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 : Ritalin, Concerta, Medadate CD, Daytrana Methylphenidate : Dexedrine, Adderall, Vyvanse Amphetamine 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 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 CASE STUDY AVAILABLE SCHOOL-BASED SUPPORT SERVICES
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