Attention Deficit Hyperactive
Disorder… a Teacher’s Perspective
by
ADHD, or Attention
Deficit Hyperactivity Disorder, is a label given to children and adults who
suffer from inattention, impulsivity, hyperactivity, and boredom. ADHD is one
of the most common mental disorders among children. The National Institute of
Mental Health reports that three to five percent of all children — perhaps as
many as two million American children — are diagnosed with ADHD, an average of
at least one child in every classroom in the United States.
Many educators believe that ADHD is over diagnosed and
overmedicated. They feel that ADHD is the result of bad teaching, bad
parenting, and willful disobedience by children. On the contrary, ADHD is a real neurological disorder that
must be treated as such. According to Harvard Medical School, Attention
Deficit Disorder is caused by insufficient availability of the neurotransmitter
norepinephrine in the central nervous system. Stimulant medications, such as
Ritalin, can increase the levels of norepinephrine and help relieve the
symptoms of inattention, boredom, and impulsiveness.
The
Itch
Garrulous students occupied my sixth grade classroom after
lunch, a few actually seated for class, many clustered with friends in small
groups, and some strolling leisurely into the classroom. I took a deep breath,
preparing for ninety minutes of geometry.
I stood before my class and raised my hand, feeling a moment
of satisfaction as murmurs dwindled slowly. Twenty-eight students sat
quietly, their eyes focused on me. Melissa, as usual, was not in her seat
or looking at me. She weaved her way around desks slowly approaching
me. I felt familiar frustration rise toward the child that I nicknamed
“The Itch.” Students began whispering among themselves, and it would be
difficult, if not impossible, to regain their attention. I sighed as
Melissa handed me an envelope. “Mom said to give you this.”
I didn’t admonish Melissa for interrupting class.
Melissa loved math, was happy in school, an A student, energetic and
bright. But she was impulsive— often blurting answers without raising her
hand and handing me notes in the middle of class. She was, “The
itch.”
I sighed as I opened the envelope immediately in front of
the class. Bad protocol, but experience had taught me it was best to
respond quickly to parents. The envelope contained a card with a handwritten
message inside. The class became a roar of talking, laughing, and
whispering voices as with a pounding heart I read,
“Please accept this small token of my deep appreciation in regards to the pleasant phone call I received about my daughter, Melissa Smith. It was truly a nice surprise (as well as a shock) to have a teacher call and praise a child about her good grades rather than calling about a discipline problem. I can honestly say that I have never had a teacher call me to tell me what a good job Melissa was doing in class. Ms. Allen, you made my day. Melissa is lucky to have been in your class! Thank you for having such a positive impact on my daughter and much continued success to you! Sincerely,
Amy Smith.”
Tears wet my eyes. I turned my back to the class and
faced the board. I allowed myself the luxury of reading the card
again. Melissa would continue to be a challenging child in any teacher’s
classroom. But she, and equally as important, her peers would
learn.
Several things I did were unorthodox. I “wasted”
instructional time calling Melissa’s mother during class. And even worse,
I discussed Melissa’s progress in front of other students. If an
administrator had walked into my classroom while my back was turned, while my
students were off task and talking I most certainly would have faced a
reprimand and a letter would have been put in my file.
During the years I spent in the classroom I have watched
students like Melissa learn— and yes, I sometimes met failure with students who
didn’t succeed. On those occasions, I did not consider myself a failure,
although many in my profession would. The needs of some children were beyond
those that could be met in my classroom.
The
Tasmanian Devil
Three review problems written on the overhead projector
welcomed students as they entered the classroom. Students were required
to sit quietly and copy and answer the problems. It was a necessary
“warm-up” routine designed to engage their sixth-grade minds in “school
mode.” Richard Hunt, also known as the “Tasmanian Devil,” sat in an
exclusive front row seat. His desktop contained one sneaker, one shoelace, and
one pencil. Richard was intensely concentrating on inserting the shoelace back
into the eyelets of his sneaker. No textbook, paper or any other
implement of learning cluttered his otherwise empty desktop.
I handed him a copy of the overhead review questions.
“Start your warm-up, Richard,” I whispered. He didn’t acknowledge my
presence. I took the sneaker, rather forcefully because he didn’t want to
let go. “I’ll lace your shoe; you do your warm-up.” Richard looked
unsure. His eyes remained on the sneaker in my hands while the class
finished their warm-up, his questions left blank on the paper I’d given
him.
I taught the math lesson; then students worked in small
groups practicing some problems. After a few minutes, lined paper
littered the floor in a large circle around Richard’s team. Big black
numbers filled each sheet of paper. Richard, his lips puckered in
concentration, wrote with one of my blackboard markers. He stopped,
sniffed the marker, and stared at it, fascinated. “No, that’s wrong, Richard,”
his teammate Alex said. Richard angrily threw the paper to the growing
pile on the floor enveloping his team and pulled a new sheet of notebook paper
from his binder.
“Richard, where is your pencil?” I asked.
“I don’t know. I lost it,” Richard replied,
shrugging. I stared at the child, then at his floor and desktop.
The pencil was nowhere in sight, but it could be under any one of the twenty or
thirty sheets of paper on the floor. I sighed, gave him another pencil, and
removed the marker before he could become high from snuffing.
“Would you all please help Richard clean up these papers
before you answer any more questions?”
“Yes, Ms. Allen,” students chorused.
The “Tasmanian devil” that was Richard Hunt sat in the front.
He required preferential seating. Even so, a small hurricane usually
ensued from in his general direction before the end of class. It began
with a murmur of talking. Then spitballs, staples or any number of
projectiles would fly through the air.
I was required to give Richard copies of my overhead
notes. He couldn’t copy information from the board. His writing
ability was on sixth-grade level, his reading slightly below that.
Ability wasn’t the problem. The sound the overhead projector made and the
small rainbow of light it reflected onto the ceiling fascinated him so much
that he couldn’t concentrate to copy information. He drew pictures on his
paper, fascinated by their shapes. He could spend an entire ninety-minute
class on one detailed drawing. I thought he showed exceptional ability in
art, although his art teacher didn’t think so. Richard painted his
pencils with correction fluid, and then scraped it off, leaving tiny white
shavings covering his desk and the floor. He snuffed the fluid and the
shavings.
Richard played with anything on his or his neighbor’s
desk. Because he never remembered his own supplies, or he lost them
during class, he stole supplies from his neighbor, usually causing a
disagreement. I frequently had to change the seating of students sitting
next to him due to complaints from students and parents. I gave Richard two
textbooks so he could keep one textbook at home and one in his locker.
Still the textbook was an enigma that somehow never made it to class.
Richard kept an assignment book where he recorded his
homework assignments. I initialed it before he left my class each
day. At the group home where Richard lived, he earned privileges based on
completion of the homework assignments written in his assignment book.
Still, I rarely saw his homework. It was lost in transition.
He had lived in the group home since first grade. That
year he was in a car accident that killed both of his parents. When
Richard began having behavior problems in his new home and in school, the
school psychologist, in cooperation with the school resource teacher,
administered a series of tests that revealed he had a condition known as
Attention Deficit Hyperactivity Disorder, or ADHD.
Richard is a student with a disability, also known as an
exceptional child (EC).
The Individuals with Disabilities Education Act (IDEA), a
federal law reauthorized in 1997, guarantees children with disabilities a “free
appropriate public education” in the least restrictive environment (LRE).
Children with disabilities must be educated with children without disabilities,
to the maximum extent possible. So, the least restrictive environment is
typically the regular classroom.
Children with disabilities may be removed from the regular
educational environment only when the disability is so severe that education in
regular classes is not possible. It was possible (if not ideal) to educate
Richard Hunt in the regular classroom. Toward that end, Richard’s
teachers, the school psychologist, and the assistant principal wrote an
Individual Education Plan, or IEP, for him. Richard’s IEP gave him
modifications to help him in school. These included extended time on tests,
testing in a separate room, having tests read orally to him, study guides,
preferential seating away from distractions, and copies of the teacher’s notes.
ADHD is one of the most common mental disorders among
children Richard’s age. The National Institute of Mental Health (NIMH), states
that 3 to 5 percent of all children — perhaps as many as two million American
children — have been diagnosed with ADHD. On the average, at least one child in
every classroom in the
Attention Deficit Hyperactive Disorder is perplexing because
it is not one particular mental disorder, but rather it is a group of symptoms,
or behaviors, that fall under the diagnosis of ADHD. Any one of four
groups of behaviors: hyperactivity,
impulsivity, inattention, and boredom, or any
combination of the four, lead to the classification ADHD. Richard was
inattentive and hyperactive. His attention was focused on insignificant
things in his environment, such as his shoelaces and the smell of the marker he
was using. He moved around constantly, touched his neighbors and anything
around him.
The Diagnostic and
Statistical Manual of Mental Disorders, or DSM, is a checklist of
behaviors used to classify a child with ADHD.
According to the DSM, inattention
means a child is so distracted by irrelevant sights and sounds that he or she
fails to pay attention to details and makes careless mistakes. He has
difficulty following instructions without being redirected. She loses or
forgets tools needed for a task, like textbooks, homework, toys, or pencils.
According to the DSM, some signs of hyperactivity
and impulsivity are
fidgeting, squirming, running, difficulty waiting in line or for a turn and
restlessness. The student leaves his or her seat or blurts out answers
during a classroom setting (like Melissa). He answers questions before
hearing the whole question.
This could be because children with ADHD have a lower level
of activity in the part of the brain that inhibits impulses. Scientists
at NIMH used positron emission tomography, or a brain scan, to look at brains
of people with ADHD and those without. Tests showed that the brains of
people with ADHD were less active in the area that inhibits impulses, proving
that there is a physical condition behind the behaviors classified as ADHD.
ADHD may be caused by underdeveloped connections in the
brain related to the number and size of brain cells and the number of
connections between them. If the brain lacks the neurons to process incoming
information it will process some, but the rest will be lost, like a computer
unable to run software due to lack of available memory. Some programs may
run on low memory, but they must be shut down before you can run others or the
computer will freeze and nothing will run. An ADHD student’s mind, like that
computer, becomes overloaded with information, and the student becomes
distracted. It will take time for information to process through overloaded
neurons in the brain of a child with ADHD, longer than the time it would take
an average child. Therefore, students
with ADHD need extended time for assignments and tests.
ADHD seems to be genetically inherited. Children with ADHD
usually have at least one close relative with the disorder. One-third of
all fathers who had ADHD will pass it on to their children. The Surgeon
General’s report in 1999 proposed a dopamine-transporter gene on chromosome 5,
and a dopamine-receptor gene on chromosome 11 as possible sources of genetic
variation. Severe ADHD may be caused by abnormalities in the
dopamine-transporter gene (DAT1).
Stimulants increase the availability of dopamine,
controlling the symptoms of ADHD. Stimulants given to increase dopamine
availability include methylphenidate (Ritalin, Metadate,
and Concerta). Ritalin is the most widely known
form of methylphenidate, a central nervous system stimulant. In normal
adults it effects are more potent that caffeine and less potent than
amphetamines. In children with ADHD, it has a calming, focusing effect.
Other stimulants used to treat ADHD are amphetamine (Adderall),
dextroamphetamine (Dexedrine, Dextrostat), and pemoline (Cylert). Some
children who do not respond to stimulants are given antidepressants such as bupropion (Wellbutrin).
Side effects of such stimulants are reduced appetite,
insomnia and, less frequently, liver damage. On a cautionary note,
stimulants do not have Food and Drug Administration (FDA) approval for use in
children. A physician treating a young child with ADHD may prescribe a
medication that has been approved by the FDA for use in adults or older
children. This is called "off-label" prescription. Even though the
FDA approves a stimulant for a defined population (adults), after that drug is
approved and on the market, any physician may prescribe the drug to any patient,
including children. The sponsor, however, is allowed to market the drug only
for the approved population. This is why most drugs used to treat mental
disorders in children are dispensed with this warning: "Safety and
efficacy have not been established in pediatric patients." A
physician who prescribes an “off-label” drug for a child does so without the
benefit of any research on safety and dosages in children.
While researchers study the genetic roots of ADHD,
environmental and nongenetic factors are equally
compelling. Hyperactivity and inattention correlate positively in
children whose mothers smoked or used alcohol or other drugs during
pregnancy. Alcohol and nicotine in cigarettes may damage developing nerve
cells in fetuses. Fetal alcohol syndrome (FAS), caused by the mother’s
heavy alcohol consumption during pregnancy, is a condition leading to behaviors
similar to those of ADHD. FAS can also cause intellectual impairment, low
birth weight, and physical abnormalities in addition to ADHD-like symptoms.
Cocaine — including crack, the smokable
form — when used by a pregnant woman, seems to interfere with the
formation of brain receptors in the fetus. In such children, incoming
signals from the senses (eyes, ears, and skin) are not transmitted to the brain,
so the child seems unaware of his surroundings. These children often display
ADHD symptoms.
Dr.
Jekyll and Mr. Hyde
Taylor Reed moved into our school district a few weeks after
the school year started for his second try at sixth grade. He was
prescribed Ritalin for ADHD. After two weeks in our school, his math teacher, a
veteran teacher of twenty years, threatened to quit if Taylor wasn’t removed
from his class. Taylor’s behavior was disrupting his class so Taylor was put
onto my team for science and math. But before he joined my team, he was caught
selling marijuana to another student and suspended for ten days. By the time I had started working with
Taylor was a high-achieving student during science. He
couldn’t read the science textbook, but would listen when partnered with
another student who read to him. He answered all the science questions
carefully in neat, beautiful handwriting. He loved hands-on
activities. He was a model student who did well.
During math, however he turned into Mr. Hyde. The
first day of class he said, “I am not going to do that fucking work. It’s
too hard. You need to learn to fucking teach.” The rest of the days
followed a disturbingly similar pattern. One day he made the mistake of
calling a student named Jamal a “crack head.” Jamal punched him, and then
Taylor threw a desk at Jamal. I had to call our security guard to remove
Taylor from my class.
Taylor was truly a Jekyll and Hyde. He was a dedicated
student during science who changed into an
unrecognizable monster during math class in the afternoon. There were two
reasons: First, Taylor didn’t like math. Second, he took a 24-hour
dose of Ritalin in the morning, but the timed-release dose didn’t seem to work
properly because his impulsivity became more pronounced during the afternoon.
My goal was to get through math class each day without
physical violence erupting in my classroom. I had given up on teaching
anyone math. Taylor started sitting under the table in the back of the
classroom. He said the lights hurt his eyes in the front of the
classroom. I breathed a sigh of relief. He was quiet. I could
teach the others.
Taylor was not successful. He scored so low on his
end-of-grade math test that The Committee on Special Education placed him in a
more restrictive environment for the seventh grade — the Behaviorally Educably
Handicapped class which consisted of twelve students, one
teacher, and one teacher’s assistant. He would finally receive the help
he so badly needed, but too late. Taylor would be sixteen in January of
his eighth grade year and a prime candidate to drop out.
What
turned Dr. Jekyll into Mr. Hyde?
How could this happen? Melissa, Richard, and Taylor
all suffer from the same disorder, ADHD. All three take medication for their
disorder. Melissa is a strong A student, who frustrates her teachers, but
her behaviors are controlled. Richard is a “Tasmanian Devil,” who is hard
to manage but will learn in the regular classroom — with modifications of
course. He will probably not earn A’s or make the honor roll, but he will
learn. In contrast, Taylor is truly “Mr. Hyde.” He has not been
successful either in the regular education environment or in the more
restrictive environment of the behaviorally educably handicapped
classroom. He is in trouble with the law and a prime candidate to drop
out without even the skills necessary to perform the most menial jobs in
society.
What is the difference? The answer is chance; call it
luck or fate. Melissa was fortunate. She had a caring mother who
monitored her progress closely and worked with her doctors and the school
system from the time she was diagnosed in kindergarten. Richard was also lucky;
he lived in a group home where the child welfare system protected him. When he
began having difficulty at school, something was done for him immediately.
Richard was put on Ritalin and monitored closely, by both the school system and
his caretakers. He will most likely finish high school and may go on to
college.
Why didn’t his teachers help him? Simple, he spent so
little time at one school that his teachers didn’t know him. It takes
several months, sometimes a whole school year, to get a student placed in a
more restrictive environment. Even when glaring signs of trouble in school and
with the law were evident, Taylor still floundered in the regular educational
system until age fifteen. Taylor didn’t have anyone to advocate for him.
Therefore, teachers and parents of children with ADHD must
work miracles every day in the least restrictive environment and in the
home. Pediatricians and physicians do the only thing they can do:
prescribe medication. Social workers, psychologists, and psychiatrists
that work with children are underpaid and overworked. The government and child
welfare protect our children while scientists continue working to find a “cure”
for this perplexing disorder called ADHD.
Note: Although Melissa, Richard, and Taylor are
representative of typical students, they do not exist.
References
ADHD.com,
the online community (2004). http://www.adhd.com/index.html
Buresz, Allen MD. Natural Health and
Longevity Resource Center. Attention Deficit Disorder &
Hyperactivity Success. Retrieved July 5, 2003 from http://www.all-natural.com/add.html
Least
Restrictive Environment Coalition. (1999-2001). Laws on LRE. Retrieved July 5, 2003, from http://www.lrecoalition.org/02_lawsOnLRE/#3
National
Institute on Drug Abuse. (June 25, 2003). Methylphenidate (Ritalin).
Retrieved July 5, 2003, from http://www.nida.nih.gov/Infofax/ritalin.html
National
Institute of Mental Health. (September 30, 2004). Attention Deficit
Hyperactivity Disorder http://www.nimh.nih.gov/publicat/adhd.cfm#intro
The
ADHD Information Library. (2003) Retrieved October 5, 2004 from http://www.newideas.net
U.S. Department of
Health and Human Services (1999), Mental
Health: A Report of the Surgeon General. Rockville, Md. http://www.surgeongeneral.gov/library/mentalhealth/home.html
Publication
Information
Education Today. Issue 2,
Term 2. (2005).
Education Articles. 2006. http://www.edarticle.com
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