Attention Deficit Hyperactivity Disorder and Learning - Research Paper Example

 ADHD and Learning Introduction Attention Deficit Hyperactivity Disorder (ADHD) is a behavioral disorder is diagnosed in approximately three to five percent of children of school age. Although the disorder is present in both sexes, it is most common in males. ADHD is a disorder where the child has problems with being highly impulsive, exhibiting over-activity or inattentiveness, or some combination of these three aspects (PubMed Health). ADHD is the most commonly diagnosed behavioral disorder in children and the most well studied (Myayes, Bagwell and Erkulwater 1). Children with ADHD tend to have a much higher level of activity than normal children, and often act impulsively. The principle of ADHD is heavily debated, as all children show some degree of this behavior, especially in early age (Myayes, Bagwell and Erkulwater 15-16). ADHD is a complex disorder and the exact symptoms that children show can differ significantly from one another (Lougy and Rosenthal 22). This case study considers Alice, a ten-year-old girl who has ADHD and experiences considerable learning difficulties and problems establishing friendships as the result of this disorder. Literature Review Diagnosis of ADHD ADHD has a range of symptoms, which are generally grouped into three categories. These are impulsive behavior, hyper activity and lack of attention. There are nine diagnostic symptoms for inattentiveness, five for hyperactivity and three for impulsivity. ADHD is a difficult disorder to diagnose, as many of the behaviors can be associated with other conditions as well as normal behaviors that occur as part of childhood. The complexity of the symptoms means that there are many children who are incorrectly diagnosed with ADHD, and others who have ADHD but have not been diagnosed. One of the difficulties in diagnosing ADHD is that the symptoms are only evident at some points in time, most commonly during school hours. A child with ADHD generally does not show the symptoms during a physician’s visit, and so other people must be the source of this information (Myayes, Bagwell and Erkulwater 5). In fact, children are often first diagnosed with ADHD when they enter school, because many of the behaviors associated with ADHD do not appear to be abnormal without the increased demands on attention, sitting still and following direction that are present in the school environment (Lougy and Rosenthal 22). In addition, ADHD often co-occurs with other disorders, and some of the behavioral symptoms that are part of ADHD also occur as part of other disorders (Myayes, Bagwell and Erkulwater 20) .To assist in diagnosis; the American Academy of Pediatrics recommends the following guidelines. That children have at least six symptoms from either impulsivity and hyperactivity, or six from the attention category, some of which began prior to seven years of age That the severity of symptoms has been significant enough to cause difficulties in a range of settings including peer relationships, home and school That the symptoms have been present for six or more months, are not caused by another condition or problem, and have been observed in at least two different settings (PubMed Health) Causes, Diagnostic Tools and Treatments Despite the prevalence of research into ADHD and how prevalent the disorder is, the causes are not clear. It has been suggested that instead of a single cause of ADHD, there may be many. One suggested mechanism has been that ADHD is related to behavioral inhibition deficits (Myayes, Bagwell and Erkulwater 26-27) . Some evidence for this potential cause comes from the fact that children with ADHD tend to perform poorly at tasks which require a level of control over inhibition (Liotti et al. 377). This model suggests that the underlying dysfunction is based on biological mechanisms, in particular neurophysiological problems. However, there is currently little evidence to support this model or any other (Myayes, Bagwell and Erkulwater 27). It has been argued that ADHD is a polygenic disorder, which has the potential to be either exacerbated or minimized by factors in the environment (Lougy and Rosenthal 10). While further research is needed to elucidate the exact factors that produce and influence ADHD, it is crucial to understand this disorder, and how it affects children who have it. One of the approaches to treat ADHD in children is the use of a stimulant. Some of the most common stimulants used are Concerta, Adderall or Ritalin. In the United States, approximately one child out of every 20-25 makes use of a stimulant medication (Myayes, Bagwell and Erkulwater 1). There are many different types of stimulants, some of which last a short time but act immediately, while others are extended release. The effectiveness of these varies from one child to the next (Myayes, Bagwell and Erkulwater 33) .However, the use of stimulants to treat children is a highly controversial field. One reason for this controversy is that many physicians receive financial benefits from prescribing stimulants, or have connections to pharmaceutical companies (Myayes, Bagwell and Erkulwater 7). This controversy is a large part of the reason that alternative methods of treatment are often used in conjunction to or instead of medication. An alternative method that is often used to treat children with ADHD is psychosocial treatment. Behavioral treatments act to increase the child’s awareness of the link between behavior and its consequences. This approach can involve the use of parent training, where the parents are taught alternative techniques of helping their child that are effective with the ADHD, such as the use of time-out and positive reinforcement (Myayes, Bagwell and Erkulwater 35) . Developmental Milestones One of the complicated aspects of ADHD is that a child with ADHD looks and acts the same way as normal children most of the time (Lougy and Rosenthal 9). Research suggests that one of the inherent differences between ADHD children and normal children is that children who have been diagnosed with ADHD mature later than those who do not have the disorder. The timing of changes that occur within the brain during development is different between the two groups, with the largest difference occurring in the area of attention and action, differences which are commonly observed in the behavior of ADHD children (Hamilton). Although the diagnosis of ADHD does not generally occur at the toddler stage, there are often many indications of ADHD in children at this age, such as difficulties in temperament, high amounts of activity and problems with compliance (Teeter 55). Many of the behaviors that are symptoms for ADHD are common for children that are experiencing problems with sensory or motor skills (Cheatum and Hammond 16). Many, although not all, children who have ADHD also exhibit sensory modulation dysfunction. This dysfunction means that the child is not able to effectively provide regulation and organization to the responses that they show to sensory information. For children with ADHD, events that provide a large amount of sensory information can be difficult and may result in an exasperation of ADHD behaviors (Mangeot et al. 399). As such, while sensory development problems is common within children with ADHD, this is not consistently present across all children with the disorder. Children with ADHD tend to show problems with the planning and execution of motor responses and coordination (Teeter 17). Children with ADHD experience similar motor development issues to children with other disorders, such as dyspraxia, learning disability and oppositional defiance disorder (Cheatum and Hammond 3). An examination into motor problems in ADHD boys between eight and twelve years of age and non-ADHD boys showed that a median of 88% of ADHD boys exhibited moderate to severe motor problems to 14.8% in the non-ADHD group. Furthermore, a median of 64% of ADHD boys exhibited severe motor problems, while a median of 0% of the non-ADHD boys did (Stray et al.). This indicates that motor function problems are a significant factor for children with ADHD, and they may experience issues in this area throughout their development. As infants age, they tend to develop a strong attachment to their parents or primary caregivers, with the strongest bond often formed between the child and its mother. The child seeks closeness to the mother, and looks to them for reassurance and support. However, infants with ADHD often show avoidant behaviors, such as not crying when their parent leaves the room and showing a lack of interest when the parent returns. These infants tend not to like being held, and do not cling to their parent when they are picked up (Teeter 56). This is one area where their social-behavioral development is different than normal children, however, there are others. Children with ADHD experience significant psycho-social difficulties, which become increasingly problematic during their school years. They have difficulty in remembering and recalling information, in paying attention during class, in following instructions and in sitting still. This limits their performance at school, and can also alienate them from classmates and teachers who do not understand the causes of their behavior and view them as being disruptive (Lougy and Rosenthal 22) Attention and memory are the primary cognitive aspects that differ between children with ADHD and normal children. Toddlers that do not have ADHD have a significant ability to learn that is often underestimated, and as they grow into infants, they develop the beginnings of an understanding of memory and begin to pay attention to things that need to be remembered. Despite this, young children do not have a significant ability to use strategies to improve their memory and to remember specific things (Teeter 66-68). Toddlers and young children with ADHD exhibit a lower level of memory and also make fewer attempts to try and remember specific things. Despite this, children with ADHD do not inherently possess lower intelligence than those that do not have the disorder. Rather, children with ADHD have problems with learning due to the symptoms of the disorder, such as hyperactivity, memory and inattention. One estimate suggests that up to 40% of all children with ADHD also have a learning disability (Lougy and Rosenthal 22-23). Language development primarily occurs from infancy through to preschool, it is estimated that children have learnt anywhere from 8,000 words to 14,000 by the time that they are six years old, at a rate of up to eight words a day (Teeter 66). ADHD does not have a substantial effect on language and speech, however, one area where it does is related to inhibition. A child with ADHD has a tendency to talk more often and make more vocal noises than other children, regardless of whether he is talking to himself or to another person (Lougy and Rosenthal 26). Family History and Cultural Background This report considers a ten-year-old white girl from San Diego, California, named Alice. Alice has a younger brother who is seven years old and a sister who recently turned 15. Her parents divorced when she was eight, and her mother has sole custody of her and her siblings. While her mother is currently dating another man, Alice feels that he does not like her, and is annoyed at how much time her mother spends helping Alice. Neither of Alice’s siblings have ADHD, and tend to believe that her symptoms are the result of wanting attention, rather than being medical. Alice has lived in the same area for most of her life, and her family is strongly Christian. They do not know anyone else that has ADHD, and her mother receives mixed advice about what to do with Alice’s behavior. Although she has a African-American grandmother on her father’s side of the family, Alice has been brought up almost exclusively with the white, Christian culture. Educational Program Children with ADHD tend to have difficulty in the school environment, resulting in significant amounts of failure (Teeter 44). The behavior of children with ADHD is often disruptive within the classroom, and hinders their ability to perform well at school. While definitions of underachievement vary, it is estimated that between 18% and 53% of all children with ADHD underachieve academically, and perform at a lower level that expected for their intelligence (Lougy and Rosenthal 22-23). Alice has been held back a year once already, and her teachers are in discussion about whether she should be allowed to move onto the next year with her classmates or be held back another year. She has a lot of problems in school, and finds it difficult to pay attention to what she is being taught. She is prone to impulsive behavior, and has been sent home on multiple occasions because of this. While she has been diagnosed as having ADHD, her teachers are too busy to care for her needs and feel that she is a disruptive influence in the classroom. Furthermore, some students do not believe this diagnosis, because ADHD is more common in males, and believe that Alice is ‘acting up’ in order to gain attention as the result of her parents’ divorce and being a middle child. Strengths and Resilience One of Alice’s biggest strengths is that she is strongly self-aware. She has been told a lot about her condition, and although she has not been able to understand all of it, she has a strong sense that she is different than other children. This self-awareness, coupled with her innate stubbornness means that she will sometimes try and repress some of the symptoms of her ADHD and act like other children. However, even though she is on medication, this is only sometimes effective and she is often frustrated at her inability to be normal. She also has strengths that are partially related to her ADHD, such as being very energetic and always interested in trying something new. Her main area of interest is anything to do with the outdoor, and her self-awareness and ability to reflect on her own behavior is a strong source of resilience and helps her to come with the difficulties that occur as part of her disorder. Facilitating Learning Learning styles are an important aspect of a child’s education, and not all children learn effectively from the same types of teaching. For individual children, the specific learning style or combination of learning styles that are most effective may differ, however, the temperament and presence of any disorders can provide important information. For Alice, like other children with ADHD, some learning styles are difficult to comprehend. For example, Alice finds it difficult to sit still for long periods of time, or to concentrate on one thing. Because of this, she tends to not pay attention to lessons that are being taught verbally and quickly loses interest in reading. While auditory and visual learners are often the most common approaches to teaching, children with ADHD often benefit from kinesthetic learning. Kinesthetic learning involves the child being actively involved in what is being taught. Some of the most effective kinesthetic approaches involve lessons that are wholly activity based, such as science labs, crafts, model building or field trips. While teaching all lessons in this manner would not be practical from an education point of view as well as for other students, many lessons can be modified to include aspects that help kinesthetic learners. For example, allowing a kinesthetic learner, such as Alice or a child with ADHD, to have something in their hands to fidget with while they are reading or listening can significantly help a the child to learn. Another classroom modification that can be easily achieved is rearranging where the child is sitting to allow them to be near the front of the classroom. The benefit of this is that it places the child near any activity that is occurring, increasing their engagement in learning. Another approach is to allow the child to work standing even in instances where the rest of the class is sitting. Services and Testing Modifications Modifications of academic testing are important for students like Alice who have ADHD. Her disorder means that the standard types of tests that students take are more difficult for her and she scores poorly as a result. Tests and homework assignments for Alice should be modified to be more engaging and shorter. One form of modification may be requiring Alice to go and do something specific, rather than filling out a sheet of paper. Test modification may involve asking questions to Alice orally, rather than requiring her to write her answers, or the use of technology. The use of one-on-one tutorials is also an important service, because this form of learning is much more interactive and engaging, and has the potential to help Alice in ways that a teacher in a full class of children cannot. A variation of this is the use of peer tutoring, where children in the class are paired with one another, as this is also interactive, and provides children like Alice with immediate feedback. Social and Behavioral Needs Home and school relationships often become strained when a child has ADHD due to the behavioral problems that are associated with it. For parents, there are inherent difficulties, because the child is difficult to control, and does not show the level of obedience and affection that a parent might expect. A child with ADHD places a lot of stress on the parent and their family system, creating more negative interactions and fewer positive ones than are normally present (Teeter 51). Raising a child with ADHD often requires considerably more time than a non-ADHD child. This can result in parents not having time for other activities, and potentially resenting the child because of it. Likewise, other people within the family may be unhappy with the amount of attention that the ADHD child gets compared to other siblings or other household members (Lougy and Rosenthal 52). Alice has two siblings both of whom receive much less attention than Alice, which creates a strained relationship between them and their mother as well as with Alice. Alice’s mother also does not spend much time with her partner, which he finds frustrating, resulting in a similar problem. Additionally, Alice does not show the same level of affection to her mother that her siblings do, and her mother finds this disconcerting and upsetting. ADHD can have a significant negative effect on the child’s ability to form and maintain friendships. Children with ADHD tend to quickly move from thought to action, often not considering or being aware of the consequences of their behavior. Because of this, they are frequently regarded as being immature, and also have difficult in exciting social events, such as birthday parties. These types of actions have a substantial impact on the way that the child is perceived by others their age, and can frequently lead to them being ignored or excluded on the basis of their unpredictable and different behavior (Lougy and Rosenthal 26). This is a problem that Alice often experiences, and her behavior has made it difficult to make friends. Encouraging Behavior and Relationships It is important that strategies are put in place to help to support Alice’s constructive behavior, while decreasing negative behavior. It is also crucial to support her in establishing friendships and building self-esteem. Children with ADHD respond well to positive reinforcement, either in the form of tangible rewards or emotional ones. Alice already shows a strong level of self-awareness, so this could be incorporated into this approach. This could be achieved through Alice rating her own behavior each day and a teacher also rating it. This would help to establish a connection between behavior and consequences, and Alice could then be rewarded for a certain number of positive days (Shapiro, DuPaul and Bradley-Klug 545). The positive reinforcement would also play a role in increasing Alice’s self-image, and the resultant behavioral modifications would help her to make friends. As part of this intervention it would be possible to teach Alice more about positive actions in friendships and in relationships. Conclusion This case study has considered a young girl named Alice with ACHD and the problems that this creates in her school and home life as well as potential solutions. Although Alice’s ADHD makes some aspects of her learning difficult, she can be assisted through the use of kinesthetic learning techniques, modified tests and positive behavioral reinforcement. Bibliography Cheatum, B.A., and A.A. Hammond. Physical Activities for Improving Children's Learning and Behavior: A Guide Toe Sensory Motor Development. Human Kinetics, 2000. Print. Hamilton, J. "Study: Brains in Adhd Kids Mature Later". 2007. (November 12): NPR. July 31 2012. . Liotti, M., et al. "Abnormal Brain Activity Related to Performance Monitoring and Error Detection in Children with Adhd." Cortex 41 (2005): 377-88. Print. Lougy, R.A., and D.K. Rosenthal. Adhd: A Survival Guide for Parents and Teachers. Duarte, CA: Hope Press, 2002. Print. Mangeot, S.D., et al. "Sensory Modulation Dysfunction in Children with Attention-Deficit-Hyperactivity Disorder." Developmental Medicine and Child Neurology 43 (2001): 399-406. Print. Myayes, R., C. Bagwell, and J. Erkulwater. Medicating Children: Adhd and Pediatric Mental Health. President and Fellows of Harvard College 2009. Print. PubMed Health. "Attention Deficit Hyperactivity Disorder". 2012. (March 25): July 31 2012. . Shapiro, E.S., G.J. DuPaul, and K.L. Bradley-Klug. "Self-Management as a Strategy to Improve the Classroom Behavior of Adolescents with Adhd." Journal of Learning Disabilities 31.6 (1998): 545. Print. Stray, L.L., et al. "The Motor Function Neurological Assessment (Mfnu) as an Indicator of Motor Function Problems in Boys with Adhd." Behavioral and Brain Functions 5.22 (2009). Print. Teeter, P.A. Interventions for Adhd: Treatment in Developmental Context. New York, NY: The Guilford Press, 1998. Print. Read More