Volume 16 Issue 2
By Sherry Posnick-Goodwin
Rosa Coss of the San Jose Teachers Association
The boy drops his pencil every few minutes in Jeanette Davis’ special education class at Hosler Middle School in Lynwood. He twists and turns in his seat, drums his fingers on his desk, and constantly raises his hand, calling for help while his teacher is assisting other students. Midway through the math lesson, he begins writing in his journal.
“Rickie, we are not writing in our journal now. We are doing math,” says Davis, a member of the Los Angeles County Education Association. “Please put the journal away.”
Rickie Freeman has trouble sitting still and concentrating on his work because he has attention-deficit/hyperactivity disorder (ADHD), a condition that’s increasing among students.
Studies show that every classroom teacher is likely to have at least one student with attention deficit disorder (ADD) or ADHD in their classroom each year, making it the most common behavior disorder in children. According to a study by the national Centers for Disease Control and Prevention (CDC), nearly 10 percent of children between the ages of 4 and 17 have a form of the condition, compared with 8 percent reported in 2003. The rise may be due to increased awareness and diagnosis. Symptoms include having difficulty staying seated and concentrating on schoolwork, and constantly interrupting conversations and activities. To make the situation even more challenging for teachers, most students with ADD/ADHD are in general education classrooms.
Even in a special education classroom, it’s a challenge, Davis admits.
“When negative and inappropriate behavior occurs, it makes things really chaotic. Even one child with this condition in your classroom can have a very big impact. I love these children because they are smart and have a lot to offer, but sometimes people may not know it because their behavior is out of control.”
Facts about ADD/ADHD
ADD/ADHD is a neurobiological disorder that runs in families. There is no cure, although symptoms can be managed with medication and behavior techniques.
While people may joke about having ADD, it’s a serious condition that puts students at risk of dropping out of high school or taking longer to graduate, according to a UC Davis School of Medicine report. If undiagnosed or untreated, it may cause problems in adulthood including anxiety, depression, substance abuse and difficulty in the workplace and with relationships. Individuals can also have a poor self-image — especially when it’s undiagnosed — and mistakenly think of themselves as “lazy, crazy or stupid,” according to CHADD (Children and Adults with Attention Deficit/Hyperactivity Disorder), an organization dedicated to increasing public awareness.
There are three types of people with the condition: those who have difficulty when it comes to concentration, individuals who have problems with hyperactivity and impulsivity, and those who have symptoms in both categories, which is most common. Rates of diagnosis are comparable among whites, blacks and some Hispanic groups, notes a study by the CDC.
“There are a wide range of symptoms,” says Sandra Rief, who has written several books and presented workshops at CTA’s Good Teaching Conference on the topic. “While some individuals have hyperactivity, others have the inattentive type and don’t display disruptive behaviors. Some children have a hard time with social skills, while others are socially adept. It depends on the child.”
Children with ADD/ADHD may be very bright and even gifted, says Rief, a former resource specialist in San Diego who is a nationally and internationally known speaker. But when it prevents a child from achieving success, it can cause frustration in the classroom.
“These children have behaviors and performance difficulties that are frustrating and often perplexing to parents and teachers,” says Rief. “We need to remember ADHD is a brain-based disorder that causes certain behaviors, and it’s not deliberate. It’s not a matter of trying harder; many of these children put forth far more effort than the average child. It may take them three to four times longer to do homework, and then they can get a zero because they forget to take it out of their backpack.”
More boys than girls are diagnosed with the condition, and girls are more likely to have ADD without the hyperactivity component, says Rief. Girls may “slip under the radar” because, though unfocused and struggling to keep up at school, they aren’t bothering anybody. So their disorder often goes undiagnosed until middle school, high school or beyond.
“The condition also commonly affects an individual’s organization, planning and other ‘executive function’ skills,” explains Rief. “Those with ADD/ADHD are developmentally immature in their self-regulation and self-management abilities in spite of how intelligent they may be.”
Overcrowded classrooms make it more difficult to teach these students, says Rief, and NCLB has resulted in less recess and classroom “wiggle time” for students who need to get up and move around, which has especially impacted students with this condition.
Most youngsters with ADD/ADHD display symptoms by age 7 for a period of at least six months, and are often identified by second grade, says Stephen Brock, a member of the California Faculty Association who coordinates the CSU Sacramento program for future school psychologists. Teachers are usually the first to notice that a student has poor concentration and difficulty sitting still in a way that is outside the developmental norm for that age group. Then parents are consulted, and the child is assessed by a school psychologist, physician or mental health professional.
There is no single test that can determine whether a child has ADD/ADHD. Children who are fidgety or inattentive don’t always have ADD/ADHD.
“It’s important to look at the whole child,” says Brock, past president of the California Association of School Psychologists. “There may be other reasons why a child has trouble focusing or sitting still. The child may be experiencing emotional problems or worried about something.”
It’s not unusual for children to have other learning disabilities in addition to ADD/ADHD, which makes diagnosis “tricky,” adds Brock.
Only the most extreme cases enter the special education system, and 27 percent of all students in special education programs nationwide have ADD/ADHD, says Brock. Classroom interventions are the first recourse after diagnosis, and if those don’t work, families may consider medication.
Teaching students with ADD/ADHD
Dylan, 8, bounces a ball and throws it up in the air while his mother, Lisa Vieler, confers with teacher Rosa Coss after the final bell rings at Glen River School in San Jose. Dylan’s mother and teacher talk on a frequent basis and say that working as a team — with constant communication — is the key ingredient in helping a child with ADD/ADHD achieve academic potential. The approach is working; Dylan is above grade level.
“Rosa sends me e-mails and telephones me and lets me know if something isn’t quite working,” says Vieler, who also has a daughter with the condition. “It makes all the difference. Then if something happens in class, I can have a conversation with Dylan and figure out whether something caused him to behave in a certain way, or if we need to try a different behavior strategy, or whether we need to see the doctor and adjust his medication.”
Last year Dylan had four periods of medication modification. For weeks at a time, Dylan struggled. Coss talked with Vieler on a regular basis to let her know how changes were affecting Dylan, who has problems with impulse control, interacting with peers and focusing on tasks.
“Thank God Rosa loves him,” says Vieler. “Otherwise, he would have just been a problem kid making it difficult for her in the classroom.”
Coss laughs and says that keeping in close contact with parents makes her job easier.
“When I noticed a change in Dylan’s behavior, I would communicate that to his mother, and she would get on it right away. Sometimes the medication needed to be adjusted, and other times she just needed to talk to him. When she discussed my concerns about his behavior, he would come back to school the next day with much better behavior.”
Coss, a member of the San Jose Teachers Association, has one or two students with ADD/ADHD in her general education classroom each year. It has gotten more difficult to teach these students as class size has increased, but certain strategies have helped.
“I try to keep them close to me,” says Coss. “I do a lot of repetitive reminding for them, too. And sometimes they need a few extra rewards. I had one student who got a little stamp every time he finished his work, and if he got five stamps, he could go to the prize box. The other kids weren’t jealous; they understood he had difficulties.”
Davis constantly uses positive feedback with ADD/ADHD students. “I say ‘thank you for sitting in your seat’ and ‘good job’ and ‘keep it up.’”
“I understand they have to fidget to focus. Sometimes I am like that, doodling in a lecture. As long as they are not disturbing the other kids, it’s OK.”
It helps to keep them busy, she adds, so they have a positive way to channel excess energy.
“I make them my little assistant. I will have them pass out papers, write assignments on the board, and I give them lots of responsibilities. It makes them feel like a leader, and they love it.”
Rief suggests breaking up instruction to include activities with movement and talking. She also recommends structuring larger assignments by dividing them into short, manageable increments with separate due dates and monitoring points along the way.
“Provide visual cues and reminders on cards or pictures in strategic locations,” she advises. “And provide more frequent monitoring, feedback on performance and reinforcement for students with ADD/ADHD. Anticipate problems that can arise from lack of structure, unclear expectations or environmental triggers in the classroom and adjust accordingly.”
The use of technology and multimedia is especially engaging for students who have trouble concentrating, she adds.
Students with ADD/ADHD can sometimes work well with student partners or “buddies” who are supportive, tolerant and well-focused, she adds. “They can assist with clarifying directions, make sure assignments are recorded in planners, remind students to turn in work, and help with other tasks or activities.”
Brock suggests that teachers use mornings for more rigorous academic instruction, since studies show that on-task behavior of students with ADD/ADHD worsens progressively throughout the day. Auditory cues are also helpful, such as playing a tone at irregular intervals to remind students to monitor their on-task behavior.
“It’s essential to give much encouragement and praise, because these students are easily discouraged,” he says. “And teachers should keep in mind that rewards used with these students lose their reinforcing power quickly and must be changed or rotated frequently.”
To learn more about ADD/ADHD, please visit the Children and Adults with Attention-Deficit/Hyperactivity Disorder website at www.chadd.org or the Centers for Disease Control and Prevention at www.cdc.gov/ncbddd/adhd.
Living with ADD/ADHD
Individuals can have the condition and be very successful in life. Just ask Marshall Zaun, former Teacher of the Year at Endeavor Middle School in Lancaster.
The 42-year-old computer teacher was not diagnosed or treated as a child because the condition was not recognized in those days. Students were considered to be “fidgety” or behaving badly.
“I didn’t sit through class well, and I don’t sit through meetings well now, because I’m tapping my fingers and fidgety,” says Zaun, a member of the Teachers Association of Lancaster. “I can hold my own now, but as a kid I was on the hyperactive side. I had to keep busy or I became a royal pain. My teachers were always telling me to go run a lap and sending me on errands. Somewhere along the way I became the computer repair guy in school. It became a hobby of mine, and now I’m teaching it.”
He still has problems focusing, and his students realize that it may take more than one attempt to get their teacher’s attention.
What does it feel like to have ADHD?
“There’s a point where I’m done,” Zaun explains. “There’s a point where there’s all I can take. There’s a point where I can’t focus, and I have to get up and do something. Sometimes you don’t feel like your brain is functioning the way you want it to, and your brain and mouth are working faster than they should be working.”
Zaun had poor attendance in regular school and was sent to a continuation high school, where he not only graduated but became the valedictorian. He credits his high school English teacher with being the one who “reached” him and influenced him to become a teacher.
“When I was really fidgety, she allowed me to get up and to move and do things. She did things with song lyrics to help me understand material, and that held my interest. And she allowed me to work at my own pace.”
Zaun worries about students today with ADD/ADHD. With the pressure of testing, teachers seldom tell students to go run a lap or move around if they have excess energy. Recess has been cut or eliminated at many schools, along with physical education classes. Struggling students are given “double periods” of math and English in lieu of electives. Hands-on learning has been replaced with rote memorization and test prep. There may be no opportunity to let off steam, he says.
“I don’t know if I would have survived that,” says Zaun. “You have to allow these kids to get up and move around.”
As a student, Zaun was constantly reprimanded for talking and walking around the class.
“Today, as a teacher, I’m also talking and walking around the class,” he muses. “I guess you could say that this is the perfect job for me.”
Medication for ADD
Even if a child is bouncing off the walls, a teacher should never recommend or insist that parents put their child on medication, says Sandra Rief.
“Teachers can get into serious trouble with their school district by doing so,” she says. “We are educators, not medical experts, and medication decisions are strictly between parents and their physician.”
What teachers can do if they suspect undiagnosed ADD/ADHD is suggest a “team” meeting with teachers, parents, a school administrator, school psychologist, counselor and others to share concerns, discuss strategies that have been tried, and plan “next steps” to help the student.
“If the recommendation to parents is to have their child evaluated, it is best coming from the team rather than an individual teacher,” says Rief.
The CDC reported in 2005 that 2.5 million children are being medicated for ADD/ADHD in the U.S., and that the rate of medication among students with a reported diagnosis is about 40.6 percent in California. A 2007 study by the Mayo Clinic in Minnesota states that medication has “long-term academic benefits” and that students taking medication show improved reading scores compared with those with the condition who do not receive medication. They also have better attendance and are less likely to be held back. But side effects steer some parents away, including lack of appetite, headaches, queasiness and insomnia.
A National Institute of Mental Health study states that children who are treated with medication alone do not do as well academically as children who receive both medication and adjustments to the classroom environment.
Short-term stimulants such as Ritalin are typically prescribed when a child is first diagnosed, says school nurse Dawn Fox, a member of the Sacramento City Teachers Association. Because the medication is short-acting, parents and doctors must submit authorization forms for it to be dispensed at school. New forms must be submitted every time the dosage changes. Students may take longer-acting dosages after it is determined they have no adverse reactions.
“Teachers may be under a misconception that these medications will decrease hyperactivity in a child,” says Fox. “But these medications are stimulants that are prescribed to improve a child’s ability to focus. Sometimes it will help with hyperactivity and children will become less impulsive, but not always. So teachers may think the medication isn’t doing its job and the child needs a higher dose because the child is bouncing all over the place, but that isn’t true.”
Teachers can judge the effectiveness of medication, says Fox, by answering the following questions: Are students completing homework more often? Are they more attentive in class and able to answer questions? Are they keeping up with the rest of the class and on the right page?
One of the most difficult things for school staff is making sure that students actually take their medication, adds Fox. Teachers can walk students to the office at lunchtime to make sure they get their pill. School nurses try to keep an eye on students to make sure they are taking medication properly and not having adverse effects, but that is difficult in districts with very few school nurses or none at all.
There are other ADD/ADHD medications that students can take that are non-stimulants and have a calming effect, such as Strattera, but they may take as long as six weeks to have an impact.
Medication is not a cure for ADD/ADHD, but it can help those with the condition manage their symptoms. While some health care professionals such as Dr. Dean Edell believe children are overmedicated, others maintain that is not the case.
CHADD supports the use of stimulant medications, with behavioral modification and counseling.
“That may include things like social skills training. It may include family counseling, individual counseling, behavioral therapies, behavior modification,” notes Evelyn Green, president of CHADD, in a CNN interview. “Medication is a piece of the picture, it works for lots of kids, it certainly worked for my child, and it works for a lot of adults. But it doesn’t work for everybody, and it’s not a magic bullet.”
Visit WebMD at www.webmd.com/add-adhd/guide/adhd-medical-treatment to find more information about the control of ADD/ADHD symptoms using medications.