ADHD is one of the more recognizable acronyms in the field of learning disabilities. It also tends to be misunderstood and misrepresented in popular discourse, used as often to joke about one’s inability to sit still and concentrate as to describe an actual health condition. Drawing on research and her own classroom experience, Becky Bollinger sheds some light on ADHD in this installment of her series on diverse learners. In addition to clarifying what ADHD is and is not, Becky offers some practical ways for schools, teachers, and parents to respond.
ADHD is not this feeling of restlessness that you get after you’ve sat for too long or the reason why you feel like you need to fidget with your pencil or why you forget what you were intending to get when you went to the grocery store.
ADHD is a persistent problem, a persistent pattern of inattention, and hyperactivity or impulsivity that interferes with functioning or development.
That word “persistent” is really important. It’s ongoing. It’s continual, and it’s actually interfering with how I’m able to go about my day and complete the tasks that are asked of me or the responsibilities that I have.
Also, it’s important to understand that ADHD, the symptoms, have to be inconsistent with typical development. So of course, a five year old is going to have a shorter attention span than someone in middle school or high school or an adult. We have to compare the symptoms with what is typical.
We had talked previously about the categories of disabilities, and ADHD falls under the category of “other health impairments.” ADHD is a health impairment. It’s not a learning disability. Of course, ADHD can significantly impact learning, but it is first, a health difference or… Brain scans show that there’s actually physical differences in an individual with ADHD and without. And I would understand it to be like a chemical imbalance in the brain. There is actually different levels of chemicals. There’s actually a physical difference in an individual that has ADHD.\
There are three main types of ADHD.
First, is the inattentive type, and this is when this individual is distractable and it can be with external things or internal. So the individual might be distracted by watching his peers around him or seeing something outside the window or too much on the walls. This person could also be distracted by internal things like they’re hungry or they’re tired or they’re thinking about something outside of the classroom or outside of what they’re doing at the moment. When someone struggles with the inattentive type of ADHD, it also impairs their working memory, so they struggle to remember what tasks they’re supposed to be completing. And like keeping a list of things in their mind that they need to be doing is really hard to keep track of that and to remember bits of information or tasks that they need to do.
The second type of ADHD is the hyperactivity/impulsivity type. This is actually the least common that someone would just have this category of ADHD. And this is what we think of often with restlessness, hyperactivity. They keep moving around they cannot stop talking. It’s constantly flowing. Rapid decision making. Being very impulsive. That would be characteristics of this type of ADHD.
And most commonly, there’s the combined type. And that’s when an individual struggles with the inattentive part and also the hyperactive component of ADHD.
When we talk about ADHD, there are all these different symptoms, and it can be challenging to know, is this child, is this symptom, is this being inattentive? Is it just part of typical childhood development, or is it actually something more substantial that we need to be looking at? What’s the way forward? Or how do we help this child?
And maybe looking toward more of a diagnosis.
And linked to this video, we’re going to have a checklist that could give you an idea of whether or not these symptoms are great enough or persistent enough to merit a diagnosis. This tool is just to give you an idea, maybe a frame of reference considering the symptoms of both categories. And it’s important to realize that six or more symptoms in each category have to be present for a diagnosis to be made
And again, this would require going to talk to a family doctor. It’s not something that you can just diagnose on your own.
So when an individual has ADHD, what’s going on? Why are they experiencing these challenging behaviors? What’s actually happening?
And this is how I understand it. So a child in their brain, they’re asked to do something. They complete a task and the synapses in their brain fire, but they don’t have enough energy to reach the destination or for the task to actually be carried through.
So a child is set out to get his book out of his locker. And on the way, he’s fully intending to go do that. That’s his plan. He understands that’s what he’s asked to do. And on the way, he sees a pencil on the floor and he kicks a pencil. And then he remembers that we’re having soccer today. And he runs back into the classroom and he says, “I want to have [this certain position] in soccer today!” And all of a sudden he never completed the task. He got sidetracked. He had good intentions, but he wasn’t able to complete them or carry them out.
And that tends to be what happens when a child has ADHD. It can even happen with completing their math paper or their assignments. They know they’re supposed to, they know what they have to get done, but they can easily get off track. ADHD is also known as something called a self-regulatory disorder, which is basically where a child has difficulty regulating their environment, the things around them, difficulty regulating their attention, their activity, their impulses, organization, even regulating their emotions.
And so all of those pieces, we somehow need to help them to manage their environment, manage themselves in a way that they can be successful and that this ADHD isn’t disrupting who they are and how they’re able to function in life.
So where does ADHD come from?
Approximately 75% of ADHD is hereditary. So when a parent is struggling with ADHD, it’s very likely that their child will as well.
Also, 25% of ADHD can be environmental as well, and especially when there’s stressful, prenatal or postnatal experiences that a child has or traumatic experiences. Those can play into when a child has ADHD and is struggling with these types of things.
So when a child is struggling with ADHD, what should we do about it? How can we help them?
First I think we need to take a look in our classrooms and find ways to train them to manage this difficulty ways in our classrooms to accommodate and help these children. So the first thing I believe that children need is the structured environment, and the more organized and predictable things can be in the classroom, the better that they will be able to kind of fit into those expectations.
I often have put a checklist on students’ desks that give a list of the tasks they need to complete, like as part of the morning routine and then also later in the day. This checklist says about the same thing every day. Things like
But when a child has ADHD… or I’ve worked with children with ADHD that consistently look at that checklist every day. The other students probably haven it memorized. They can know what’s on there without looking. But I’ve seen students regularly check in and cross each thing off as they complete them to help them keep on track. It’s like a reminder. And I know the parents that use this as well. Like for morning routines, bedtime routines to help as a child, to kind of train themselves to complete a list of tasks.
Also, I think as teachers, it’s really helpful and healthy if we can incorporate opportunities for purposeful movement in the classroom. So this child might struggle to sit in his chair and needs to get up and get moving. And so if we can incorporate that in the rhythms of our instruction, that can be really helpful.
An example might be moving and sitting on the carpet for a certain class. Or often every day when we have review like, we have review before math and we do our math facts. We have review before science class with the vocabulary that we’re learning. We always stand for those reviews. It’s always like I think almost every class in the day we’re standing for a piece of it that just gives them an opportunity to get out of their seat, move around.
Every afternoon between spelling and penmanship class, we get up and do two minutes of exercises, and this is fun for everyone. It’s good for everyone, but it’s especially a way to help the students that need that opportunity for movement.
Also, I think that we would do well to experiment with the environment a little bit. So when a child is struggling with movement and moving around, one child would do better up front, very close to the teacher so that the teacher can be there and check in with them. But another child with ADHD might be better off in the back row where there’s not as much of a distraction to the people behind them. And so experiment with that.
Also, maybe moving them away from the window or moving them to a place where they are called in to focus—to attention more effectively.
Also, children, we can teach them about self-regulation and about building awareness of themselves and an awareness of, well, “how do I fit in this space, and how should I be moving around, and what should or should not I be doing?”
And sometimes when a child has ADHD, they can act like they’re run by a motor. Like they’re just going and there’s no stopping. One thing that I found helpful is to look at something like this and talk about with them. “How is your engine running?” We might have, in the blue zone. It’s too slow when we’re tired and we’re not engaged. Just right. And then too fast. And even talking to students about at recess the level of speed that your engine is going. It’s okay that it’s higher then. But when we’re in the classroom, when it’s time for math class, our engine should be at a certain level. And so there’s ways to teach children how to build awareness of who they are and how they should be acting.
I have some other objects here that could be helpful for a child.
This is called a kick fix, and we have some students that put this around the legs of their chair as just something that they can be using their feet on it to help with some of the restlessness.
Also, this is what I would call a wobble cushion, or we’ve called it a super sitter before. But it’s amazing when a child needs to sit on this, or sometimes you have to ask them if they want to. And if some children don’t like this at all. But if they enjoy this kind of thing, if they sit on this, it takes more energy to sit, and it actually kind of requires you to sit with a good posture to do this. And it could be a way to help give them an opportunity to release that energy that they have.
Also, sometimes when children struggle with ADHD, they have a difficulty understanding time and the passing of time and kind of knowing where they are and how much time they have to complete something. And this is a handy little timer. It’s called a time timer. And actually what happens is with this. When you have let’s say you have 15 minutes and you need to complete your assignment by then this goes down on its own. And if we were sick for 15 minutes, you would watch it. It would gradually go down. And then at the zero, it would Ding, and so my students love this because it helps them to kind of pace themselves a little bit. And the child that’s struggling with staying on track, this could be a great motivator to say, “I’m going to be finished by the time this gets down to zero!”
And so those are some tips, some a few pointers things to try out.
Of course, it will really depend on the child and whatever a combination you use, it needs to be helping the problem, not making it worse. And so you have to feel that out and think about what would be the most helpful for this child, and kind of experiment and try some things out.
So after you try all of these accommodations you’re trying to work with and train the child to manage their difficulty. Sometimes that training and accommodation isn’t enough. And one of the options that we can consider is medication. And what is this? Let’s try to get an understanding a little bit of how ADHD medication works.
So typically a child would take a stimulant if you remember back to when we talked about the synapses firing and not reaching the destination, what a stimulant or like Ritalin would do would give the synapses in the brain a boost so that they are able to reach the destination. And then what will happen is it will enable the child to complete the task that he’s asked to do. You could think of it maybe as a super booster to get through the fritzing, going off and connecting with other synapses.
A stimulant can be given daily and wear off like a stimulant does not have long term impact. It will just give them that extra boost that helps those chemicals be balanced in their brain. And then by the evening it will be worn off. And so I have seen adults—or I’ve talked to adults—who have taken a stimulant when they know that they have to be able to get their tasks completed today, get a lot completed. But then on the day where it doesn’t matter so much, well, then it’s okay and they don’t take it. So it’s a tool when ADHD becomes so overwhelming that we don’t know what to do next.
And it can help someone get back on track so that maybe they can start working on those organization things and themselves. And so then hopefully eventually they wouldn’t need to take it anymore. But it is a resource. It’s something that could be really helpful to get an individual on track.
There’s a question of addiction, and I’ve asked this question to a professional and she said that addiction will only happen if someone’s taking a stimulant when they don’t really have ADHD. And so if they’re taking this stimulant and they have ADHD, it’s actually meeting a physiological problem. So it’s actually meeting this chemical imbalance, and it actually will help them to just function more normally and be able to be more successful.
It can be difficult to find the proper dosage, and that will take a lot of work between the family doctor and parents and teachers and kind of communicating and giving feedback. And, “how is it going?” And a good family doctor will start the child on the smallest dosage possible and then gradually build as needed to figure out what’s the proper dosage for this child. And of course, as a child grows, the dosage is going to need to increase simply because they’re becoming an adult— their body—they’re growing. When a child’s dosage needs to increase, that doesn’t mean they’re getting addicted to it. It means that they’re just growing. There is also the concern of side effects, and that’s possible. Some children experience side effects. Some do not. And so again, it’s just something you’re going to have to try out and see what’s going to work for us.
And so medication is something that I think we should consider as a valid option, something to consider and to try. When we’ve tried all the other things. We’ve tried the accommodations. We’ve tried training and working with them, and those are not helping us. Then I think it’s worth looking into.
As teachers, it can be really easy for us: “Parents, we just want you to try this because…” We see, especially in our classrooms when the environment is more structured. Some of these things show up even more than they do in the home setting, just because you’re expected to sit and to complete your work and do all of these tasks. And so I do think, though, that it’s really important for us as teachers to talk graciously with parents, to give them grace and realize, like, there’s a lot that they have to think through here, and they have to wrestle with the complexities of this and their own emotions and all of this. Like, “do we want to give our child medication like this?” And so I think that’s really important that as teachers, we offer time, we offer grace.
Yes, I do think we need to be honest and to be specific about the struggles that we’re finding in the classroom. I think also, we do well to communicate that we’re recommending this out of care for the child. Like we really care for them and we want them to be successful. We see their frustration. And if we communicate that care too, I think that parents may be able to hear us better, but it also takes time to build up credibility. It takes time to… You’re going to need to have relationship and really work closely. At the end of the day, it is the parent’s decision, what they’re going to do and for the sake of their child.
And so as teachers, we can advocate. We can be a spokesperson. But we do need to respect parents as well, and the decisions that they make for their children.
So I wish I could ask you what questions you have about this. What more could we explain? But in the description box, there’s going to be a list of resources with some books. And Russell Barkley is an incredible author, someone that I would trust as someone to look at, to read what he’s written about, working with ADHD in school and at home. And he has some books that could be worth looking at.
So I hope that you feel a little better informed about what ADHD is and how you could help someone in your life that is struggling with this disability.
CONTRIBUTOR: Becky Bollinger
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