Diagnosis can and should only be made by a trained medical professional



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Overview
According to the American Psychiatric Association, Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurobehavioral disorders of childhood and can persist through adolescence and into adulthood. The American Psychiatric Association’s Diagnostic and Statistical Manual-IV-TR estimates that 3 to 5 percent of school-age children are affected by ADHD. The cause(s) and risk factors contributing to ADHD are unknown, although it seems to be more prevalent among boys than girls. The most common core characteristics are:


  • Distractibility (poor sustained attention to tasks)

  • Impulsivity (impaired impulse control and delay of gratification)

  • Hyperactivity (excessive activity and physical restlessness)

In order to be diagnosed ADHD, these behaviors must be excessive, long-term and pervasive1. A key factor is the symptoms that caused impairment are present before age seven and continue for at least six months2. Furthermore, these symptoms must create a real handicap in at least two areas of a person's life, such as school, home, work or social settings3. These criteria set ADHD apart from the normal distractibility and impulsive behavior of childhood, or the effects of a busy lifestyle. Some examples of recognizable behavioral signs of youth diagnosed with ADHD include but are not limited to:




  • Difficulty sitting still

  • Short attention span

  • Frequent “spacing out”

  • Trouble sharing or waiting his or her turn

  • Quickly moving from one activity to the next

  • Frequent signs of distraction and disorganization of thoughts
  • Trouble making and keeping friends

These behavioral signs are common among youth with ADHD; however, do not indicate a diagnosis of the disorder. Diagnosis can and should only be made by a trained medical professional 4.


Understanding the Club Member with ADHD

Understanding ADHD can be somewhat challenging since medical experts are still learning about this disorder. This is coupled with myths about the disorder that fail to recognize its causes and implications. It is important for Club professionals to understand that ADHD is a real disability that effects all aspects of a person’s life, though it does not need to be handicapping. Club members with ADHD will more commonly have difficulty with handling homework, completing tasks, following instructions, staying attentive to programs, and getting along with other Club members.


Clinical experience has shown that the most effective treatment for ADHD is a combination of medication (when necessary), therapy or counseling to learn coping skills and adaptive behaviors and parent education5. Medication often is used to help normalize brain activity, as prescribed by a physician6. Stimulant medications (Ritalin, Dexedrine and Adderall) are commonly used because they have been shown to be most effective for most people with ADHD7. However, many other medications may also be used at the discretion of the physician. Club professionals should not attempt to diagnosis Club members as ADHD but can provide appropriate and proper feedback (as deemed by the local organization) to parents and/or guardians concerning behaviors and actions. Parents should consult a trained medical professional to ensure proper diagnosis of ADHD.

Although medication can be an important component of treating ADHD, it is only one piece of a responsible treatment plan. Other equally important components of treatment include providing a supportive Club environment and reinforcing adapting skills such as time management, organizational and memory skills. Also, empowering Club members to learn can be assisted in understanding how they learn best, and what kind of physical setting is the most productive for them. Establishing an appropriate communication plan is essential. Some common components of communication plans include an outline of staff responsibilities in referral, a method of documenting Club members’ behavior over a period of time, a step by step approach on observations and communications, how to communicate with parents and when necessary medical professionals among others. More information on Club professionals’ role in a comprehensive treatment plan can be found in the resources section.


Strategies and Approaches

Understanding ADHD encourages many new choices for creating an environment that are both healthy and productive for ADHD Club members. With a positive and empowered perspective, Club professionals can promote activities to the ADHD Club member that make good use of the Club member’s time, teach essential life skills, provide educational content, use surplus energy, are fun and improve self-esteem. The following strategies are intended to provide a general approach to educational programming for ADHD Club members. Of course, staff should tailor their approach to the individual needs and interest of Club members. Each category begins with educational strategies that are consistent with the Project Learn approach for all members yet are still supportive to ADHD Club members. Immediately following these suggestions is a list with more ADHD specific educational strategies.



Creating an Appropriate Learning Environment
ADHD supportive:


  • Provide as much flexibility as possible in allowing Club members to study in environments they feel comfortable. This provides a sense of belonging to their environment and ownership to the material that are studying.

  • Charts and bulletin boards that track positive behavior performance such as homework completion, attendance and good conduct are helpful in reinforcing positive behaviors and giving immediate feedback on behaviors.

  • An ideal learning environment for all members but specifically for ADHD members is one that is organized with well-defined, posted rules and schedules. The learning environment should cater to a diverse selection of learning opportunities, interactive experiences and creative projects.

ADHD specific:


  • ADHD Club members should sit in relaxing areas with less distracting features. Avoid placing ADHD youth in front of windows, open doors, high traffic areas and bright colored walls, objects and projects.

  • Distractions that many Club members may find normal on a given day are magnified to an ADHD Club member (e.g. voice intercoms during homework time, talking in the room, poor lighting, uncomfortable room temperature).

  • ADHD Club members should never be isolated or placed in a corner to study; Club members tend to drift away or feel detached from other members. Promising approaches indicate improvements in ADHD Club members’ behaviors and self-esteem when surrounded by positive peer members.

  • Club professionals should be attentive to the needs of ADHD Club members while not setting them apart from other youth.



Homework Help and Tutoring



ADHD supportive:


  • Club professionals should take in account what has been learned and observed from the Club member’s learning style, interests, needs, individual education plan and other significant adults to develop a homework help and tutoring plan.

  • In collaboration with other stakeholders, develop an assignment sheet for all assignments. Parents, teachers and Club professionals should sign off on all tasks as a tool to monitor the student's work and use the sheet for daily communication.

ADHD specific:

  • ADHD Club members should know in advance what they will learn. Providing visual aids, giving written as well as oral instructions and verifying understanding are all ways to help students focus and remember the key parts of homework help and tutoring.


  • ADHD Club members will need extra help for a longer period of time than will other students; decrease this dependence gradually.

  • Club members with ADHD often need to learn techniques for monitoring and controlling their own attention and behavior. For example, provide youth with several alternatives when they lose track or direction (e.g. looking for instructions on the blackboard/bulletin boards, raising hands, cue cards, visual reminders or quietly asking a peer helper).

  • Use creative approaches to help ADHD Club members feel as they belong in the homework and tutoring setting (e.g. peer tutoring, cooperative learning groups, group discussions, group leaders, recognition and appropriate incentives).

  • Young people with ADHD need scheduled, routine and goal-oriented academic time. Club members should come to expect homework help time and should often be reminded of its importance. In addition, these Club members often need additional academic goal-setting support and assistance in focusing on goal attainment (e.g. Goals for Graduation, Goals for Growth, etc.).



High-Yield Learning Activities for ADHD Club Members


ADHD supportive:


  • Club members with ADHD respond to fun and enjoyment just as any other young person. Academically beneficial yet fun activities should be the cornerstone in helping Club members learn throughout the Club.

  • Club professionals should consistently seek to redirect socially unacceptable behaviors into other areas to build positive outcomes for youth (e.g. using hyperactivity to engage a Club member in a recreational learning activity).
  • Many ADHD youth find activities boring; Club members should be introduced to new people, places, things as well as connected to what they find interesting. (e.g. field trips, sports, supervised internet searches, art programs, appropriate pop culture books and magazines).



ADHD specific:


  • Using high-yield learning technology and games such as computers, cameras, chess and puzzles allow Club members to explore and move around actively. This approach can be very effective in helping ADHD Club members identify an interest and become self-directed learners.

  • Activities involving positive role modeling clear directions and rules, positive peer interaction as well as requiring total mental and physical involvement are academically as well as socially beneficial for ADHD youth (e.g. team sports, karate, swimming, stepping, musical performances, games room activities).


Working with Parents, Other Significant Adults and Schools





  • Work with parents to establish continuity between completing schoolwork in the Club and at home. Encourage parents to find a quiet study area at home and set regular schedules for working together to do homework and to organize book bags and school supplies.

  • Invite positive and appropriate adults who are successfully handling any type of chronic disorder to speak with all Club members about handling these impairments.



ADHD specific:


  • Determine if a Club member diagnosed with ADHD has a comprehensive treatment plan and explore ways for the Club to support this plan.

  • Create and continue an open line of communication between all stakeholders involved in supporting treatment particularly parents and teachers.

  • Sponsor events for medical experts to talk with parents and staff about understanding and assisting ADHD youth.
  • Invite teachers or others who are experienced with teaching ADHD youth to serve as volunteer tutors and in other Club roles. Share and exchange information with teachers to assist the Club member’s development.




Recognition and Incentives


ADHD supportive:


  • Reward Club members regularly for any good behavior – even little things such as following instructions and staying attentive. Youth with ADHD often spend most of their day being told what they are doing wrong. They need to be praised for good behavior.

  • Reward Club members when they finish schoolwork, not just for good grades. Staff can give extra rewards for earning better grades.

  • Only promise what you will deliver. Youth in general take promises and commitments by adults very seriously.

  • Don’t allow behavior inconsistent with the rules of the Club. Hold all youth to the same standard.


ADHD specific:


  • Club professionals should look for and encourage ADHD Club members’ strengths, interests and abilities. They should be assisted to use these as compensations for any limitations or disabilities.

  • ADHD Club members should receive consistent praise, good words, smiles and pats on the back. Because low self-esteem is common among youth with ADHD, frequent positive recognition is very important.

Resources
Web sites

Attention Deficit Disorder Association http://www.add.org

Children and Adults with Attention Deficit http://www.chadd.org

Hyperactivity Disorder

KidSource http://www.kidsource.com/
kidsource/pages/dis.add.html

ADDvance Magazine www.addvance.com



ADDitude Magazine http://www.additudemag.com

Beth's Little Corner of Cyberspace www.pcnet.com/~dodge


Greater Rochester ADD Association www.netacc.net/~gradda/

ADD on About.com http://add.about.com
Books for Club Professionals, Parents and Other Significant Adults


  • Barkley, R.A. (1995). Taking Charge of ADHD: The Complete, Authoritative Guide for Parents. New York: Guilford Press. Paperback, 294pp.

  • Educators Manual: Attention Deficit Disorders. An In-Depth Look from an Educational Perspective. Plantation: CHADD. Paperback, 80pp. Can only be ordered from CHADD's distributor, Caset by calling 1-800-545-5583, or from the ADD WareHouse Catalog at 1-800-233-9273.

  • Copeland, E. D., & Copps, S.C. (1995). Medications for Attention Deficit Disorders and Related Medical Problems: A Comprehensive Handbook. Plantation, Fla: Specialty Press. Hard cover, 406pp.

  • Sourcebook for Children with Attention Deficit Disorder: A Management Guide for Early Childhood Professionals and Parents. Published by COMMUNICATION SKILL BUILDERS (The Psychological Corp.) 1-800-763-2306. Levine, M. (1994).

  • The Attention Deficit Disorders Intervention Manual. Columbia, Mo.: Hawthorne Educational Services. Paperback, 404pp.


Books for Children and Teens with ADD


  • Crist, J. (1996). ADHD: A Teenagers Guide. King of Prussia, Penn.: Center For Applied Psychology. Paperback, 173pp.:Written specifically for teens with ADHD, presents information and practical advice.

  • Bramer, J.S. (1996). Succeeding in College with Attention Deficit Disorders. Paperback, 189 pages. Plantation, Fla.: Specialty Press. A very practical, well written, useful book for college students with ADD and those planning on going to college. Also recommended for counselors and educators.


  • Moss, D. (1989). Shelly the Hyperactive Turtle. Rockville, Md.: Woodbine Press. Hardcover, 24pp. An illustrated story, for young children ages three to seven.

  • Fellman, W. R. (1997). The Other me: Poetic Thoughts on ADD for Adults, Kids and Parents. Plantation, Fla.: Specialty Press. Paperback, 121 pp. A collection of poems for adults with ADD and parents of children with ADD.

41 American Psychiatric Association. “Fact Sheet: ADHD.” (Washington, D.C.: March 2001). www.psych.org/public_info/adhdfactsheet42401.pdf.

2 Jaska, P. “Fact Sheet on ADHD/ADD.” (Highland Park, Ill.: 1998). http://www.add.org/content/abc/factsheet.htm. Attention Deficit Disorder Association.

3 Ibid.


5 Booth, R.C. “Basic Info about Attention Deficit Disorder.” Attention Deficit Disorder Association. (1999).

6 Ibid.

7 Ibid.






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