ADHD

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    • 00:11

      TINA RAE: My name's Dr. Tina Rae.And I work at the University of East Londonas a professional and academic tutoron the doctorate course for educational psychologists.My special interest is in the areaof well-being and mental health.In this tutorial, I'm going to talk about ADHD.I'm going to attempt to define ADHD as a condition,and also discuss some of the complexitiesaround this whole diagnosis process,and how difficult that can be for both staff, parents,and the children involved in the process.

    • 00:42

      TINA RAE [continued]: And I'm then going to think about what the implications areof that diagnosis within the classroom context,and how parents and teachers can support childrento engage in the classroom more appropriately, moreeffectively, notwithstanding the difficulties that they have.So what is ADHD?ADHD is basically a syndrome whichencompasses a range of behaviors including hyperactivity,attention deficit, a deficit in attention,and levels of impulsivity which are really quite extreme.

    • 01:14

      TINA RAE [continued]: So combined together, those kinds of behaviorsreally do present difficulties for individual children,their parents, and teachers in the classroom.These children find it very difficultto pay attention for any significant period of time,unless of course an activity is very structured, and very kindof chunked into very short bursts,and interspersed with other activities.

    • 01:38

      TINA RAE [continued]: So if you had one main activity, they'dfind that very difficult to maintain their concentrationand attention for any length of time.The other element that's here, really,is the level of impulsivity that these childrenexpress both verbally and physically.They find it very, very difficult to respondin a considered way, and to stop, think, and reflect.

    • 02:01

      TINA RAE [continued]: And very often what happens is that theywill make impulsive gestures and responses, particularlyto a teacher who's trying to correct themor trying to support them, even, but alsoto other children within that classroom context.So in essence, it's very, very difficult.Because you will find that these children are almostwhat I would call hyper-vigilant, veryaware of what's going on.

    • 02:25

      TINA RAE [continued]: That kind of level of serotonin, I think,that they are having to deal with on a daily basiscan be pretty exhausting.But it's also exhausting for teachers in the classroomcontext, as well.The overall prevalence currently is around 3% to 10% percentin school-age children.And three to four times more boys are diagnosed than girls.

    • 02:48

      TINA RAE [continued]: Around 30% to 50% percent of those childrenwill continue to have the symptomsor display the symptoms right through adolescenceand into adulthood.And for some, those symptoms will go on wellinto their adult lives.The diagnosis has to be made via a multi-agency,multi-disciplinary team.And that usually will include a pediatrician.

    • 03:10

      TINA RAE [continued]: It has to include a pediatrician.Members of the CAMS team-- so theywill actually be working with that child or young person.And also, there's usually an educational child psychologistwho will work with the child or young personin school, alongside the parents, the child themselves,and the teachers.This is important, because prior to this development of makingit multi-agency, the assessment, therewas an awful lot of debate around diagnosesthat were made purely in a clinic.

    • 03:40

      TINA RAE [continued]: So a child would go to a clinic, and the clinicianmight ask the parents to undertake a strengthsand difficulties questionnaire.Or they would use what we call the Conners Rating Scales.And these are two tools that are stillused quite often, I think, in terms of the diagnosis.But what was missing, generally, wasthat this diagnosis would take place purely in the clinic.

    • 04:02

      TINA RAE [continued]: And what I think is important from the teachers' perspectivesis that those children are seen within the classroom context.Because sometimes the behaviors can and do differ.And that is really, really important.I also think that it's very, very difficultto make a diagnosis of this naturewhen you're just seeing a child for, say, an hour,in a clinic context and listeningto a parent's perspective.

    • 04:25

      TINA RAE [continued]: So I think we've moved on.And I think it's really important to note that.And we now are making diagnoses that Ithink are far more accurate.Once the assessment's made, from my perspective--and from the child's perspective--I think that's just the very beginning.Because what has to happen then is, so what do we do?We have to have a plan of action in termsof how we support that child or young person in the classroomcontext.

    • 04:49

      TINA RAE [continued]: What can be contentious in terms of the intervention thatsubsequently follows the diagnosis is that very often,the child may be prescribed some kind of Ritalinor other medication-- some kind of medication--that is actually going to presumably calm themdown and enable them to become more focused and centeredwithin a classroom context, and be able to pay more attentionand learn more effectively.

    • 05:18

      TINA RAE [continued]: And there is a huge debate in the educational worldaround whether or not this is the right way to go,in terms of actually medicating children-- whether or not,very often, putting in place behavioral intervention,support for parents, and changing the diet of the child,for example, are more effective.

    • 05:40

      TINA RAE [continued]: I'm quite pragmatic about this.I think you have to take it on a case by case basis.But for many children and their parents, the response will be,well this really has made a difference,having the medication.The problem is that although thereis some evidence-- a lot of evidence,primarily from the States-- that this is effectiveand it does work, there also is a lack of evidenceor research-- there is not a research base,I don't think-- in terms of the long-term effects of this.

    • 06:08

      TINA RAE [continued]: Because we haven't had people who've been on this medicationfor, say, 30 years or so.What would be the end result, in terms of any symptoms or sideeffects that they might experience in the longer term?I think in the classroom, it's really difficult.Because if you've got a child who is continuallyshouting out, who is unable to sit still,who keeps getting out of their seat, who needs to wanderaround, that can cause huge problemsin terms of actually maintaining a balancebetween inappropriate and appropriate behaviors.

    • 06:42

      TINA RAE [continued]: So in terms of actually managing the behavior,I think that's really quite tricky.But it's something that can be done.But it just means that whoever is actuallyteaching that child has got to have a real will and motivationto make that work.And is it takes a lot of energy to do that.But I think that if we are reallygoing to include these kinds of children in a mainstreamcontext and support them effectively, then we do,I think, as practitioners and educationalists,have a duty of care to actually ensure that those systems arein place within that classroom.

    • 07:15

      TINA RAE [continued]: I think it can be really, really difficult for a young person.Once you've been labeled as havingspecial educational needs, and you're on medication,and there are different structures beingput in place for you, I think that particularly adolescentsthat I work with are very aware of that.And I think there are times when theyfeel very vulnerable about it.

    • 07:36

      TINA RAE [continued]: I also think that they can feel extremely isolated in a schoolcontext.Because they can become the butt of other people'sbullying and jibes.And I think also they can feel isolated socially.I've had children who I've been working with ADHD who'vesaid quite openly that they feel as though they're different,they're weird, that they are ostracized,that they are not included in other people's activities.

    • 08:00

      TINA RAE [continued]: And it's very difficult, for example with younger children,when what tends to happen is theydon't get invited to sleepovers.They don't get invited to people's birthdays, primarilybecause other parents are worriedabout having to discipline a child who is, in their eyes,unmanageable.In the classroom context, the majority of teacherswill make use of what I call primarilybehavioral approaches.

    • 08:26

      TINA RAE [continued]: And they will introduce very, very clear rules,sanctions, rewards.And there will be a rewards systemfor that individual child.And I think that's important as well, because it's aroundactually getting the child to begin to self-monitor.So if targets are set, and they try to meet those targets,and they get rewarded for that, thereis something very important about that kindof positive reinforcement that they experience.

    • 08:52

      TINA RAE [continued]: I think the other thing that needs to be in placeis a system of time out, where that child isable to take themselves out of the classroom.Because sometimes they've got, in addition to the ADHDor as part of the ADHD, significant sensory issues.So they will get very wound up by loud noises,by lots of movement around them.

    • 09:14

      TINA RAE [continued]: And they'll need to actually go for some time out.And that's something that is not particularly--it's easy to sort out in a primary school.It's probably harder in secondary.But it's not particularly difficult, I don't think,in any school to actually get some kind of system in place.I think as well there's somethingaround the development of social skills-- social and emotionalskills development and programs to support that.

    • 09:36

      TINA RAE [continued]: So most of these children, I wouldexpect them to have some kind of social skills programwhere they can actually go and practice the kinds of skillsthat they need in order to actually engagein friendship groups.If a child is really distracting othersand is becoming quite verbal in the classroom context,very often, I would suggest that the teacher comes alongside.

    • 09:59

      TINA RAE [continued]: So rather than standing over themand engaging in some kind of combative situationor verbal dialogue that's going to lead to an argument,it's best to actually move in and get downto the child's level.So first, sitting down-- rather than stand over them,I'd say you get down and you kneel at the side of the desk.And you talk to them.You talk them gently through, and ask themwhat they're doing, and remind themwhat they should be doing, what their target isfor that lesson, being very clear and specific.

    • 10:26

      TINA RAE [continued]: How long have they got to do on the activity?What's the remaining time that they need to spend on it?What do they need to do after that?So it's just setting it out very clearly.These children need to have very clear, specific timeframes for everything.And the seating arrangement's paramount.I always see ADHD children at the front, next to the teacher,if that's where they're teaching.

    • 10:48

      TINA RAE [continued]: Or, if they're at table in a primary classroom,next to the teacher or next to someone else who's actuallyproviding positive reinforcement,and they are a role model to them.I also think it's about being observant all the time,and catching the behaviors before they escalate.This is very similar to anger management strategies.You would get in there and actually support the childto re-frame, to move them out of the situation,or to give them an activity that'sa calming activity as well.

    • 11:17

      TINA RAE [continued]: Lots of these children actually would benefit,I think sometimes, from moving away from the academic activityto something that is purely practical and tactile.So in many infant classes, for example, Key Stage 1,you can see children with ADHD whowere given five minutes or 10 minutesto go and play in the LEGO or withsome Plasticine-- something that's actually physicalthat they're doing-- and then return to the taskthat they've got to do.

    • 11:45

      TINA RAE [continued]: For parents, I think that they need some support, particularlyin managing behavior, in managingtheir own emotional responses.Because very often what happens in a home context is itcan escalate.And it can get into a kind of real verbal screaming match,at times, with a child, particularlyif the parent feels that they're not being listened to,that the rules aren't being followed.

    • 12:08

      TINA RAE [continued]: So I think it's around giving parentssome real training in how to manage behavior,how to use reward systems themselves,how to put in place the sanctions, the boundaries,the rules of the house for the child.But also education around things like sleeping patterns--how to manage that.How to also ensure that the child's diet isfree of additives and the kinds of thingsthat would actually reinforce or perpetuatethat level of hyperactivity.

    • 12:37

      TINA RAE [continued]: Because some of the stuff, in terms of attitudes,there is a link there, definitely.So in this tutorial, I hope that you'vebeen able to access the definition of ADHDand understand some of the presenting features of childrenand young people who have such a diagnosis,and also, have considered some of the contentious issuesaround the diagnosis, and the possible interventions in termsof both behavior management and the medical sidein terms of medicating children with such a diagnosis.

    • 13:11

      TINA RAE [continued]: From my perspective, and I know from teachersthat I work with-- their experiences and the feedbackthat I get working in schools with childrenwith social and emotional behavior difficulties--this is an emotive area.And I think it's really, really important to reinforce the factthat managing children's behavior and complex needs,such as these children, is difficult.

    • 13:33

      TINA RAE [continued]: It's draining.And it demands a great deal of energy,patience, and a real level of emotional literacyfrom those people who are engagedin supporting the children and young people.Very often it's too easy to label themas being naughty, defiant, unpleasant individuals.And actually, they have a special educational need.

    • 13:54

      TINA RAE [continued]: So we need to make sure that we differentiate for that just asmuch as we would for any other special needs in the classroom.

ADHD

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Abstract

Hyper-vigilant, impulsive and inattentive are just a few words that describe Attention Deficit Hyperactivity Disorder (ADHD). Dr. Tina Rae, Senior Lecturer at the University of East London, describes ADHD in depth. She explains the diagnosis process and the implications of diagnosis in the classroom. Finally, Dr. Rae offers strategies that can be used by parents and teachers.

SAGE Video Tutorials
ADHD

Hyper-vigilant, impulsive and inattentive are just a few words that describe Attention Deficit Hyperactivity Disorder (ADHD). Dr. Tina Rae, Senior Lecturer at the University of East London, describes ADHD in depth. She explains the diagnosis process and the implications of diagnosis in the classroom. Finally, Dr. Rae offers strategies that can be used by parents and teachers.

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