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Managing ADHD in the Classroom

- Normal school rules such as don’t run, stay in your seat, don’t be late, don’t call out are difficult for
ADHD
- Chairs that are made from balls to allow them to fidget in a controlled way
- Spaces that allow children to sit in different ways and not just standard classroom chairs
- Introduce activities such as climbing walls to deal with hyperactivity and urge to climb
- Due to tendency to interrupt, create a system where they have to get a talking stick or a similar aid
- Classrooms are often packed with stimuli which can be distracting
o Create spaces without visual distraction for children with ADHD to concentrate in
- Teach tips for organisation and let them speak with white boards


Impact of Comorbid Issues in the Classroom (Psychosocial)
- Depression (suicide behaviour is 10% for ADHD, 1% for ‘normal’)
- Anxiety and mood swings
- Drug abuse (self-medicating)
- Family problems (attachment issues)
- Identity issues (troublemaker tomboy)
- Criminal behaviour
o Not necessary separate- should treat problems not the symptoms

Medication
- Can improve cognition
o WM
o Motivation
o Inhibitory control
o Attention
- Can have side effects
o Sleep disturbance
o Nausea
o Abnormal heart rhythm
o Bladder problems
o Anxiety and paranoia
o Irritability and aggression

Research for Medication says:
- No association between amphetamine medication and serious cardiovascular events
- Atomoxetine may affect Cardiovascular system, they are not clinically significant in most patients
- Adderall is the same genetic makeup as amphetamines which is used in the US to treat kids
o Same genetic makeup as speed which caused 157 deaths a year and can be 14 years prison
- Data from supplementary protection certificate does not suggest there are associations between
atomoxetine and suicidality or aggression
- ‘Risk for serious cardiovascular adverse events associated with atomoxetine is extremely low and
the benefits of treating ADHD outweigh the risks’ (Martinez, 2013)
o Question of whether we want to treat the child’s ability to sit still and be quiet or what they
are their parents feel is causing them the most suffering?



Risks of Cardiovascular problems with ADHD medication (Martinez, 2013)
- Stimulant medications for ADHD including Methylphenidate and amphetamine are generally safe
and well tolerated
o Small but statistically significant increases in blood pressure and heart rate are among the
adverse events of stimulant treatment in all age groups
- Non-stimulant medication atomoxetine has also been associated with increased heart rate and
blood pressure
o These are generally minor, time limited and of minor clinical significance
- Medications do not cause sudden and unexpected cardiac death or serious cardiovascular problems
i
...
clinically significant increases in QTc
- Caution should be taken when considering medication for patients with personal or family history
or other risk factors for cardiovascular disease

Drug treatment for ADHD and suicide behaviour (Chen, 2014)
- No evidence for a positive association between the use of drugs and the risk of suicide behaviour
- Results pointed to a reverse association, suggesting a potential protective effect of drugs for ADHD
and suicide, particularly stimulants; due to increases in the dopamine system associated with
rewards
o High validity with the use of within patient designs to control for confounding effects


Role of diet and behaviour (Breakey, 1997)
- Review paper showed that a range of studies showed a statistically significant change in behaviour
with a dietary intervention
- A degree of change was found with partial responses (not always all or nothing)
- Colours and additives and flavour preservatives as suspect items that affect behaviour in diet
- Important with ADHD to also observe sleep and physical problems when looking at diet
Skills training (psychosocial treatment) for ADHD (Schoenfelder, 2016)
- Drug treatment may be good at treating some symptoms but alone does not suffice in providing
children the skills to live with the deficits associated with ADHD
o Best approach may be a multimodal plan that is drugs and psychosocial skills development
- Between 20-30% of ADHD children to not benefit from drugs
o Side effects can include insomnia and diet suppression
- Psychosocial treatments include interventions designed to address behavioural, emotional,
interpersonal aspects of the disorder
- Inattention and off-task behaviour in class inhibits learning and school engagement
o Causes social problems with peers and teachers
- Children experience stress and frustration related to psychosocial problems which can lead to
comorbidities
o Anxiety, conduct disorder, substance misuse and depression
- Rely on parents, teachers or professionals to learn and implement contingency management
procedures to manage behavioural and functional problems associated with ADHD
- Don’t necessarily reduce symptoms of ADHD such as distractibility
o Do improve children’s functioning across multiple settings
- Multimodal Treatment study for ADHD; drug/psychosocial intervention combinations
o Drugs reduced core symptoms
o Behavioural treatment in addition to medication saw significant improvements in:
§ Social skills

§ Parent-child relationships
- Types of skills training
o Behavioural Parent Training (BPT)
§ Parents learn and use behavioural reward principles to adapt behaviour
• Reduce aggression symptoms and parent-child conflict
o Behavioural Classroom Management (BCM)
§ Teacher implemented classroom rules with daily report to track progress
• Improves attention, aggression and social skills
• Equips teachers to foster peer relationships and deal with ADHD in classroom
o Behavioural Peer Interventions (BPI)
§ Parents and staff trained to manage contingencies in children’s social situations
• Improvements in behavioural and academic functioning and prosocial
behaviour
o Organisation Skills Training (OST)
§ Teaches skills lacking due to ADHD symptoms (managing time, planning tasks)
• Improve homework compliance and organisation skills


Non-Pharmacological Interventions for ADHD (Sonuga-Barke, 2013)
- Fatty-acid free supplementation produced small but significant reduction in ADHD symptoms

Environment, Cognitive Enhancement and Physical Exercise (Halperin, 2011)
- ADHD now chronic that continues into adolescence and adulthood
- Continued treatment throughout lifetime problematic and costly
- Need long lasting treatments that have a lasting effect after an intervention is finished
o Use of physical exercise to promote brain growth which may produce enduring effects and
treatments for the disorder

Mindfulness training for behavioural and attentional problems in ADHD (Weijer, 2011)
- Adolescents with ADHD involving parents as well
- Attention and behaviour problems reduced and EF improved
o Self-report measures- not the most reliable (low validity)
- Performance on attention tests were found after mindfulness training
o Effect waned at 16 week which questions the sustainability of the intervention
§ Need to develop maintenance strategies

Classroom behaviour management strategies (Nye, 2015)- telephone SENCO
- Positive praise and rewards
- Clear structure and communication
- Positive relationships
- Emotional support and training
- Alternative tasks and redirecting attention when distracted






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