Attention Deficit Hyperactive Disorder
Over the last couple of months I have had a number of requests for information concerning ADHD, so I thought I would write down some thoughts on ADHD. Attention Deficit Hyperactive Disorder is one of the most controversial psychiatric disorders in America today. This problem is often misunderstood and misdiagnosed. However, very fine epidemiological studies, which have been replicated many times, indicate that there is a rate between
three and five percent of people with ADD in the general population. This suggests that although ADD is misdiagnosed, it is not over diagnosed. I believe that the misdiagnosis of ADHD occurs because we do not have a clear and comprehensive understanding of the causes. Therefore, we are unable to develop an operational definition that allows clinicians and researchers to precisely define who has ADHD and who does not. However, we have learned a great deal over the last 50 years concerning the symptoms and some of the causes of this widespread disorder.
Careful, genetic studies of families, particularly twin studies, consistently indicate that ADHD is a genetic condition. In fact, a child of an ADHD parent has a 25 percent chance of also having this disorder. This is much greater than the general population. Research has also consistently shown that although there are many areas of the brain that are affected by ADHD, the catecholamine ridge and frontal sub-cortex systems of the brain are the most affected. In layman’s terms, these systems roughly constitute the frontal lobes of the brain. They are responsible for our ability to plan ahead, organize the many sensory stimuli coming into the brain, understand the behaviors of others, and restrain our impulses. Research has demonstrated that these ridge regions of the brain are significantly smaller in individuals with an Attention Deficit Disorder. Interestingly, long-term use of stimulant medication appears to help these individuals’ brains develop to more age-appropriate levels.
In spite of our knowledge, we still do not have definitive chemical, genetic, or neuroimaging markers to use to diagnose this disorder. Like most psychiatric disorders, we have to rely on behavioral symptoms. The primary behavioral symptoms of an Attention Hyperactive Disorder include deficits in control of attention and impulsivity. Almost all of these individuals are distractible. It is not that they can’t pay attention, but rather that they pay attention to too many things at once and can’t figure out the irrelevant stimuli. Furthermore, we have relatively recently discovered that many of these individual also over-focus. That is, they get locked onto a stimuli or a task and can’t break away. For all of us, part of having good attention skills is being able to be flexible—to focus at some point and at other points shift our focus. These individuals have great difficulty shifting focus. Again, it isn’t that people with ADHD can’t focus; it’s that they have trouble filtering out stimuli and shifting their focus from one thing to another.
Almost all of us have experienced an impulsive and hyperactive child who cannot control their behavior impulses and appears to be running wild. Impulsive individuals act before they can think through the consequences of their actions. This symptom, as with most of the symptoms of ADHD, is a behavior that we all engage in once in a while. It is the frequency and the lack of control that cause these symptoms to suggest an Attention Deficit Disorder.
In addition to these symptoms, there are a number of secondary symptoms related to frontal lobe functioning which scientists have labeled executive functions. Our frontal lobes could be thought of as an orchestra conductor. Like an orchestra, our brain is made of many different, individual components with different functions. However, to be effective, the activities of each component must be coordinated into a whole. This is the responsibility of the conductor and of our frontal lobes. In addition to helping us control our attention and our impulses, the frontal lobes also help us organize ourselves. They allow us to break complex tasks down into smaller parts and decide the order in which we should do each smaller task. They also have a critical function in the memory process. They help us manipulate individual memories and then store and retrieve information in our long-term memory. Finally, a key executive function is self-monitoring. Self-monitoring allows us to initiate tasks, sustain our effort, and identify when we have wandered off task. Problems in organization, memory, and self-monitoring are also significant symptoms of Attention Hyperactive Disorders.
Another reason why it is difficult to diagnose Attention Hyperactive Disorders is that the frontal lobes are greatly affected by biological states such as emotion, nutrition, and sleep. A key factor in making a differential diagnosis for ADHD is to carefully look at the individual’s history. Unlike sleep deprivation, ADHD is a lifelong condition and oftentimes there will be a consistent family history of this disorder. Although individuals with ADHD also have difficulty with their feelings, usually their problems at home and work are caused by organizational deficits rather than emotional problems. They are unable to meet deadlines, forget appointments, or their spouses complain about the piles they leave all over the house. Furthermore, careful interview with adolescents and adults with suspected ADHD can help to eliminate the diagnosis of certain other conditions. Whereas an individual who is depressed will often be distracted, his/her distractions tend to be more internal and negative (sad or morbid) in nature. On the other hand, individuals with ADHD will tend to be distracted by both external and internal stimuli, some of which are negative but some of which are positive. For example, they may not be able to get their mind off the fishing trip they’re going to be taking this weekend or the new guitar they’ve ordered online. Finally, individuals with ADHD often have a different quality to their impulsivity. Their behavior has a kid-in-the-candy-store or a “Tigger” (the exuberant character in the Winnie the Pooh stories) quality that depressed or anxious individuals don’t have.
Finally, proper diagnosis and treatment of ADHD can make a huge difference in an individual’s life. Understanding why they are having problems in getting the right medical treatment and psychotherapy can mean the difference between failing or succeeding not only at work but in their social and emotional relationships.
Michael Ryan, Ph.D.
The Institute for Multi-Sensory Education assists districts in the implementation of the RTI (Response to Intervention) Model.
School districts nation-wide are choosing to implement the RTI model. Response to Intervention seeks to identify struggling students as early as possible and incorporate a variety of intervention methods with varying levels of intensity and duration. The goal is to accelerate these children to full functionality at grade level through appropriate intervention strategies. This program has been highly effective in reducing the percentage of special education referrals. Education professionals are finding that many students identified as special needs, simply do not possess the knowledge and skills necessary to become successful readers.
The strategies covered throughout the Institute for Multi-Sensory Education can be incorporated into any tier of the RTI model. The multi-sensory strategies will aid in allowing educators to meet the needs of each individual learner, including those considered at-risk.
Tier I can include any part of the IMSE’s Orton-Gillingham Outline and can be administered in a whole group, individual, or small group setting as part of your regular classroom instruction time.
In Tiers II and III, teachers or specialists can administer more personalized multi-sensory intervention strategies through small group and individual instruction beyond the 90 minutes of regular daily instruction.
English as a Second Language
Orton-Gillingham Method Useful in Teaching English as a Second Language
Researcher and author of Teaching and Assessing Phonics, Jeanne S. Chall, states that students for whom English is a second language (ESL) may experience difficulty discriminating sounds that are not in their native language. Chall adds that confusion will be lessened considerably if the teacher is aware of variations and provides additional support through teaching phonemic awareness.
The Institute for Multi-Sensory Education continues to provide the most up-to-date and successful multi-sensory program for all teachers. ESL, transitional, and bilingual teachers are finding Orton-Gillingham training to be the most systematic, structurally sound method of reading instruction available. A multi-sensory phonetic strand in conjunction with whole language is essential for a balanced approach to meet the needs of all children.
Please see our endorsement from Passaic Public Schools concerning this issue.
Winner of Recipe for Reading
Congratulations
We wish to congratulate Elizabeth Edwards of Johnson City, Tennessee, as the latest winner of our free drawing.
She won a copy of Recipe for Reading, by Nina Traub. We look forward to announcing future winners.
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