Addressing Barriers to Learning: Helping Students Cope with Disruptive Behaviors



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Addressing Barriers to Learning: Helping Students Cope with Disruptive Behaviors (ADHD, ODD, CD)

  • QUESTION: WHAT DO THESE DISORDERS LOOK LIKE IN THE CLASSROOM?

ADHD: Core Symptoms

  • Fidgets
  • Squirms in seat
  • Easily distracted
  • Difficulty waiting turn
  • Blurts out answers
  • Difficulty following directions
  • Difficulty sustaining attention
  • Shifts quickly and often between activities
  • Forgetful
  • Avoidance of tasks that require sustained attention
  • Poor organization
  • Interrupts/intrudes
  • Restlessness
  • Talks excessively

Subtypes of ADHD (DSM-IV)

  • ADHD, Combined Type
  • ADHD, Primarily Hyperactive-Impulsive Type
  • ADHD, Primarily Inattentive Type

New Thinking (Barkley, 2008)

  • DSM-V will probably not have ADHD, Primarily Inattentive Type – another disorder altogether (not impulsive, sluggish cognitive tempo, hesitant, shy, socially anxious)

Definition: ADHD

  • ADHD is a developmental disorder, or a disorder of age-inappropriate behavior, that is characterized by difficulties with persistence toward a goal, working memory, impulsiveness, and inhibition. Onset is during childhood.

What causes ADHD?

  • Multiple causes
  • Not parenting skills
  • Not social factors
  • All reliably supported causes fall in the realm of biology (neurology, genetics)
  • 25-35% attributed to acquired brain injuries
  • 65-75% due to genetics/ heredity

Oppositional Defiant Disorder (ODD)

  • Argues
  • Loses temper, angry
  • Defies rules
  • Easily annoyed, deliberately annoys
  • Resentful
  • Spiteful, vindictive
  • Non-compliant
  • Blames others

ODD VS. ADHD-HYPERACTIVE

  • ADHD-HYPERACTIVE
    • IMPULSIVE
    • NOT PURPOSEFUL
    • SHOWS REMORSE
    • INABILITY TO CONTROL ACTIVITY LEVEL

Conduct Disorder (CD)

  • Aggression to people and animals (bullies, fights, weapons)
  • Destruction of property (fire setting, vandalism)
  • Deceitfulness or theft (lies, forgery)
  • Serious violations of rules (stays out at night, runs away, truant)

Relationship between ADHD/ ODD/ CD

  • ADHD can cause ODD – negative cycle of coercive behavior
  • 50% of ODD alone goes away in 2 years; if ODD is comorbid, it is more resistant and a precursor to CD
  • CD is a precursor to Antisocial Personality Disorder

MEDICATION

  • STIMULANTS
    • Methylphenidate: Ritalin, Concerta, Medadate CD, Daytrana
    • Amphetamine: Dexedrine, Adderall, Vyvanse
  • STRATERRA (ATOMOXETINE)
  • ANTI-HYPERTENSIVES
    • Guanfacine, Guanfacine XR, Clonidine

Why use medication?

  • Results of hundreds of studies indicate that stimulant medication and Atomoxetine (Strattera) are the most effective treatments available for ADHD.
  • Safety is well established.
  • Medication treatment improves 70-90% of clinical cases and normalizes 50-60% of such cases.

Why use medication? Cont.

  • Medications are convenient to administer, with the least effort.
  • Can be used for years, even into adulthood.
  • Active in community settings where no caregivers may be present to provide active treatment (unsupervised activities, driving alone or with friends, free time in schools, bus rides, etc.)

Stimulants

  • Most well studied drugs in psychiatry.
    • Used for more than 40 years, 350+ studies, and thousands of cases.
  • What’s new?
    • Extended release delivery systems
      • The 5 P’s- Pills, pumps (Concerta), pellets, patches, pro-drug (Vyvanse™)

Behavioral Benefits of Stimulants

  • Increased concentration and persistence
  • Decreased impulsivity and hyperactivity
  • Increased work productivity
  • Decreased likelihood of grade retention
  • Decreased days absent from school
  • Increased reading achievement by age 18
  • Better emotional control
  • Decreased aggression and defiance
  • Decreased antisocial activities

Benefits of Stimulants (cont.)

  • Improved compliance and rule following
  • Better working memory and internalizing language
  • Improved handwriting and motor control
  • Improved self-esteem
  • Improved attention and reaction time during driving performance

Benefits of Stimulants (cont.)

  • Note on use of stimulants in preschoolers
    • Stimulant medication is considered safe to use with preschoolers; however, preschoolers exhibit a decreased degree of change relative to older children.
    • Additionally, preschoolers exhibit an increased risk of side effects (e.g., insomnia, poor appetite, and weight loss)

Side Effects of Stimulants

  • Largely benign; <5% discontinue use due to adverse events.
  • Mild Weight Loss (mean= 1-4 lbs.)
  • Growth effects are short term and limited to first 3 years of therapy
  • Most common:
    • Insomnia (50% +)
    • Loss of appetite (50% +)
    • Headaches (20-40%)
    • Stomach Aches (20-40%)

Strattera (Atomoxetine)

  • Effective for kids, teens, and adults;no abuse potential.
  • Reduces ADHD, ODD, and aggression
  • Also, treats anxiety
  • Less insomnia
  • Takes 3-4 weeks to get the full result

MANAGEMENT OF ADHD BEHAVIORS

  • Planning and Organization
  • Attention to task
  • Work completion
  • Impulsivity
  • Social Skills

WHAT IS YOUR ROLE AS A TEACHER?

  • CLEAR RULES AND EXPECTATIONS
  • FAIR AND LOGICAL CONSEQUENCES
  • STUDENT PARTICIPATION IN ESTABLISHING CONSEQUENCES/ REWARDS
  • ROLE MODEL
  • LOOK FOR STUDENT STRENGTHS
  • FLEXIBILILTY

Basic Considerations for Classroom Management

  • Decrease total workload (How much work does the student need to do to show he knows and/or is proficient in the task?)
  • Give smaller amounts of work at a time
  • Target productivity first, accuracy later

More Basic Considerations

  • Use the traditional desk arrangement
  • Seat the student close to teaching area
  • Keep homework to 10 minutes per grade level
  • Do not retain
  • Establish a school ADHD liaison

Classroom Management Tips

  • Allow some restlessness at work area
  • Build in frequent exercise breaks
  • Organize by using color-coded binders
  • Use white erase boards for question and answer times instead of hands in the air

Classroom Management Tips, cont’d

  • Always be thinking “How do I involve this child within my lesson plan”
  • Schedule more difficult subjects in AM
  • Intersperse low with high appeal activities
  • Be more animated and theatrical
  • Require continuous note taking

18 Great Ideas

  • Know that parents are Shepherds, not Engineers
  • Reduce Delays, Externalize Time
  • Externalize Important Information
  • Externalize Motivation (Think Win/Win)
  • Externalize Problem-Solving
  • Use immediate Feedback

18 Great Ideas, cont’d

  • Increase frequency of consequences
  • Increase accountability to others
  • Use more salient and artificial rewards
  • Change rewards periodically
  • Touch more, talk less
  • Act, Don’t Yak
  • Use rewards before punishment

18 Great Ideas cont.

  • Keep your sense of humor
  • Anticipate problem settings (make a plan)
  • Keep a sense of priorities
  • Maintain a Disability Perspective
  • Practice Forgiveness (student, self, parents, others)

Punishment cont.

  • Loss of tokens /Response Cost
  • Moral essays/Reflection papers
  • Establish a “Chill Out” location
  • Formal time out in class or private room
  • In-school suspension or go to IBS class

The Punishment Hierarchy

  • ADHD children are punished 2 to 8 times
  • more than other children SO:
  • Swift justice is the key to discipline
  • “Do a Task” – variation of time out
  • -have desk in back of class with worksheets
  • -child told what they did wrong and given a number
  • -child goes to desk and completes number of worksheets assigned

Peer Tutoring

  • Children are more sensitive to other children so peer tutoring can be effective.
  • Teach new concepts and skills to class
  • Break class into dyads
  • Have one student tutor and quiz the other
  • Alternate student/tutor roles
  • Re-organize into new dyads weekly

STRATEGY INFORMATION SHARE

  • WHAT WORKS?
  • WHAT DOESN’T?

CASE STUDY

AVAILABLE SCHOOL-BASED SUPPORT SERVICES



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