Thesis Research Book: Semester 1 by Lschultz

ADHD

DESIGN THESIS Lindsay Schultz

Syracuse University Fall 2014

Table of Contents What is ADHD Definition of ADHD Types of ADHD ADHD Statistics ADHD Treatments Perceptions of ADHD Story of fidgety Philip Story of Johnny Head-In-Air ADHD Timeline Names of ADHD timelines Comorbities of ADHD Executive functions

5 7 8 10 12 14 16 22 26 30 36

ADHD Challenges Social challenges Importance of Peer Relationships ADHD Behavior Strengthen Peer Relationships Competitive nature of childhood Child Development Stages Self Esteem Social skill vs. social performance deficit 5 Gifts of ADH

45 47 53 57 64 65 70 75 78

Current Therapy Fidget toys The Perfect Playdate Social thinking program Social competence intervention Froebel Philosophy & gifts Education Tips Montessori Method Current Education System

88 89 90 92 94 95 96 98

Appendices

103

INTRO Having grown up with Attention Deficit-Hyperactivity Disorder (ADHD) without being diagnosed till my late teen years, I am hyper aware of the effects it can have on a person’s life. ADHD causes deficits in behavioral inhibition, sustained attention and resistance to distraction, and the regulation of one’s activity level to the demands of a situation. As I gained a better understanding on what these deficits were, my childhood began to make much more sense! Before, I had a general understanding of what ADHD was: something that made it very difficult for me to pay attention and get my work done. I was very aware of the effect it had on my academic achievement, but I wasn’t aware of the other ways ADHD was affecting my life. My research has shown that I’m not alone on this. The disruptive behaviors that are common among those with ADHD, such as fidgeting, interrupting and short attention span, often overshadow other damaging comorbidities. One such comorbidity is difficult peer relationships. All humans want to feel accepted. For children, acceptance is an integral part of developing their self-esteem. Dr. Jellinek, the Chief of Psychiatry at Massachusetts General Hospital, says, “When we look at statistics on how children with ADHD fare down the line, in terms of lower-than-average educational achievement, employment, and marriage stability, one wonders how much is the disorder itself holding people back, versus how the disorder made them feel about themselves and their capabilities from earliest childhood.” Negative peer relationships affect a child’s immediate happiness and can increase the risk of developing depression and/or anxiety. Data from parents report that children with a history of ADHD are almost 10 times as likely to have difficulties that interfere with friendships. Helping a child avoid social stigmatization at an early age can help them gain self-confidence and limit insecurities at such a young age. 2 hours and 257 words later, I am typing random words and telling my friends random stories that pop into my head. If my friends didn't know me, they would think I was crazy. Well, they do think I am crazy but they are okay with it. When I was little, however, people weren’t so relaxed about my behavior. I wasn’t Lindsay just being Lindsay; I was Lindsay acting strange and attracting unwanted attention. I didn’t understand the concept of proper “personal space”, so my friends would get annoyed when I stood too close to them when we are talking. They would say things like, “Oh my gosh Lindsay, why are you standing so close to me?” Fortunately, I had a best friend that even at my loudest and most distracting times, her shy self kept on loving me. Not all kids find someone right away that appreciates them for who they are. When I was with my friend, I felt comfortable being myself because I didn’t feel judgment towards my ADHD behaviors. However, when other friends and peers made comments on my behaviors, I became incredibly self-conscious and hurt. One step towards an ADHD child gaining self-esteem is for them to understand the unique, positive qualities that come with the disorder. In The Gift of ADHD, written by Lara Honos-Webb, a clinical psychologist, 5 different positive characteristics of ADHD are explained. These characteristics are creativity, ecological consciousness, interpersonal intuition, exuberance and emotionally expressive. If directed in the correct context, these character-

istics can make a person a valuable being within a community. A child with ADHD needs to exercise these characteristics to be able to perform in difficult areas of life, such as work, home or school. Engaging in activities that activate one or many of these characteristics provides opportunities for a child to receive positive experiences and encouragement. Having positive social experiences increases a child's self-esteem and consequently will make the child want to become more active in social activities. The same is true for the opposite: the more negative experiences a child has, the less likely he or she is going to want to be placed in similar situations. Children with ADHD don’t learn from past experiences, making it difficult for them to take a lesson from one play experience and translate it into another. Certain behaviors also get in the way of children having positive peer interactions. ADHD children tend to interrupt at inappropriate times, fidget with their hands and feet, act out their feelings rather than “feel” them, have little social etiquette, such as personal space and have an excess of energy that can lead them towards acts of aggression. There are social skills training programs that help children with ADHD and other disorders learn proper social skills to have successful interactions with their peers. These programs act as a microcosm to social settings like the playground, allowing children the opportunity to practice socializing in a safe and comforting setting. One problem with these programs is that the training is only beneficial if the environment is set up the same for the actual social situation and the practiced one. If a child practices social cues on the playground, he or she will not be able to relay the same information to a playdate at home. With an expectation for academic success, performance and behavior in the classroom is catered to before social behaviors and deficits. Focusing on helping ADHD children have positive peer experiences, I am looking to design a game or tool that embraces their positive characteristics while working to prevent their disabling behaviors from surfacing. I am taking influence from a list of features by leading ADHD researcher, Russell Barkley, which helps provide positive outcomes for children with ADHD. This list includes increasing novelty and stimulation to enhance attention and performance, having tasks be of high interest and having them be active rather than passive, limited time activities, including physical exercise to increase attention span and including hands-on, direct-instruction materials. Using these guidelines and mixing them with fun “play” activities will provide children with ADHD a chance to strive in the play environment.

WHAT IS ADHD 3

Definition of ADHD

ADHD is a neurodevelopmental disorder affecting both children and adults. It is described as a “persistent” or on-going pattern of inattention and/or hyperactivity-impulsivity that gets in the way of daily life or typical development. Individuals with ADHD may also have difficulties with maintaining attention, executive function (or the brain’s ability to begin an activity, organize itself and manage tasks) and working memory.

Definition taken from the National Resource Center on ADHD

Types of ADHD

Primarily Inattentive Type • • • • • • • •

Fails to give close attention to details or makes careless mistakes Has difficulty sustaining attention Does not appear to listen Struggles to follow through on instructions Has difficulty with organization Avoids or dislikes tasks requiring sustained mental effort Is easily distracted Is forgetful in daily activities

Primarily Hyperactive/Impulsive Type • • • • • • • • •

Fidgets with hands or feet or squirms in chair Has difficulty remaining seated Runs around or climbs excessively Has difficulty engaging in activities quietly Acts as if driven by a motor Talks excessively Blurts out answers before questions have been completed Has difficulty waiting or taking turns Interrupts or intrudes upon others

Combined Type • Meets both inattentive and hyperactive/ impulsive criteria

ADHD Statistics

Heritability of ADHD ADHD has a heritability rate approaching 80 percent, meaning that up to 80 percent of the differences in attention, hyperactivity and impulsivity between people with ADHD and those without the disorder can be explained by genetic factors. 1 The Centers for Disease Control and Prevention says that 11 percent of American children, ages 4 to 17, have the attention disorder. That’s an increase of 42 percent in just eight years. 2 • 6.4 million American children ages 4-17 have been diagnosed with ADHD • 42% Increase in ADHD diagnoses over the past 8 years

Ages of Diagnosis 8 years: average age of diagnosis for children with mild ADHD 7 years: average age of diagnosis for children with moderate ADHD 5 years: average age of diagnosis for children with severe ADHD 3

Average age of ADHD diagnosis is 7 years

The age when symptoms of ADHD typically first appear is 3-6 years

In a classroom of 25-30 children, it is likely that at least 1 will have ADHD

ADHD affects 5-8% of school age children

Males are almost three times more likely to be diagnosed with ADHD than females.

Boys and girls display very different ADHD symptoms:

Boys’ symptoms are obvious and “external”

Girls' symptoms are less obvious and more "internal"

• Impulsivity or “acting out” • Hyperactivity, such as running and hitting • Lack of focus, including inattentiveness • Physical aggression

• Being withdrawn • Low self-esteem and anxiety • Intellectual impairment and difficulty with academic achievement • Inattentiveness or a tendency to “daydream” • Verbal aggression: teasing, taunting or name calling 4

ADHD Treatment

Types of Treatment

One in five American children who has been diagnosed with ADHD is not receiving medicine or mental health counseling for their disorder.

• Therapy and Other Support • Medication Therapy and Other Support • Psychotherapy • Behavior therapy • Talk therapy • Social skills training • Family support groups

Medication There are two main types: • Stimulant • Non-Stimulant 5

Recent research has found that children diagnosed with ADHD have a poorer response to medication when their primary care provider reports depressive symptoms from the parents. 7 Children who take medication for their ADHD not only are less impulsive, restless and distractible but are also better able to hold important information in mind, to be more productive academically, and to have more internalized speech and better self-control. As a result, they tend to be liked better by other children and to experience less punishment for their actions, which improves their self-image. 8

Currently, 6.1% of all American children are being treated for ADHD with medication. 6

Drugs such as Ritalin boost an ADHD child's capacity to inhibit and regulate impulsive behaviors

Psycho-stimulants, like Ritalin, have been found to improve the behavior of between 70 and 90 percent of children with ADHD older than five years. 9

Medications do not cure ADHD but they can help children control their symptoms on a day-to-day basis. 10

Perceptions of ADHD

ADHD is Real Nearly every mainstream medical, psychological, and educational organization in the United States long ago concluded that Attention-Deficit/Hyperactivity Disorder (ADHD) is a real, brain-based medical disorder. These organizations also concluded that children and adults with ADHD benefit from appropriate treatment. 11 What makes ADHD different from other conditions is that the symptoms are excessive, pervasive, and persistent. That is, behaviors are more extreme, show up in multiple settings, and continue showing up throughout life. 12

ADHD should be depicted in the media as realistically and accurately as it is depicted in scienceâ&#x20AC;&#x201D;as a valid disorder having varied and substantial adverse impact on those who may suffer from it through no fault of their own or their parents and teachers. There is no question among the worldâ&#x20AC;&#x2122;s leading clinical researchers that ADHD involves a serious deficiency in a set of psychological abilities and that these deficiencies pose serious harm to most individuals possessing the disorder. Russel A. Barkley, PhD

The Story of Fidgety Philip

This story, written in 1844 by Dr. Heinrich Hoffman, is considered to be the first published account of ADHD by a medical professional. It was published in a children’s book called “Struwwelpeter”, that Hoffman had designed for his 3-year-old son. Fidgety Philip demonstrates the predominantly Hyperactive/Impulsive ADHD type. 14

“Let me see if Philip can Be a little gentleman; Let me see if he is able To sit still for once at the table.” Thus Papa bade Phil behave; And Mama looked very grave. But Fidgety Phil, He won’t sit still; He wriggles, And giggles, And then, I declare, Swings backwards and forwards, And tilts up his chair, Just like any rocking horse-“Philip! I am getting cross!” See the naughty, restless child Growing still more rude and wild, Till his chair falls over quite. Philip screams with all his might, Catches at the cloth, but then That makes matters worse again. Down upon the ground they fall, Glasses, plates, knives, forks and all. How Mama did fret and frown, When she saw them tumbling down! And Papa made such a face! Philip is in sad disgrace . . .

As he trudged along to school, It was always Johnny's rule To be looking at the sky And the clouds that floated by; But what just before him lay, In his way, Johnny never thought about; So that everyone cried out, "Look at little Johnny there, Little Johnny Head-in-Air!" Running just in Johnny's way Came a little dog one day; Johnny's eyes were still astray Up on high, In the sky; And he never heard them cry "Johnny, mind, the dog is nigh!" Bump! Dump! Down they fell, with such a thump, Dog and Johnny in a lump! Once, with head as high as ever, Johnny walked beside the river. Johnny watched the swallows trying Which was cleverest at flying. Oh! what fun! Johnny watched the bright round sun Going in and coming out; This was all he thought about. So he strode on, only think! To the river's very brink, Where the bank was and steep,

And the water very deep; And the fishes, in a row, Stared to see him coming so. One step more! oh! sad to tell! Headlong in poor Johnny fell. And the fishes, in dismay, Wagged their tails and swam away. There lay Johnny on his face, With his nice red writing-case; But, as they were passing by, Two strong men had heard him cry; And, with sticks, these two strong men Hooked poor Johnny out again. Oh! you should have seen him shiver When they pulled him from the river. He was in a sorry plight, Dripping wet, and such a fright! Wet all over, everywhere, Clothes, and arms, and face, and hair: Johnny never will forget What it is to be so wet. And the fishes, one, two, three, Are come back again, you see; Up they came the moment after, To enjoy the fun and laughter. Each popped out his little head, And, to tease poor Johnny, said "Silly little Johnny, look, You have lost your writing-book!â&#x20AC;?

The Story of Johnny Head-In-Air

Dr. Heinrich Hoffman also wrote a story describing the predominantly Inattentive ADHD type, called “The Story of Johnny Head-In-Air.” 16

Fidgety Philipâ&#x20AC;&#x2122;s character, the tiring little boy that is always finding trouble, has manifested itself in modern culture in characters like Dennis the Menace and Calvin from â&#x20AC;&#x153;Calvin and Hobbes.â&#x20AC;? 18

Calvin and Hobbes

Dennis the Menace

1936 1798

“The incapacity of attending with a necessary degree of constancy to any one object.” ~Sir Alexander Crichton

1957

FDA approved Benzedrine as medicine. Dr. Charles Bradley found it helped behavior in young patients.

Herbert Freed and Charles Peifer study the use of Thorazine on ‘hyperkinetic emotionally disturbed children’.

1952

1902

Considered the scientific starting point of the history of ADHD. British pediatrician described, “An abnormal defect of moral control in children.”

APA issued first Diagnostic and Statistical Manual of Mental Disorders (DSM). ADHD was not included.

1969

Conner’s rating scale is published by C. Keith Conners. This leads to revised editions of the rating scales for parents and teachers.

1967-8

National Institute of Mental Health (NIMH) gives a number of grants to researchers to study the effectiveness of stimulants on children with ADHD symptoms.

1968

Second DSM was published. It included ‘Hyperkinetic Impulse Disorder’ for the first time.

1937

Study published describing the use of Benzedrine in children with behavior problems. (Dr. Charles Barkley)

1844

German physician Heinrich Hoffmann created the children’s story, “Fidgety Phil”.

1908

Alfred F. Tredgold describes ‘high-grade feeble minded’ children who likely had a form of mild brain damage that caused them to have ADHD-like anti-school behavior.

1955

1963

C. Keith Connors publishes a study on the effects of Ritalin in ‘emotionally’ disturbed children.

FDA approved Ritalin (psychostimulant).

1970

The Comprehensive Drug Abuse Prevention and Control Act of 1970 makes stimulants schedule 3 medications. Story published by the Washington Post creates controversey around the diagnosis of ADHD and the use of stimulants.

ADHD TIMELINE

1981 1971

The Comprehensive Drug Abuse Prevention and Control Act makes stimulants schedule 2 medications.

Dr. Russel A. Barkley writes his first of 17 books about ADHD: Hyperactive Children: A Handbook for Diagnosis and Treatment.

1996

An updated AAP report, Medication for Children with Attention Disorders, published in 1996, stresses that drug therapy should be combined ‘with appropiate management of the child’s environment and curriculum’.

1975

Anti-ritalin movement greatly expands as several books are published to help re-inforce the belief that ADHD ins’t a real diagnosis, was created by drug companies to make money, or that hyperactivity is caused by food allergies and food additives.

2007

1995

Release of 3rd edition of the DSM. Changed the name of the disorder to attention-deficit disorder (ADD) with two subtypes (with hyperactivity and without hyperactivity).

Warning labels on ADHD medications are updated to include warnings about the possibility of cardiovascular risks and risks of adverse psychiatric symptoms.

Joseph Biederman publishes one of the 1st of hundreds of medical studies about children with ADHD.

1987 Section 504 of the Rehibilitation Act of 1973 allows students with ADHD who qualify to get additional help and services at school to help them succeed.

Strattera, the first non-stimulant treatment for ADHD is approved.

Dr. Barkley begins publishing The ADHD Report newsletter.

1980

1973

2002

1993

Release of revised DSM version 3. Removed the hyperactivity distinction and changed the name to Attention DeficitHyperactivity Disorder (ADHD). Combined 3 symptoms: inattentiveness, impulsivity and hyperactivity into a single type.

2000

4th DSM released, with 3 subtypes. 1) Combined type ADHD 2) Predominately Innatentive type 3) Predominately HyperactiveImpulsive type

18%

16%

14%

1967 Federal government funds (National Institute of Mental Health) first used for studying effect of stimulants on children with hyperactivity

12%

10%

Franklin Ebaugh: (1923) evidence that ADHD could arise from brain injury

Shekim et al., 1985

Miller et al., 1973

Lambert et al., 1978

Peterson et al., 2001

King and Young, 1982

Sir George Still: (1902) First to describe ADHD

1930s

1920s

1910s

1900s

1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1

1940s 1950s

Benzedrine Desoxyn

Biphetamine, Ritalin

1960s

Adderall

Cylert

Ritalin SR

Dextrostat, Dexadrine

DSM-I

“Minimal Brain Dysfunction”

198

1970s

DSM-II

“Hyperkinetic Reaction of Childhood”

DSM-III

“ADD with or wit hyperactivity

thout y”

80s

“ADHD, undifferentiated ADD”

DSM-III-R

1990s

Metadate ER

Concerta, Methylin ER

Focalin, Adderall XR, Metadate CD

Rowland et al., 2003

Visser et al., 2005

Wolraich et al., 2012 Neuman et al., 2005 Wolraich et al., 2012

“ADHD: IA, HI, combined subtypes”

DSM-IV/DSM-IV-TR Ritalin LA, Strattera, Methylin oral/chewable Vyvanse

Visser et al., 2013

Akinbami et al., 2011

Visser et al., 2010

Akinbami et al., 2011 Loe et al., 2008

Schneider and Eisenberg, 2006 Akinbami et al., 2011

Akinbami et al., 2011

Burd et al., 2003

Barbaresi et al., 2002

Leibson et al., 2001

Bird et al., 2006 Bird et al., 2006 Froehilch et al., 2007

Nolan et al., 2001 Rowland et al., 2001 Gadow et al., 2002 Canino et al., 2004

Costello et al., 2003

Wolraich et al., 1996 Wolraich et al., 1996

Newcorn et al., 1994 Newcorn et al., 1994 Tiet et al., 2001

Shaffer et al., 1996

Scahill et al., 1999

Cohen et al., 1993

August and Garfinkel, 1989

Legend: survey data National Survey of Children’s Health (NSCH) National Health Interview Survey (NHIS) Other surveys

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

2000s

2010s

Kapvay

Intuniv

Focalin XR

Daytrana

DSM-5

The Past Names of ADHD Moral Problem of Children or their Parents

Organic Brain Disease

Minimal Brain Damage Minimal Brain Disorder

Attention Hyperac Disorder

*with 3 su

Behavioral Disorder

Hyperactive Child Syndrome

Brain-Injured

Attention-Deficit Disorder (ADD)

n-Deficit ctivity (ADHD)

ubtypes

Minimal Brain Disfunction

Hyperkinetic Reaction of Childhood

Nervous Child

Hyperkinectic Impulse Disorder

Hyperactivity

Learning Behavioral Disabilities

Clumsy Child Syndrome Hyperexcitability Syndrome

Comorbities of ADHD

The most common disorders to occur with ADHD • Disruptive Behavior Disorders • Oppositional Defiant Disorder • Conduct Disorder • Mood Disorders • Depression • Mania/Bipolar Disorder

• • • •

Anxiety Disorders Tics and Tourette Syndrome Learning Disabilities Difficult Peer Relationships

100 90

History of ADHD

No History of ADHD

Percentage of Children

80 70 60 48.9

50 40 30

34.5 27.4

23.0

21.1

20 10 0

6.3 Emotional Problems

7.5 Conduct Problems

5.9 Hyperactivity and Inattention

7.3 Peer Problems

5.8 Total Difficulties

Results of Strengths and Difficulties Questionnaire, based on parent-report, 2003 National Health Information Survey: percentage of children aged 4 to 17 who scored a high level of difficulty in each of four scales analyzed and in total difficulties, by attention-deficit/hyperactivity disorder (ADHD) diagnosis status.

Conduct Disorder Conduct Disorder is often referred to as delinquency and is more commonly seen in boys than girls. Children that have both ADHD and CD are twice as likely to have difficulty reading, and are at a greater risk for social and emotional failure. 24

About 7% of those with ADHD have tics or Tourette Syndrome

About 25% of children with ADHD also have a conduct disorder

Depression Negative experiences with their peers takes a heavy toll on a childâ&#x20AC;&#x2122;s self-esteem. As these occurrences add up, the child with ADHD can become discouraged and about one in four may become clinically depressed. Treatment of children with ADHD and depression includes minimizing environmental traumas, such as difficulty playing with others.

Between 10-30% of children with ADHD also have depression

Children with ADHD and other disorders appear to face greater impairments in their relationships with peers.

Up to 20% of individuals with ADHD also may manifest bipolar disorder

Anxiety Students with ADHD and anxiety report more school, family, and social/peer problems than students who only have ADHD.

Tics and Tourette Syndrome Tics can become more noticeable or exaggerated when patients are treated with stimulants.

Around 40% of people with ADHD have oppositional defiant disorder

Up to 30% of children with ADHD will also have an anxiety disorder

Up to 50% of children with ADHD have a coexisting learning disorder

Peer Relationships Children with predominantly inattentive ADHD may be perceived as shy or withdrawn by their peers. Research strongly indicates that aggressive behavior in children with symptoms of impulsivity/hyperactivity may play a significant role in peer rejection. 25 31

32 26

Executive Functions

As most children grow up, they gain the ability to engage in mental activities, known as executive functions, that help them deflect distractions, recall goals and take the steps needed to reach them. In the early years, the executive functions are performed externally: children might talk out loud to themselves while remembering a task or puzzling out a problem. As children mature, they internalize, or make private, such executive functions, which prevents others from knowing their thoughts. Children with ADHD, in contrast, seem to lack the restraint needed to inhibit the public performance of these executive functions. 27 The executive functions can be grouped into four mental activities: • Operation of working memory • Internalization of self-directed speech • Controlling emotions, motivation and state of arousal • Reconstitution: breaking down observed behaviors and combining the parts into new actions not previously learned from experience

A Psychological Model of ADHD A loss of behavioral inhibition and self-control leads to the following disruptions in brain functioning: IMPAIRED FUNCTION

CONSEQUENCE

EXAMPLE

Nonverbal working memory

Diminished sense of time Inability to hold events in mind Defective hindsight Defective forethought

Nine-year-old Jeff routinely forgets important responsibilities, such as deadlines for book reports or an after-school appointment with the principal

Internalization of self-directed speech

Deficient rule-governed behavior Poor self-guidance and self questioning

Five-year-old Audrey talks too much and cannot give herself useful directions silently on how to perform a task

Self-regulation of mood, motivation and level of arousal

Displays all emotions publicly; cannot censor them Diminished self-regulation of drive and motivation

Reconstitution (ability to break down observed behaviors into component parts that can be recombined into new behaviors in pursuit of a goal)

Limited ability to analyze Fourteen-year-old Bed stops behaviors and synthesize new doing a homework behaviors assignment when he Inability to solve problems realizes that he has only two of the five assigned questions; he does not think of a way to solve the problem, such as calling a friend to get the other three questions

Eight-year-old Adam cannot maintain the persistent effort required to read a story appropriate for his age level and is quick to display his anger when frustrated by assigned schoolwork

Lisa Burnett

SOURCES

1. Barkley, Russell A. “Attention-Deficit Hyperactivity Disorder.” Scientific American Sept. 1998: 66-71. Web. 2. Holland, Kimberly, and Elsbeth Riley. "ADHD by the Numbers: Facts, Statistics, and You." Healthline. N.p., 4 Sept. 2014. Web. Oct. 2014. <http://www.healthline.com/health/adhd/factsstatistics-infographic#2>. 3. Holland, Kimberly, and Elsbeth Riley. "ADHD by the Numbers: Facts, Statistics, and You." Healthline. N.p., 4 Sept. 2014. Web. Oct. 2014. <http://www.healthline.com/health/adhd/factsstatistics-infographic#2>. 4. Holland, Kimberly, and Elsbeth Riley. "ADHD by the Numbers: Facts, Statistics, and You." Healthline. N.p., 4 Sept. 2014. Web. Oct. 2014. <http://www.healthline.com/health/adhd/factsstatistics-infographic#2>. 5. http://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/ADHD_Resource_ Center/FAQ.aspx 6. http://www.healthline.com/health/adhd/facts-statistics-infographic 7. Honos-Webb, Lara. "Coping with the Rest of the World." The Gift of ADHD: How to Transform Your Child's Problems into Strengths. Oakland, CA: New Harbinger Publications, 2005. 182. Print. 8. Barkley, Russell A. "Attention-Deficit Hyperactivity Disorder." Scientific American Sept. 1998: 66-71. Print. 9. Barkley, Russell A. "Attention-Deficit Hyperactivity Disorder." Scientific American Sept. 1998: 66-71. Print. 10. Honos-Webb, Lara. "Coping with the Rest of the World." The Gift of ADHD: How to Transform Your Child's Problems into Strengths. Oakland, CA: New Harbinger Publications, 2005. 182. Print. 11. "7 Facts You Need To KnowAbout ADHD." Global ADHD Awareness Month October 2014 RSS. N.p., 1 Sept. 2011. Web. Nov. 2014. <http://www.adhdawarenessmonth.org/adhdfacts/#citations>. 12. "7 Facts You Need To KnowAbout ADHD." Global ADHD Awareness Month October 2014 RSS. N.p., 1 Sept. 2011. Web. Nov. 2014. <http://www.adhdawarenessmonth.org/adhdfacts/#citations>. 13. Barkley, Russell A. "International Consensus Statement Issued." The ADHD Report 5.2 (2002): 89-91. Web. 14. Hallowell, Edward M., M.D., and John J. Ratey, M.D. "The Evolution of a Disorder." PBS. PBS, n.d. Web. Oct. 2014. <http://www.pbs.org/wgbh/pages/frontline/shows/medicating/adhd/evolution.html>. 40

15. http://upload.wikimedia.org/wikipedia/commons/9/9d/Struwwelpeter_2.jpg 16. Hallowell, Edward M., M.D., and John J. Ratey, M.D. "The Evolution of a Disorder." PBS. PBS, n.d. Web. Oct. 2014. <http://www.pbs.org/wgbh/pages/frontline/shows/medicating/adhd/evolution.html>. 17. http://www.gutenberg.org/files/12116/12116-h/images/023-t.jpg 18. Hallowell, Edward M., M.D., and John J. Ratey, M.D. "The Evolution of a Disorder." PBS. PBS, n.d. Web. Oct. 2014. <http://www.pbs.org/wgbh/pages/frontline/shows/medicating/adhd/evolution.html>. 19. www.TheDragonflyForest.blogspot.com 20. http://leanblitzconsulting.com/wp-content/uploads/2012/01/Dennis_The_Menace.20120106_small-241x300.gif 21. http://www.cdc.gov/ncbddd/adhd/timeline.html 22. http://www.eyetoeyenational.org/media/downloads.html 23. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1563970/figure/F1/ 24. Pliszka, S.R. (2003). Psychiatric comorbidities in children with attention hyperactivity disorder: implications for management. Paediatric Drugs, 5, 741-750. 25. National Resource Center on ADHD. (2008). What We Know: AD/HD and Coexisting Conditions. www.help4adhd.org/documents/WWK5.pdf 26. chrome-extension://oemmndcbldboiebfnladdacbdfmadadm/http://www.chadd.org/portals/0/am/images/understading/iceberg.pdf 27. Barkley, Russell A. "Attention-Deficit Hyperactivity Disorder." Scientific American Sept. 1998: 66-71. Print. 28. Barkley, Russell A. "Attention-Deficit Hyperactivity Disorder." Scientific American Sept. 1998: 66-71. Print. 29. Watterson, Bill. Calvin and Hobbes. Kansas City: Andrews, McMeel & Parker, 1987. 115. Print.

ADHD CHALLENGES 43

Social Challenges

• A child with ADHD is often impulsive, lacking the adequate pause between impulse and action. Poor listening skills are a common byproduct of impulsivity. • A child with ADHD may be insensitive to subtle interpersonal cues. Children who have attention difficulties often misread social signals, this may lead to overreacting to ambiguous social situations. This can also lead to under-reacting. • A child affected by ADHD can’t control what captures his or her attention; any internal or external stimulation can be distracting to a child with ADHD. When a child’s attention fades in and out, he or she often misunderstands directions, which results in difficulties following through on instructions accurately. • Children with ADHD have trouble applying past experiences to future problems and are unable to predict the consequences of their actions. • Children with ADHD get themselves into social binds without being aware of their predicament or of how they got there because they lack awareness of the consequences of their social behavior.

Some children can’t learn social skills on their own. There are ways you can help your child practice positive social skills: • Time-limited date: children tend to remember more vividly the last 15 minutes of an interaction • Play activities that are intrinsically simple and enticing: this can minimize the need for intense social interaction.

Importance of Peer Relationships

• The earlier the child’s difficulties with peer are noticed, the more successful intervention may be. 1 • Contributes to children’s immediate happiness and may be important to their long-term development. • In some cases, children with peer problems may also be at risk for behavioral and mood disorders, substance abuse and delinquency as teenagers. • Their inappropriate social behavior leads to acrimony at home and difficulties sustaining and establishing friendships. • Gives rise to depression and anxiety.

Parents report that children with a history of ADHD are almost 10x as likely to have difficulties that interfere with friendships. 2

Parents of children with a history of ADHD report almost 3x as many peer problems as those without a history of ADHD. 3

"Children whose attention deficits give rise to social difficulties suffer emotional problems, including depression and anxiety. Their inappropriate social behavior leads to acrimony at home and difficulties in establishing or sustaining friendships." -Australian Child Psychologist Louise Porter 4

What does not paying attention look like?

A student named Mike reported that, rather than listening to what was going on in class, he would find himself drawn to watching the way the sun reflected off the leaves of the trees outside the class window, the way the wind blew through the leaves, and the way the squirrels played among the branches. He found himself asking why the leaves are green and how the squirrels lived off of the tree. From the teacherâ&#x20AC;&#x2122;s standpoint, this behavior looked like a failure to pay attention to the classroom tasks required for success in school. However, Mikeâ&#x20AC;&#x2122;s apparent disengagement was actually engagement with the small natural landscape available to him through the window of the classroom. A 2001 study found that the symptoms of ADHD were relieved by time spent in nature (Faber-Taylor, Kuo, and Sullivan 2001). The study found that children were better able to concentrate, complete tasks, and follow directions after spending playtime in natural, especially green, settings. The authors explain their findings by suggesting that being in nature facilitates a state of involuntary attention that is effortless and provides a rest from directed attention, the capacity to focus narrowly. The authors argue that the use of directed attention is like exercising a muscle, and it results in fatigue. The involuntary attention that is promoted by activity in nature offers the child a rest, allowing her to exert directed attention afterward. 6

Children with ADHD...

Behave Better...7 • • • • • • •

In one-to-one situations When doing tasks that they enjoy or find interesting When supervised When work gets done earlier in the day When tasks are broken down to smaller and more immediate steps When there is some immediate payoff to behave well When they are with their fathers

Manifest more of their symptoms...8 • • • • •

In group settings When they must perform boring work When they must work independently of supervision When their work must be done later in the day When they are with their mothers

"In school alone, a child with ADHD could receive 20,000 corrective or negative comments by the time he or she is 10 years old." Michael S. Jellinek, M.D. 9

Behavioral Interventions â&#x20AC;&#x153;They need to be actively engaged in learning in contrast to passive listening. They need to receive simplified instruction in short bursts and be allocated extra time to complete tasks.â&#x20AC;? Australian child psychologist louise Porter 12

Strengthen Peer Relationships

Ways to help your child build and strengthen peer relationships: • Recognize the importance of healthy peer relationships for children. These relationships can be just as important for a child's success as grades are. • Keep up to date on your child’s social development at school and involve your child in activities with his or her peers. • Check to see if the local community or your child's school has a peer program available. 13

A Need for a Positive Play Experience

Peer Relationships

Social Situations

Hyperactive-Impulsive

Children w/ ADHD 61

We must assume medication alone will not address the peer problems of children with ADHD. Children with different types of ADHD may experience different problems in the social environment. Those who are ADHD Combined type may be rejected or more disliked by peers than those whose primary problems involve inattention exclusively. 15

The Competitive Nature of Childhood

One Psychologist attributes the high rates of depression that accompany learning disorders to this emphasis: "In our modern technological society, where education is more important and more highly valued than ever, academic achievement and schoolrelated intelligence have attained an importance that is probably far greater than ever before." (Migden 2002, 155)17 • Confusion, though it is essential to creativity, gets a bad rap in our culture, which makes a virtue of being sharp and quick at all times. These cultural demands overlook the value of being slow and uncomprehending. • Kids with ADHD may have an intrinsic need to spend more time in nature and are therefore doubly injured by the current technological cultural trend. • There is a cultural element in your child's being labeled as oppositional or defiant. We live within a culture that values teaching children conformity and compliance over self-reliance. This clashes with the tendencies of children with ADHD, who are often perceived as sensitive and charismatic. • Children with ADHD feel poorly about themselves in part because of the extreme emphasis on school achievement over all other talents and interests. When children with ADHD behave badly, it is usually because they feel badly about themselves. • Any "gifts" associated with ADHD are often buried under pressures to succeed in the classroom, on a sports field and in social circles. These places are not routinely nurturing for kids who suffer from the disorder. Statistically, children with ADHD will have many experiences of failure in educational settings. This includes a 33 percent chance of being held back one year in school, with up to 35% of children diagnosed failing to complete high school. (Barkley 2000) 16 64

Child Development Stages

Body Image

Ability to pay Attention

• A sense of body image begins developing around age 6.

• A 6-year-old should be able to focus on a task for at least 15 minutes. • By age 9, a child should be able to focus attention for about an hour.

Following Commands • A 6-year-old child normally can follow a series of three commands in a row • By age 10, most children can follow five commands in a row.

Difficulties • Children who have problems following commands may try to cover it up with back-talk or clowning around. They will rarely ask for help because they are afraid of being teased. • Language delays may be due to hearing or intelligence problems. In addition, children who are unable to express themselves well may be more likely to have aggressive behavior or temper tantrums.

School-Age Children • By age 5, most children are ready to start learning in a school setting. • Peer acceptance becomes more important during the school-age years. • Friendships at this age tend to be mainly with member of the same sex. In fact, younger school-age children often talk about members of the opposite sex as being "strange" or "awful." Children become less negative about the opposite sex as they get closer to adolescence. • School-age children are highly active. They need physical activity and peer approval, and want to try more daring and adventurous behaviors. 18

"When we look at statistics on h down the line, in terms of lower achievement, employment, and wonders how much is the disor versus how the disorder made t and their capabilities from earli

how children with ADHD fare r-than-average educational d marriage stability, one rder itself holding people back, them feel about themselves iest childhood."

Michael S. Jellinek, M.D. 19

Self-Esteem

People with poor self-esteem often rely on how they are doing in the present to determine how they feel about themselves. They need positive external experiences to counteract the negative feelings and thoughts that constantly plague them. Healthy self-esteem is based on our ability to assess ourselves accurately and still be accepting of who we are. This means being able to acknowledge our strengths and weaknesses and at the same time recognize that we are worthy and worthwhile. 20 If a child struggles in areas that society highly values, such as school or playing team sports, he may feel tremendous self-doubt. Children need to experience a sense of accomplishment to feel good about themselves. It is up to the parents to help your child discover his areas of competence and reinforce those strengths. As children develop, healthy peer relationships begin to have a greater impact on how they see themselves. In elementary years, itâ&#x20AC;&#x2122;s no longer enough just to have parental love. The respect and acceptance of friends is almost as important. 21

It is important for the child to learn how to deal with failure or frustration without losing self-esteem

Research on risk and resilience strongly suggests that the most important factors that determine life success for adults with LD/ADHD is not IQ or academic success, but self-esteem, self-awareness, and selfdetermination. 22

Research in developmental psychology makes it clear that any child with peer problems may be deprived of a number of important learning experiences, including the principles of egalitarian interacts (i.e., to â&#x20AC;&#x153;give and takeâ&#x20AC;? with others). 24

Social Skill vs. Social Performance Deficit

An important issue when considering peer problems involves the distinction between a social skill vs. social performance deficit. Social Skill Deficit Children with this deficit have not mastered age-appropriate social behavior and do not know how to make and keep friends. They lack the ability to accurately read social cues and often use inappropriate communication in social exchanges. Social Performance Deficit Children with this deficit know how to behave appropriately, but are unable to apply their skills in everyday interactions with other children. 25

GIFTS NOT DETRIMENTS

5 Gifts of ADHD

Creativity The symptoms of ADHD may represent a desperate attempt on the part of the child to give his mind the unstructured time it needs to explore. Creativity requires free time to explore, to play, and to pretend. Ecological Consciousness Not only do children with a diagnosis of adhd learn through engagement, they have an ardent curiosity about the living, breathing organic world. They often feel connected with and attuned to nature and animals. Interpersonal Intuition ADHD may be seen as an intuitive form of intelligence that picks up the present state of individuals, which they may not want to convey. The problem for a child with ADHD is that he cannot stop his interpersonal intuition and sensitivity to others' emotions from flooding his experience. Because a child cannot process intense emotions, he will often resort to acting out the emotions of others in disruptive behavior. Exuberance What doctors and teachers call hyperactivity can also be called exuberance. Exuberance is characterized by high energy and an intense interest in and curiosity about the world. Exuberant children are often playful, intense, and fun to be around. Emotionally Expressive Children with ADHD have little emotional control. An ADHD child may be prone to more frequent emotional reactions because he is so responsive and sensitive to life, to other people, and to his connection with others. 28 78

"Many of the symptoms of ADHD are disruptive, but I see many of these disruptive traits as expressions of underlying talents." 27 Lara Honos-Webb

SOURCES

1. http://www.cdc.gov/ncbddd/adhd/conditions.html 2. http://www.cdc.gov/ncbddd/adhd/conditions.html 3. http://www.cdc.gov/ncbddd/adhd/conditions.html 4. Yau, Elaine. "Living with a Pocket Dynamo." Editorial. South China Morning Post 03 July 2011, Features sec.: 09. South China Morning Post. Web. Sept. 2014. 5. http://images.agoramedia.com/EHBlogImages/lisa-aro/2014/04/DistractionDiagram01.jpg 6. Honos-Webb, Lara. "Showing the Way, Ecological Consciousness." The Gift of ADHD: How to Transform Your Child's Problems into Strengths. Oakland, CA: New Harbinger Publications, 2005. 112-16. Print. 7. R. A. Barkley & K. R. Murphy (2006) Attention deficit hyperactivity disorder: A clinical workbook (3rd ed.). New York: Guilford Publications. Copyright 2006 by Guilford Publications. 8. R. A. Barkley & K. R. Murphy (2006) Attention deficit hyperactivity disorder: A clinical workbook (3rd ed.). New York: Guilford Publications. Copyright 2006 by Guilford Publications. 9. Jellinek, Michael S., MD. "Behavioral Consult Don't Let Self-Esteem Be Crushed by ADHD." Pediatric News Feb. 2010, Vol. 44 No. 2 sec.: 36. Print. 10. Watterson, Bill. Calvin and Hobbes. Kansas City: Andrews, McMeel & Parker, 1987. 10. Print. 11. Watterson, Bill. Calvin and Hobbes. Kansas City: Andrews, McMeel & Parker, 1987. 73. Print. 12. Yau, Elaine. "Living with a Pocket Dynamo." Editorial. South China Morning Post 03 July 2011, Features sec.: 09. South China Morning Post. Web. Sept. 2014. 13. http://www.cdc.gov/ncbddd/adhd/conditions.html 14. Watterson, Bill. Calvin and Hobbes Sunday Pages: 1985-1995. Kansas City, MO: Andrews. McMeel Pub., in Cooperation with the Ohio State U Cartoon Research Library, 2001. 53. Print. 15. Zumpfe, Holly J., and Steven Landau. "Peer Problems." Attention Magazine. CHAAD, n.d. Web. 9 Sept. 2014. 16. Honos-Webb, Lara. "Alternative Educational Options." The Gift of ADHD: How to Transform Your Child's Problems into Strengths. Oakland, CA: New Harbinger Publications, 2005. 191. Print. 17. Honos-Webb, Lara. "How to Navigate the Educational and Mental Health Systems." The Gift of ADHD: How to Transform Your Child's Problems into Strengths. Oakland, CA: New Harbinger Publications, 2005. 181. Print. 18. http://www.nlm.nih.gov/medlineplus/ency/article/002017.htm 19. Jellinek, Michael S., MD. "Behavioral Consult Don't Let Self-Esteem Be Crushed by ADHD." Pediatric News Feb. 2010, Vol. 44 No. 2 sec.: 36. Print. 82

20. "Self-Esteem." Self-Esteem. N.p., n.d. Web. Nov. 2014. <http://cmhc.utexas.edu/selfesteem. html>. 21. Cohen, Cathi. "Raising Self-Esteem." Raise Your Child's Social IQ: Stepping Stones to People Skills for Kids. Silver Spring, MD: Advantage, 2000. 95. Print. 22. http://www.eyetoeyenational.org/programs/program_model.html 23. Watterson, Bill. Calvin and Hobbes Sunday Pages: 1985-1995. Kansas City, MO: Andrews. McMeel Pub., in Cooperation with the Ohio State U Cartoon Research Library, 2001. 31. Print. 24. Zumpfe, Holly J., and Steven Landau. "Peer Problems." Attention Magazine. CHAAD, n.d. Web. 9 Sept. 2014. 25. Zumpfe, Holly J., and Steven Landau. "Peer Problems." Attention Magazine. CHAAD, n.d. Web. 9 Sept. 2014. 26. Spear, Peggy. "Is ADHD Really a Gift?; Bay Area Therapist and Author Thinks So, Raising Eyebrows Among Experts." Contra Costa Times 24 May 2005, TIMEOUT sec.: D01. Print. 27. Spear, Peggy. "Is ADHD Really a Gift?; Bay Area Therapist and Author Thinks So, Raising Eyebrows Among Experts." Contra Costa Times 24 May 2005, TIMEOUT sec.: D01. Print. 28. Honos-Webb, Lara. The Gift of ADHD: How to Transform Your Child's Problems into Strengths. Oakland, CA: New Harbinger Publications, 2010. Print. 29. Watterson, Bill. Calvin and Hobbes Sunday Pages: 1985-1995. Kansas City, MO: Andrews. McMeel Pub., in Cooperation with the Ohio State U Cartoon Research Library, 2001. 81. Print.

CURRENT SYSTEMS & THERAPY 85

Social stigmatization further diminishes self-esteem and subsequent opportunities for peer interactions. Thus, a vicious cycle emerges in which rejection leads to less chance to practice appropriate social behaviors, which then evokes greater exclusion. 1

Fidget Toys

Good Fidgets Are: • Silent • Unobtrusive • Tactile (not visual) • Safe • Tools (not toys) • Inexpensive • Teacher-approved 2 Sydney Zentall, Ph.D., of Purdue University, studied the factors that help ADHD children succeed in the classroom. According to Zentall, an activity that uses a sense other than that required for the primary task, like listening to music while reading a textbook, can enhance performance in children with ADHD. Doing two things at once, she found, focuses the brain on the primary task. Zentall calls these sensory-motor activities “distractions.” We call them fidgets: mindless activities you can do while working on a primary task. Fidgeting is more intentional than just moving around in your seat. It’s pacing or doodling while on the phone or chewing gum while taking a test.3

Setting Up The Perfect Play-Date

1. Invite over one child at a time. 2. Arrange a supervised, time-limited play-date 3. Invite your child's friend to a highly attractive activity. 4. Set strict limits on TV, computer, and video game time during play-dates. 5. Set the stage for playing freely. 6. Review good host behavior 7. Make a list of activities that your child can play when a friend comes over. 6

Social Thinking Program

Social Thinking was created in 1995 by speech language pathologist Michelle Garcia Winner. Through direct instruction, the program guides students on how to fight difficulties with making social choices. The main focus is on teaching students to consider the perspectives, feelings and intentions of peers and then responding appropriately. The program is divided by age and ability, into groups of up to 4 students. The age of students that can participate in this program are ages 3-70.

What does Social Thinking mean? Social thinking is about the subtle choices we make. Social Thinking is not the same as being social. While being social refers to simply having the ability to share space with others unobtrusively, Social Thinking is about breaking down abstract communication norms into concrete ideas that all clients can understand. “Thinking with your eyes” is often related to the concept of Social Thinking. 7

“Social Thinking is not teaching the ‘doing.’ It’s teaching the thinking underlying the doing.” -Pamela Crooke, Speech language pathologist

Social Skills groups become a microcosm for the social arena at school or in the neighborhood.

Social Competence Intervention Program

Mission That the intervention will allow children to take risks and experience the spontaneous enjoyment of social interaction in a safe and therapeutic setting.

Although many social skills interventions for children exist, few have shown lasting change (Teeter & Semrud-Clikeman, 1997). This finding may be partially because the child's actual social environment is rarely included in the intervention itself. The Program Creative drama activities target many areas of skill deficits in ADHD, such as accurate perception, sensory integration, use of space and movement, body awareness, physical self-control and communication. Since creative drama exercises also emphasize trust and cooperation, they help children acquire positive social experiences and allow them to work together to reach a goal. 8

The organization of the activities in the intervention follows the processes of social interaction: â&#x20AC;˘ Perception (input) â&#x20AC;˘ Interpretation (integration) â&#x20AC;˘ Response (output)

Froebel Philosophy & Gifts

Friedrich Froebel believed that play is not idle behavior but a biological imperative to discover how things work. It is pleasurable activity, but biologically purposeful. His belief that a child needed to be active and engaged in meaningful play led Froebel to make his “gifts and occupations”. These were a series of twenty devices and activities intended to introduce children to the physical forms and relationships found in nature. 9 Design Toys A design toy is different than an educational toy. Toys that are used to design with (ex. Legos, K’nex and Color Cubes), allow us to create new designs and structures. These products are not merely “toy designs” or simply “designed” for consumers, they are tools used for designing. Most blocks are time-honored design toys, but different materials offer different possibilities. All design toys find their origins in the Froebel Gifts. These are also arguably the world’s first educational toys. 10

Educational Tips

Russel Barkley (2000) outlines certain features of an educational setting that are likely to lead to positive outcomes for an ADHD child: • Positive outcomes are more likely if you increase novelty and stimulation, including color, shape, and texture, to enhance attention and increase performance. • Tasks should be of high interest to the child and active rather than passive. “Tasks requiring an active as opposed to a passive response may also allow children with ADHD to better channel their disruptive behaviors into constructive responses.” • Brief lessons with the child as an active participant will increase persistence. • Tasks and lessons should include physical exercise to increase attention span. • Positive outcomes are more likely if you include hands-on, directinstruction materials, like computers with software that promotes content learning. 11

All of the elements of an ideal educational setting listed by Barkley are fundamental to the Montessori method.

Montessori Method

The Montessori Method of education, developed by Dr. Maria Montessori, is a child-centered educational approach based on scientific observations of children from birth to adulthood.

Necessary Components of the Montessori Method: • Multiage Groupings that foster peer learning • Uninterrupted blocks of work time • Guided choice of work activity • A full compliment of specially designed Montessori learning materials 12

Maria Montessori writes, "When a fugitive mind fails to find something upon which it may work, it becomes absorbed with images and symbols. Children who are afflicted with this disorder move restlessly about. They are lively, irrepressible, but without purpose. They start something only to leave it unfinished, since their energies are directed toward many different objects without being able to settle upon any of them." (1966, 155). The implication is that if a child's inherent need to engage the sensory world is denied through emphasis on abstract learning, the symptoms of hyperactivity and difficulty in concentrating may result. 13

One of the fundamental principles of the Montessori Method is an emphasis on the child's engagement with the concrete, sensory world. A child with ADHD needs to learn through active engagement of her senses. 14

Current education system

It has been argued that the current education system is an outdated model based on principles developed in the Industrial Revolution: children are like products, and schools are like factory assembly lines that use the same approach to assemble each product. The model does not accommodate the unique needs of individual students. 15

SOURCES

1. Zumpfe, Holly J., and Steven Landau. "Peer Problems." Attention Magazine. CHAAD, n.d. Web. 9 Sept. 2014. 2. http://www.additudemag.com/adhd/article/8706.html 3. Rotz, Roland, and Sarah D. Wright. "When ADHD Kids Fidget: Better Focus Through Multitasking." ADDitude Magazine. N.p., n.d. Web. Dec. 2014. <http://www.additudemag.com/adhd/ article/3967.html>. 4. http://www.officeplayground.com/Assets/ProductPreview/pi2900-2999/2967_woodenfidgetpuzzle_1.jpg 5. http://ecx.images-amazon.com/images/I/71OBE0UEcGL._AA1500_.jpg 6. Cohen, Cathi. "Getting Started." Raise Your Child's Social IQ: Stepping Stones to People Skills for Kids. Silver Spring, MD: Advantage, 2000. 13-15. Print. 7. Martin, Katie. "Social Thinking Program Teaches Kids, and Adults, to Be Social Detectives." Editorial. San Jose Mercury News (California) 29 June 2013, NEWS sec.: n. pag. - San Jose Mercury News. Web. Sept. 2014. 8. Guli, Laura A., and Margaret Semrud-Clikeman. "Learning How to Get Along." Attention Magazine. CHAAD, Apr. 2002. Web. 9 Sept. 2014. 9. Provenzo, Eugene E. "Friedrich Froebel's Gifts." American Journal of Play (2009): 86-99. Web. 10. http://froebelusa.com/ 11. Honos-Webb, Lara. "Your Emotionally Expressive Child." The Gift of ADHD: How to Transform Your Child's Problems into Strengths. Oakland, CA: New Harbinger Publications, 2005. 191-192. Print. 12. http://amshq.org/Montessori-Education/Introduction-to-Montessori 13. Honos-Webb, Lara. "Your Emotionally Expressive Child." The Gift of ADHD: How to Transform Your Child's Problems into Strengths. Oakland, CA: New Harbinger Publications, 2005. 192-196. Print. 14. Honos-Webb, Lara. "Your Emotionally Expressive Child." The Gift of ADHD: How to Transform Your Child's Problems into Strengths. Oakland, CA: New Harbinger Publications, 2005. 192-196. Print. 15. Honos-Webb, Lara. "Your Emotionally Expressive Child." The Gift of ADHD: How to Transform Your Child's Problems into Strengths. Oakland, CA: New Harbinger Publications, 2005. 173. Print.

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Appendices

• • • •

Key Terms Interview with Miriam Rittmaster Interview with Leah Reidy Works Cited

103

Key Terms ADD Attention Deficit Disorder. This is an older term for ADHD which many people still use. Some also use it to refer to the sub足type of ADHD that has less hyperactivity and is more characterized by inattention. ADHD Attention deficit hyperactivity disorder (ADHD) is a problem of not being able to focus, being overactive, not being able control behavior, or a combination of these. For these problems to be diagnosed as ADHD, they must be out of the normal range for a person's age and development. Anxiety Patients with anxiety often worry excessively about a number of things, and may feel edgy, stressed out or tired, tense, and have trouble getting restful sleep. Comorbidity Describes two or more disorders or illnesses occurring in the same person. They can occur at the same time or one after the other. Comorbidity also implies interactions between the illnesses that can worsen the course of both. Conduct Disorder A behavioral pattern characterized by aggression toward others and serious violations of rules, laws, and social norms. 104

Depression Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. DSM-IV The classification found in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, also known as DSMIV-TR, a manual published by the American Psychiatric Association (APA) that includes all currently recognized mental health disorders. Dysthymic Disorder Chronic low-grade depression, persistent irritability, and a state of demoralization, often with low self-esteem. Executive Functions A set of mental processes that helps connect past experience with present action. People use it to perform activities such as planning, organizing, strategizing, paying attention to and remembering details, and managing time and space. Hyperactive/Impulsive Type Includes ADHD children who appear to be in perpetual motion and have a tendency to interrupt conversations or play out of turn. Inattentive Type Includes ADHD children who have trouble focusing and are easily distracted.

Interpersonal Communication The process by which people exchange information, feelings, and meaning through verbal and non-verbal messages: it is face-to-face communication. Learning Disabilities (LD) Neurological disorders that can make it difficult to acquire certain academic and social skills. Major Depressive Disorder (MDD) A more extreme form of depression that can occur in children with ADHD and even more frequently among adults with ADHD. Mania/Bipolar Disorder Involves periods of abnormally elevated mood contrasted by episodes of clinical depression. Metacognition An individual’s ability to understand and articulate how he or she learns best. Mood Disorder A psychological disorder characterized by the elevation or lowering of a person's mood, such as depression or bipolar disorder. Multimodal Treatment ADHD in children often requires a comprehensive approach to treatment; this “multimodal” approach includes multiple interventions working together, tailored to the unique needs of the child.

Non-Stimulant Medication A medication that has been approved to treat ADHD, but is not classified by the FDA as a “controlled substance.” Oppositional Defiant Disorder (ODD) Oppositional defiant disorder is a pattern of disobedient, hostile, and defiant behavior toward authority figures. Self-Advocacy Understanding your strengths and needs, identifying your personal goals, knowing your legal rights and responsibilities, and communicating these to others. Self-Esteem A term used in sociology and psychology to reflect a person's overall emotional evaluation of his or her own worth. It is a judgment of oneself as well as an attitude toward the self. Stimulant Medication This is the classification of most medications approved for the treatment of ADHD. Stimulant medications “stimulate” certain activity in the body’s nervous systems, including the production and activity of neurotransmitters. Tics and Tourette Syndrome Tics are sudden, rapid, recurrent, and involuntary movements or vocalizations. Tourette Syndrome is both movements and vocalizations. 105

Interview with Miriam Rittmaster -It could be considered a spectrum disorder -Shiny syndrome! -The mommy bloggers are relentless… they say medication is evil -Check out the ADHD studies that the Mayo clinic is doing in Rochester, minnesota -Rochester, Minnesota (a petri-dish for testing) Miriams own experience: (Criminal Defense Attorney) -I didn’t have friends growing up: people expect you to pay attention to them… to listen and remember -Until I was diagnosed, I thought I was stupid and a failure. Her daughter’s experience: -Daughter is 12 now, diagnosed at 10 -Wouldn’t have been diagnosed if I wasn’t. There was only 2 months between me getting meds and my daughter -At first I didn’t think she had ADHD because she could read for hours and can sit through a 2 hour movie Elementary school years: Terrible time -She had almost no friends and got bullied -Overweight: compulsive eating is a issue with ADHD -She found it was easier to go off & read a book -The effort it took to sustain attention was too much -She is a perfectionist -She wouldn’t ever do anything unless she could do it perfectly… she refused to read till 3rd grade because she didn’t want to make mistakes. -In school she had time tests. She would have break downs when she couldn’t get it perfect the first time around. -She wouldn't raise her hand. She would just shout out the answer, often before the teacher finished asking her question. -First test she took, I was told she wasn’t ADHD… Doctor said, “I don't trust tests.” -She didn't want to be diagnosed because she didn’t want to be like her brother -One month after getting meds, she hopped into the car after school and agreed that she was enjoying school. -She was happy with the medication. She recognized the “Me on drugs, me not on drugs” benefits. -She then accepted that ADHD is not a bad thing -She felt weird that she took pills -If asked if she had ADHD, she was matter of fact (comfortably) -The friends club at the JCC was a life saver -It’s a social skills program, part of the JCC’s child development center -Run by the social worker Her son’s experience (Jonathan): -He was put on medication at age 4 -He was climbing into dumpsters, body slamming teachers and putting kids in trash cans -You could see in his eyes that he didn’t want to be aggressive -He liked to play games outside like tag, duck duck grey duck and simon says -But it does require a group of people and everybody to participate -There wasn’t anything in particular that would slow him down or make him behave better… it was always a minute by minute scenario. -I wasn't sure about putting my son on medication, but then the doctor said, “The damage he will sustain from not being on medication will far outway any medication side effects.” -One day, I got a call from his kindergarten nurse, “did you give him his meds today?” -Me, “Is he sitting on his head? Nurse, “How did you know?” -That is always what he does when he hasn't taken his meds -He looks like the guy on the couch sitting on his head in the tv show, Mark and mindy. 106

107

Interview with Leah Reidy

Coordinator of the EYE TO EYE Syracuse University Chapter What is the EYE to EYE program? Eye to Eye’s mission is to improve the life of children with a learning disability. We fulfill our mission by supporting and growing a network of youth mentoring programs run by and for those with learning differences, and by organizing advocates to support the full inclusion of people with learning disabilities and ADHD in all aspects of society.1 How did you find out about it/get involved? I have dyslexia and a learning disorder. I wanted to become an advocate for others like myself. I was a mentor in the Eye to Eye program then I became a coordinator. What is the training that mentors go through? PowerPoint presentation that includes how to handle situations that may come up with the How do you use the label of Learning disorder or ADHD in the classroom? Do you educate mentees on the disorders? Some know they have a disorder, some don’t. Some just think its an after school program to get homework done. We explain what the program is in very laymen terms. Are the kids quick to open up? We create a safe space for children to talk about their problems. Each mentor takes their mentee child aside and talks to them about their own experiences. To try to get the kids to open up, they might then ask, “Have you ever felt that way?” What excites the kids the most? -SNACKS! -Huge bucket of supplies: duct tape, paper, scissors, paint, glitter, etc -Love being able to dig through and have no limits - Not a teacher saying what you have to do... They get to choose and the mentors help to make sure the projects include informational elements (the days start with a brainstorming session then the projects are chosen). How well do the children stay on task? They do a pretty good job staying on task because they are making an object, its hands on. If they have had a hard week and can’t pay attention, we will switch to a game so they can move around. When there are a lot of children with ADHD, we often need to take song breaks. A song break is when we stop working on our projects for a song and dance some energy away. What kind of games do you play? -Name games (like musical chairs) -They are all team-building games that use bodies themselves as the props. What is the average class size? Our goal is about 10 kids per classroom. Some classrooms have up to 20 mentors/mentees. Larger programs, such as Temple, have two classrooms of students. When do you meet? After school for an hour once a week. We have some attendance issues with kids (often in inner city schools) that are having problems at home that take priority of their time. We often have teachers thinking that are program is for kids that have unstable homes, not learning disorders. We are not an afterschool program for everyone. 108

http://eyetoeyenational.org/about/about.html

Why is visual art is the best way to empower children with ADHD? It enables them to access and cultivate their unique gifts for project-based, spatial, tactile/kinetic, and interpersonal learning. The projects embody their disorders; it helps them promote themselves when the mentors aren’t there. What are the projects? Each student makes their own project with their own mentor. They will work one-on-one with the mentor for a week or two before presenting their project to the group. Some examples of the projects are: -A boat that is filled with his or her support team -Rocket ships -”App” that can assist you with one accommodation you need help with -To create an airplane Inside includes: things we want to accomplish, things we need to accomplish and what we need to do to achieve these things

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