Chapter 5

Chapter 5: Learners
with Attention Deficit
Hyperactivity Disorder
Jason Cumming
TECP 50
Dr. Dunn
31 July 2013

History of ADHD
1798: Sir Alexander Crichton defines attention and
inattention in “On Attention and its Diseases.”
• Distinguishes abnormal inattention as
“oppositional poles of pathologically increased or
decreased “sensibility of the nerves”
1865: Dr. Heinrich Hoffmann composes “The Story of
Fidgety Philip” in his book, Struwwelpeter. It is the
first work of literature that alluded to observation of
behaviors similar to today’s definition of ADHD

1899: Psychiatrist Thomas Smith Clouston writes on the “state
of excitability and mental explosivness in children”
1902: Dr. George Frederic Still presents the concept of
psychical conditions with “abnormal defect of moral control” in
children during the “Goulstonian Lectures” at the Royal College
of Physicians of London, calling for his colleagues to
scientifically investigate the condition.
1932: Dr. Franz Kramer and Dr. Hans Pullnow provide their first
reference to the disorder, “Über eine hyperkinetische
Erkrankung im Kindesalter“ (Hyperkinetic Disorder in Children).
1934: Eugene Kahn and Louis Cohen publish Organic Driveness
in the New England Journal of Medicine from observations of
hyperkinesis in children who had encephalitis that affected
parts of the brain, and left resulting characteristics that are
now the basis for diagnosis of ADHD.

1940s: Heinz Werner and Alfred Strauss conduct study
on children with Minimal Brain Damage, leading to
the diagnosis of the Strauss Syndrome.
1957: William Chuickshank conducts a study using
children with Cerebral Palsy to discover that children
without Mental Retardation can still display
distractability and hyperactivity characteristics.
1957: Dr. Leon Eisenberg summarizes prominent
Clinical Features in the Psychiatric Journal with his
article, Psychiatric Implications in Brain Damaged
Children.

1957: Laufer and Denoff define as “Hyperkinetic Impulse Disorder
in Children’s Behavior Problems” in Psychosomatic Journal
1958: APA’s Diagnostic and Statistical Manual of Mental Disorders
(DSM-II) establishes first diagnostic criteria for
professionals/practioners.
1970: Canadian Virginia Douglas writes “Specific Disabilities of
Hyperactive Children”, naming the condition we currently know
as “Attention Deficit Disorder, with or without hyperactivity”.
1980: APA’s DSM-III first uses “Attention Deficit Disorder, with or
without hyperactivity” in the APA’s DSM.
2000: DSM-IV-TR provides the Contemporary Concept of ADHD
and establishes the diagnostic criteria currently in use.

Identification of ADHD: Ruling out all
other options
 Medical Examination
 Is there a medical reason (tumors, thyroid
condition, seizures) for
inattentiveness/hyperactivity?
 Clinical Interviews
 Interview is conducted with parents and child
(separately)
 Provides information on physical and psychological
characteristics, family dynamics and home life, and
social skills
 Ratings Scales
 Completed by teachers, parents, and children
 Based upon 18 criteria set forth by DSM-IV

Identification of ADHD: Ruling out all
other options (con’t)
 Behavioral Observations
 Continous Performance Test
 Stimuli flashing on the screen; Measures reaction to
stimuli and attentive ability.
 Tracks correct and incorrect
responses, omissions, and responses to wrong
stimulus
 Classroom Observations
 May have student brought into specially designed
classroom to observe tasks completed and the
manner/time tasks are completed.

Diagnostic Criteria
Either one of the following:
• Inattention
• At least 6 of 9 criteria set forth by DSM-IV must have
persisted for at least 6 months.
• Hyperactivity-Impulsivity
• At least 6 criteria of the 6 Hyperactivity and 3
Impulsivity (combined) must have persisted for 6
months
• All Behaviors must exist to a degree that hinders the
ability to function and learn consistently at the
developmental level expected of age and normal
capability.

Other Criteria for Diagnosis of ADHD
 Any symptoms that caused impairment prior to age 7
 Any symptoms cause impairment in two or more
settings (home, work, school, social settings)
 Clear evidence of significant impairment on ability to
function in settings such as social, academic, or
occupation.
 The symptoms do not occur during the presence of or
are accounted for in other mental disorders

Diagnosis of ADHD: Coding the Condition
 Attention-Deficit/Hyperactivity Disorder, Combined Type
 Both conditions for Diagnosis are met
 Attention-Deficit/Hyperactivity Disorder, Predominantly
Inattentive Type
 “Inattention” conditions are met, but “Hyperactivity-
Impulsivity” conditions are not met
 Attention-Deficit/Hyperactivity Disorder, Predominantly
Hyperactive-Impulsive
 “Hyperactivity-Impulsivity” conditions are met, but
“Inattention” conditions are not
 “In Partial Remission” when some symptoms are no longer
met

What Causes ADHD?
 Neurological Dysfunction -Consistent Abnormalities found in
areas of the brain.
 Prefrontal and Frontal Lobes – Controls the functions to
regulate behavior.
 Basal Ganglia – Controls coordination and motor behavior.
 Caudate and globus pallidus; present in the brain
behind the frontal lobes.
 Cerebellum – Assists in control of motor skills, contains
half of all neuron’s in the brain.
 Corpus Callosum – Connects the brain’s hemispheres for
cognitive functions.

What causes ADHD? (con’t)
 Heredity
 Parents of ADHD children have a greater chance of also
having ADHD
 Siblings of children with ADHD have 32% chance of
having ADHD
 Children of Adults with ADHD have 57% chance of
having ADHD
 Twins: Identical Twins more likely to share disorder
than fraternal twins
 Toxins and Medical Factors
 Consumption and/or use of drugs and/or tobacco place
the unborn child at an increased risk of ADHD.

Characteristics of ADHD
 Lack of Behavorial Inhibition
 Inability to control responses in
social, academic, and/or occupational settings
 Waiting in line or in turn
 Response elicits interruptions of
class, situations, or settings
 Hold normal level of attention on task when
subordinate distractions arise.
 Evidence points to abnormalities in the caudate of the
basal ganglia.

Characteristics of ADHD (con’t)
 Lack of Executive Functions
 Inability/difficulty manipulating working memory
 Forgetfulness, time management, thought processes
 Inability/difficulty following rules, guidelines, and/or
instructions
 Inability/difficulty managing emotions and reactions to
stimuli (positive or negative).
 Overreactions, over-dramatizations

 Time Awareness / Management
 Diminished problem-solving ability
 Inability to navigate or overcome obstacles in goals
 Diminished ingenuity
 Tendency to give up when tasks become more difficult
 Diminished flexibility
 Greater tendency to react on impulse because of
inability to control emotions
 Inability to assemble thoughts in an organized and
coherent manner, taking longer or unable to complete
goals.
Lack of

 Lack of Persistent Goal-Directed Behavior
 Problematic manipulation of executive functions lead
to inability or difficulty navigating, participating,
and/or completing goal-directed activities
 High variability in progression and production rates
during work strategies.
 Inconsistent accuracy, performance, or quality of work
 Lack of ability for Adaptive Behavior

 Problems Socializing with Peers
 Negative Social Status
 Long-lasting reaction to peer rejection
 Stemming from the inability to control emotions

Educational Consideration
Effective Educational Programming
 Classroom Structure / Direction
 Reduce irrelevant stimulus in the classroom
 Bright colored posters, shining objects near or
opposite windows
 Clear, defined routines
 Concrete directions, expectations, and guidelines
 Loose timelines to reduce the distraction of tight
deadlines.
 Displayed schedule and timetables for easy
reference by students

Educational Considerations (con’t)
Classroom Structure / Direction
Introduction of Lessons
Provide an organizer and help them to use it
Working towards establishment of independence
with self-monitoring
Review lessons
Set Expectations and Needed Materials/Resources
Simple directions, choices, scheduling

 Classroom Structure / Direction
 Conducting Lessons
 Consistent structure and routine
 Encourage participation with cues for tasks, calling
upon, etc. (Teach like a Champion is a great book for
strategies on this subject)
 Keeping tasks in smaller units to allow for evaluation
and self-monitoring
 Eliminate Timed Tests
 Students won’t be preoccupied with time elapsed
or time remaining; reduce stressors/pressure

Educational Consideration (con’t)
 Functional Behavior Assessment (FBA)
 Know the antecedents to undesired behavior
 Confirm the consequences for undesirable behavior
 Develop strategies for maximizing occurrence of
positive/desired behaviors
 Contingency-based self-management
 Student tracks own behavior, receive rewards and
consequences based upon behavior
 Use together for maximum awareness and performance
independence

U.S. Department of Education doesn’t recognize ADHD as
a special education category.
 Actual statistics relating to diagnosed
students, actual students, and students receiving
services is a giant disparity in number from the
students who should be receiving services.
 While some students respond well with inclusion
(mainstreaming), others respond better in self-
contained environments with other ADHD students

Medicating ADHD
History
 Benzadrine (1932)
 Originally thought disorder was to be a result of
encephalitis
 Charles Bradley’s “The Behavior of Children Receiving
Benzadrine” documents the increased performance of
students taking Benzedrine sulfate; also discusses
dosage, side effects, unfavorable responses, and
duration effects. (1937)
 Methylphenidate
 Trademarked as “Ritaline” in 1954
 Helps to control the neurotransmitters, dopamine
and norepinephrine
 Most common medication prescribed;
psychostimulant

Effectiveness of Medicating ADHD
Psychiatry Journals have been documenting the success of
medicating disorder patients since 1937:
 Charles Bradley, “The Behaviour of Children Receiving
Benzedrine” (1937)
 Matthew Molitch and John Sullivan, “The Effect of
Benzedrine Sulfate on Children Taking the New Stanford
Achievement Test” (1937)
 Maurice Laufer and Eric Denhoff: “Hyperkinetic Impulse
Disorder in Children’s Behavior Problems” (1956)
 C. Keith Connors and Leon Eisenberg; “The Effects of
Methylphenidate on Symptomatology and Learning in
Disturbed Children (1963)

Cautions Regarding Medicating ADHD
 Premature Medication Determination
 Don’t prescribe at the first sign; go through full
diagnosis procedures, ratings, criteria, and tests.
 Medicating doesn’t increase accuracy on achievement
tests. Behavior may improve, rate of task completion
may increase, but there has been very little increase in
the results of standardized achievement tests
 There should be a level of responsibility for taking the
medications and reinforcement of taking self-
responsibility of the student’s actions and initiative.
 Communicating dosage between
school, parents, physicians, and student, as well as the

Assessing Progress of the ADHD Student
 Progress Monitoring
 Students with ADHD commonly are diagnosed with learning
disabilities or intellectual disabilities.
 Monitoring of all aspects of the student’s experiences
during the school day needs to be paramount to insure
strategies are working.
 Curriculum-based measurement (CBM)
 Minimal time and task-focused measurement caters
to the ADHD student in a positive way.
 Monitoring Behavior
 Rating scales
 Direct observation
 Can work with FBAs for Reward Consequence

Transitioning to Adulthood
 Studies completed as late as 2008 have shown that about
50% of those diagnosed as children retain ADHD symptoms
into adulthood.
 Prevalence Rate of 4 -5% of adult ADHD diagnosis (similar
to that of youth)
 ADHD Coaching is very important for success in
employment, relationships, and personal triumphs.

Chapter 5

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Chapter 5