooperation, reduce anger, improve parent child interactions, reduce non compliance
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Benefits of Long-Acting PreparationsBenefits of Long-Acting Preparations
Provide unbroken coverage throughout the school Provide unbroken coverage throughout the school dayday
Avoid social embarrassment for the child by not Avoid social embarrassment for the child by not having to take medication during the school dayhaving to take medication during the school day
Negate administration of medication during external Negate administration of medication during external activities such as field trips, sports etc..activities such as field trips, sports etc..
Schools do not have the responsibility to store Schools do not have the responsibility to store medication on sitemedication on site
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Impact of MedicationImpact of Medication
Medication initially treats the core symptoms of Medication initially treats the core symptoms of ADHDADHD
Flow on effect to improved self esteem and social Flow on effect to improved self esteem and social skillsskills
Improvements allow other strategies to be more Improvements allow other strategies to be more effective i.e. behavioural management, effective i.e. behavioural management, educational strategies etceducational strategies etc
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Partnership with ParentsPartnership with Parents
Frequent telephone contactFrequent telephone contact
Frequent parent teacher conferencesFrequent parent teacher conferences
Daily report cardsDaily report cards
– Children with ADHD can place a great deal of Children with ADHD can place a great deal of pressure on family relationshipspressure on family relationships
– Behavioural modification strategies are Behavioural modification strategies are important - to be followed through at home important - to be followed through at home
– Parents must try and look after themselvesParents must try and look after themselves– In persistently difficult situations the In persistently difficult situations the
possibility of unrecognised parental ADHD possibility of unrecognised parental ADHD issues could be consideredissues could be considered
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Summary of key ADHD management Summary of key ADHD management optionsoptions
Teach hesitation and attention span skills Teach hesitation and attention span skills
Seating needs to reflect levels of hyperactivity Seating needs to reflect levels of hyperactivity impulsivity and distractibilityimpulsivity and distractibility
Create options for fidgeting, distraction, Create options for fidgeting, distraction, calling out and time keeping.calling out and time keeping.
Set up a 1-1 facility using support staff or other Set up a 1-1 facility using support staff or other resources resources
Use of response cost systems and short term Use of response cost systems and short term token economies token economies
Consideration of Medication in some cases Consideration of Medication in some cases
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The Ideal TeacherThe Ideal Teacher
Thoroughly knowledgeable about ADHD and Thoroughly knowledgeable about ADHD and accepts legitimacy of the disorderaccepts legitimacy of the disorder
Tough as nails about rules but always calm and Tough as nails about rules but always calm and positive and runs an absolutely predictable and positive and runs an absolutely predictable and organised classroomorganised classroom
Deals with homework in a pragmatic wayDeals with homework in a pragmatic way
Provides immediate and consistent feedback Provides immediate and consistent feedback regarding behaviourregarding behaviour
Willing to work with outside agenciesWilling to work with outside agencies
Avoids ridicule and criticism and can find a SoH Avoids ridicule and criticism and can find a SoH in trying circumstancesin trying circumstances
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ResourcesResources
www.specialdirect.comwww.specialdirect.com