Article 3: What is ADHD?
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magine yourself driving a car. You are making your way along a narrow, winding, mountain road. You steer the car around curve after curve high above the valley floor that stretches out below you. To your left is the mountainside, to your right a steep dropoff. There is no guardrail. You are driving at 60 mph, and your car has no brakes. Now, imagine the home screen of a laptop computer. There are dozens of windows open and dozens more files saved to the desktop. There are so many tabs and files open, that you struggle to read their labels. Among all of these, you have to find a single window, but your search function is disabled. You try your best to sort through it all, closing out what you know isn’t relevant. Every time you close one window, however, two more randomly open. Now, imagine you have a smart phone. Notifications for every single app on the phone have been turned on, and each has been assigned a unique ringtone. Every news alert, text message, social media like and follow, advertisement, and update sets your phone buzzing. It is a cacophony of ringtones, and the picture on your home screen is buried under a steady stream of notifications resembling a stock ticker. Although no metaphor can truly capture his dayto-day experience, each of these hints at what it is like inside the mind of Louis, a child with attentiondeficit/hyperactivity disorder, also known as ADHD. The National Institute of Mental Health (NIMH) defines ADHD as “a brain disorder marked by an ongoing pattern of inattention and/or hyperactivityimpulsivity that interferes with functioning or development.” Inattention describes a tendency for the mind to wander, to have difficulty focusing, and to be generally disorganized. These tendencies are involuntary. A hyperactive person is always moving around, without regard to (or understanding of) whether it is an appropriate time to do so. Fidgeting, restlessness, and excessive talking are also signs of hyperactivity. This feature of a person with ADHD can be particularly taxing on those around them and in children can lead to conflict with peers. Some children exhibit a mixture of inattention and hyperactivity. Impulsivity causes a person to act without thinking about potential consequences and to seek out instant gratification. The impulsive person often engages in risky behavior and does not pick up on social cues or norms. This was the experience of Louis. Even in preschool, he was a hyperactive child who found it
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almost impossible to sit still for any extended period of time. While playing with his peers, his attention would dissolve quickly, and he would abandon one group for another unexpectedly, forcing himself into the middle of a game without being invited or waiting his turn. He would often run around the classroom during quiet play times, and frequently blurt out comments in the middle of story time, which were often off-topic. Louis also struggled with inattentiveness. He never seemed to be listening when spoken to, which was frequently interpreted as defiance. The fact that he often didn’t follow through on instructions reinforced the perception that he was willfully ignoring adults and authority figures. In fact, Louis’s mind was like the driver of that car on the mountain pass. At times it was so singularly focused on keeping the car on the road, so to speak, that it tuned out any input it considered a distraction. Louis avoided tasks that required sustained focus, like sitting down quietly in a circle with his classmates for story time, because his brain was already taxed by the amount of information it had to process in any given moment. While this and the other metaphors above attempt to capture the feeling of living with ADHD, the reasons behind it are more scientific. ADHD is a complicated neurological disorder. Studies have shown that people with ADHD have low levels of norepinephrine, which is a neurotransmitter
William Harrison, Ph.D. Social Development Psychologist Gateway’s Middle School
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that works in concert with dopamine. Dopamine is the “feel good hormone” that controls the brain’s pleasure centers. Four regions of the brain have been shown to be impaired by ADHD: the frontal cortex, the limbic system, the basal ganglia, and the reticular activating system. The frontal cortex is responsible for high-level functions like attention and organization. This is also the region of the brain that manages executive function. People with ADHD also struggle with executive function disorder. The limbic system helps us regulate our emotions, something people with ADHD can have trouble doing. The basal ganglia are involved in a variety of brain functions. In the ADHD brain, this region will often malfunction, which results in inattention and impulsivity. The reticular activating system helps relay signals across the brain and the rest of the nervous system. Deficiencies in this region of the brain lead to impulsivity and hyperactivity. Attention-deficit/hyperactivity disorder has a real and sustained impact on neurological function. This is crucial to understand in order to avoid misdiagnosis in children. As Caroline Miller of the Child Mind Institute explains, “It’s important to keep in mind that not every high-energy or impulsive child has ADHD. Children are diagnosed with ADHD only if they demonstrate these symptoms so often that they are causing real difficulty in at least two settings—i.e., at school and at home. And the pattern that’s causing them serious impairment must persist for at least six months.” So much of the ADHD student’s experience is ‘discontinuous,’ all sorts of gaps in their language and learning develop, in addition to the observable behaviors that are disruptive in the classroom and/ or irritating to peers. Since all ADHD students also have executive functioning issues, they suffer from not only weak foundations, but also from an impoverished ability to demonstrate their conceptual understanding. It is difficult for a child like Louis to succeed in a classroom designed for neuro-typical learners without major supports. To extend the earlier metaphor, the student with ADHD needs guardrails put in place to help keep them on track.
The educational philosophy and curriculum of The Gateway School provides the type of structure and routine that helps a student like Louis thrive. At Gateway, the focus on direct, multisensory instruction dramatically improves the on-task behavior of students with ADHD. By engaging directly with a student like Louis, rather than assigning him independent activities, a teacher can help minimize inattentiveness. Lessons that engage the auditory, visual, and kinesthetic sensory receivers in combination also help keep students with ADHD focused and learning. The consistency of Gateway’s classroom environments, including a high level of structure, direct and explicit instruction, and teacher modeling, reduces the load placed on students’ executive functioning skills and scaffold their effort to implement strategies for selfregulation. As William Harrison, Ph.D., Gateway’s Middle School Psychologist, explains, “If a student has a question about what they should be doing, they can usually find it within the predictable structure and routine of the school day. You know where to hand in your homework because it’s always the same. This encourages self-regulation and autonomy and helps mitigate impulsivity.” Dr. Harrison runs social development groups for Gateway’s Middle School students. Consisting of about five students each, these groups meet once a week to discuss various topics and to address communication problems and learn new skills. By working in real time on aspects of communication, like using and reading non-verbal cues and perspective taking, students learn from their peers how to interact more effectively. This type of peerto-peer feedback suits the needs of learners with ADHD. A supportive academic environment, combined with early intervention, can set a student like Louis up for a lifetime of success in and out of school. As Ms. Miller notes, “It’s important for parents to get a good diagnosis from a mental health professional who takes the time to carefully consider the pattern of a child’s behavior and what it might (and might not) indicate. Being not only caring, but also precise about defining and treating a child’s problems when he is young, pays off many times over in the long run.” n
At Gateway, the focus on direct, multisensory instruction dramatically improves the on-task behavior of students with ADHD.
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