Title: ADHD in Children

Goals of Presentation: to inform teachers WHAT IS ADHD, how to deal with it in the classroom using a behaviour modification plan and what treatments are available?

School-aged children who have behaviour and learning problems may show signs of hyperactivity and/or inattention. If these problems are severe enough, they may be diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). The disorder impairs social and academic functioning and is often noticed in children who are failing to learn at school.
ADHD has received a lot of attention; discussion and debate amongst parents, teachers and the wider community in Australia because of the apparent recent increase in the diagnosis of the condition. Controversy has arisen over the use of medication, such as Ritalin, to control symptoms and help manage behavioural and learning problems in children. UOCA's yoga system of teaching students asanas and meditation should be the ideal solution for this problem.


Summary of Main Points of Presentation:

WHAT ARE THE KEY SYMPTOMS?

There are two main criteria used to make a diagnosis: attention symptoms and hyperactivity symptoms.
The key features associated with symptoms of inattention include:
• failing to give close attention to details and difficulty sustaining attention in tasks or play
• not listening when spoken to
• not following through on instructions and failure to finish tasks
• difficulty organising tasks and activities
• avoiding, disliking or being reluctant to engage in tasks that require sustained mental effort
• losing things necessary for tasks or activities
• easily distracted
The key features associated with symptoms of hyperactivity (sometimes known as hyperactivity-impulsivity) include:
• fidgeting with hands or feet, squirming in seat
• leaving seat when remaining sitting is expected
• running about or climbing excessively
• difficulty playing or engaging in leisure activities and often ‘on the go’
• talking excessively and blurting out answers before a question is completed
• interrupting others
To fulfil a diagnosis of ADHD, each symptom must persist for six months or more.
While ADHD is recognised as a disorder that is distinct from other childhood disorders, it frequently overlaps with other conditions such as Conduct Disorder. This can make diagnosis difficult. Also, many of the symptoms of ADHD are shared by other disorders.

HOW IS ADHD ASSESSED/DIAGNOSED?

Usually a medical professional such as a paediatrician or child psychiatrist, conducts the initial assessment or diagnosis of ADHD. It is also common for psychologists to be involved. Psychologists focus mainly on how the disorder affects behaviour and learning, and what can be done to improve this. There are various ways to measure ADHD. Psychologists use rating scales, questionnaires and other tests for collecting information from the children themselves, their parents/caregivers and their teachers. Children are observed at home and school.


HOW IS ADHD TREATED?

A. Psychological treatment : Educational Management by a teacher.

Cooperation between parents and teachers is essential for the management of any child with additional needs. Children with ADHD at school need to be supported with an educational program designed for their specific needs. School is often where the child faces their greatest difficulties, and the benefits of stimulant medication are most dramatic in this setting.

A behaviour modification program needs to be developed in collaboration with teachers, Department of Education, school support staff, parents and health professionals.

• Children with ADHD respond best to a highly organised and routine classroom structure, with a minimum of visual distraction and noise.
• They perform best if seated at the front of the room, as close to the classroom teacher as possible, preferably at a single table separated from nearby students, or next to a child who can function as positive role model.
• Frequent adult input through the day is necessary, as are frequent breaks to move around and burn off excess motor energy.

Cognitive-Behavioural Interventions:
Show child anger coping strategies like alternative responses, self management, awareness of anger.
• The child should be praised and rewarded for on-task behaviour, perhaps utilising score cards leading to special privileges within the classroom or at home.
• Daily report cards and a home communication book assist self-monitoring.
• Clear graded consequences for unacceptable behaviour need to be specified and applied without diminishing self concept.
• Underlying learning difficulties will require additional individual or small group remedial instruction.
• Other allied health professionals may be involved for example, occupational therapists can offer specific programs for handwriting difficulties, as can a speech pathologist for language difficulties

Summary
1. Keep rules clear and simple and give reminders calmly; (remember the child does not intend to be difficult); try and redirect behaviour
2. Talk to the child with their full attention and keep reinforcing this.
3. Check the child is making eye contact before giving instructions and give one or two at a time.
4. Supervise closely; the child's impulsivity may place them in dangerous situations
5. Teach child how to control anxiety and support peer relationships is also a crucial element of counselling.

B. UOCA's yoga system incorporated with the above

1. Regular yoga postures focusing on specific asanas for ADHD.
2. Specific Dhyana Meditational practice for ADHD to develop the students attention span and concentration capabilities - learning quietness through internal self discipline.
3. Pranayama breathing practices specific for ADHD to calm the body and mind integrating the two with the higher spirit.
4. Yamas and Niyamas taught to ADHD students to reinforce moral behaviour.
5. Removal of sensory stimulation using a number of techniques to adapt the child to stillness; including flotation tanks and teaching various Bhandas.

C. Medication treatment

Typically medication is generally used in more severe cases, the most commonly prescribed medication is a stimulant such as dexamphetamine and methylphenidate (Ritalin). The high level of prescribing of these medications has caused some community concern. Medication should generally not be regarded as sufficient on its own. Side effects can be mild stomach and headaches, and reduced height and weight.

UOCA does not recommend medication treatment accept in exceptional circumstances as it believes the UOCA yoga system should provide the necessary environment to deal at a root cause level any ADHD symptoms in students.


Discussion Questions:
1. Is ADHD really an illness or are they just naughty kids?
2. What should you do if you suspect you have an ADHD student in the class?
3. How could you best develop a management program for an ADHD student?

Reference: WHO CAN HELP? It is important that children who may have ADHD are able to access treatment promptly. The APS Psychologist Referral Service can help you find an APS Psychologist with experience in treating and managing ADHD; see footer.





Management needs to be individualised and includes a combination of one or more of the following interventions:
• Develop consistent routines at home, and school.

• Talk to the child with their full attention and keep reinforcing this.
• Check the child is making eye contact before giving instructions and give instructions one or
two at a time.
• Supervise closely; the child's impulsivity may place them in dangerous situations.
• Be positive about the child and continually look out for them 'being good' and praise them.
• Try to ignore minor irritating behaviour.
• Provide clear disciplinary consequences such as time-out (ages 18 months to six years) or
withdrawal of privileges (over six years) for major negative behaviours.