Thursday, March 17, 2005

Learning Portfolio on ADHD

Four years ago, I had the opportunity to tutor an elementary student with such talent that it was difficult for him to be in a regular school. He was quick to understand concepts but would always crave for playtime and attention. He was diagnosed having an Attention-Deficit/Hyperactivity Disorder (ADHD). Not that it interfered gravely on his ability to obtain and retain knowledge, but it made his socializing a task.
I tried to make our sessions together productive in a way that would not trigger an ADHD incident, but of course that was highly improbable. I had no background on education then, much more “special education”, so I had to find ways to calm him down so we could at least get his assignments done. I often wonder what it would have been like if my training had been better, if I had a formal education on Special Education. I only hope that what I have contributed to his education was enough; that his experience with school and his sessions with me were as fruitful as mine.


To increase awareness, develop appreciation, and become a more effective special education advocate to individuals with Attention-Deficit/Hyperactivity Disorder.

Introduction & Definition

In the Philippines, especially in the rural areas, we often label a hyperactive and/or impulsive child as “makulit” and an inattentive child as “mahina ang ulo.” If the behavior is more severe than most of the individual’s peer, we label him/her as “sobrang kulit” or “sobrang hina ng ulo.” Most parents think that these characteristics are but normal to children and do not need the attention of physicians and therapists. These children go on with their lives without any treatment and therapy and most of the time become liabilities at home, in school, and in the community.
One of the reasons why annoying pattern of inattention, hyperactivity, and impulsivity in children is being taken for granted is because most people are short of awareness that these behaviors are the basic characteristics of Attention-Deficit/Hyperactivity Disorder (ADHD). Other reasons include financial difficulties of families and inaccessibility of hospitals.
In the following sections, we will learn what ADHD is, what are its possible causes, how to recognize if a child has ADHD, what are the characteristics of individuals with the disorder, what are the treatments and management applicable to a child with ADHD, and where to find professional help when problems arise.

What is Attention-Deficit/Hyperactivity Disorder?

Attention-Deficit/Hyperactivity Disorder or ADHD is the most common child psychiatric condition that is manifested by an importunate pattern of inattention and/or hyperactivity/ impulsivity. These patterns are evidently and comparably more frequent and severe than is observed in individuals at the same developmental level. ADHD becomes apparent in some children in the preschool and early school years, and can persist into adulthood as well.

Epidemiology & Etiology

How Many People Have ADHD?

Studies have shown that ADHD affects roughly 3-5% of all school-age children in the United States, 2-6.7% (est.) in New Zealand, 8.7% (est.) in Germany, 7.7% (est.) in Japan, and 8.9% (est.) in China.

Most reports also indicate a ratio of 4 boys to each girl affected. Females are often under-diagnosed among adults. Other statistical summaries of ADHD in the United States are shown and listed below:

:: The chance that other members of the family may also have ADHD if one of them has one is 25%.

:: Roughly 75-80% of all those with ADHD respond to stimulant medication.

:: Teens with ADHD are four times more likely to have serious auto accidents and three times more likely to be cited for speeding.

What Causes ADHD?

Possible Causes of ADHD

Although the exact cause of ADHD is still unknown, scientists have come up with probable theories about this in the past few decades. This section explicates all the possible causes of ADHD.

Genetic Evidence

Studies repeatedly demonstrate that the child of an adult with ADHD has approximately 25% chance of having ADHD. Flick presented the studies conducted by scientists and researchers regarding the genetic linkages of ADHD. These studies include children in families where there is history of ADHD, adopted children, and twins. They showed positive results.
However, there have been numerous criticisms and obvious limitations of these studies. Reliability of participants’ recollection, prenatal conditions of twins, and prenatal conditions of adopted children were put into question. With these studies, it was hard to generalize the findings to all ADHD patients.

Brain Physiology

Neuroanatomical Evidence
According to Dr. Flick, Mirky noted in 1987 that the brain has different but interconnected parts that are involved with the aspects of attention. This system of interrelated sections of the brain is engaged with focused, sustained, selective, alternating, and divided attention. Technological advancement in recent years expanded exploration on this matter.
Brain-imaging studies at the National Institute of Mental Health indicate a smaller anterior frontal area and a lack of asymmetry in parts of basal ganglia (caudate and globus pallidus). Further studies showed that this asymmetry in the basal ganglia is not affected by the use of stimulant medication.
Researches showed that for normal children, the right side of the caudate is 3% larger than the left on the average. ADHD individual failed to show this asymmetry. Reports also showed that the right prefrontal brain region was significantly smaller in ADHD boys compared with normal. The globus pallidus was also found to be significantly smaller, especially on the right side. Hyperactive children also have smaller total cerebral volume compared to normal children.

Neuropsychological Evidence
A series of tests that includes card sorting, IQ measurement, reading skills, and verbal memory were made to evaluate children who manifests ADHD as compared to normal. An assessment of their attention and impulsivity was also done. It has been found out that ADHD individuals have frontal lobe dysfunction of the brain. It was concluded that the core deficiency of ADHD is not impulsivity but the inability to control, direct, and sustain attention.

Neurochemical Evidence
Dr. Flick acknowledged that dopamine and norepinephrine neurotransmitters may be involved in ADHD. Relative overactivity of dopamine circuits is associated with hyperactivity and impulsivity symptoms of ADHD. However, it was noted that these review on the pharmacologic effects on neuronal circuits should not be interpreted as suggesting that ADHD is exclusively treatable with medication.

To sum up, the table below shows the affected brain functions and their effect on the behavior and characteristics of ADHD individuals.

Since ADHD is a complex disorder, these biological findings are still and certainly not complete. And it is still unclear if these dysfunctions are causes or symptoms of ADHD.

Unproven Causes

All kinds of speculation have been made regarding the cause of ADHD and the following are not yet proven nor did not show relatively significant findings.

Environmental Agents

Use of Cigarettes and Alcohol during Pregnancy
A lot of disorders and disabilities in children have been correlated with maternal use of cigarettes and alcohol during pregnancy. According to National Institute of Mental Health, studies have shown that this could be a possible risk.

Exposure to Lead
High level of lead in the bodies of young preschool children is another environmental agent that may be connected to a higher risk of ADHD. Children are exposed to toxic levels of lead through lead paints. Since lead is no longer allowed in paint, older buildings in which lead still exists in the plumbing or on the walls with lead paint put children at risk.


Refined sugar or food additives were also suggested to cause or aggravate the symptoms of ADHD. According to the National Institute of Mental Health, in 1982 the National Institutes of Health found that diet restrictions helped about 5 % of children with ADHD, mostly young children who had food allergies.
However, a more recent study contradicts parental beliefs that sugar affects children’s hyperactivity. The research used sugar one day and sugar substitute on alternate days, without parents or staff or children knowing which substance was being used. This experiment showed no significant effects on the behavior or learning of ADHD children.

Poor Parenting

Some concluded that poor parenting is a cause of children’s uncontrolled behavior. This conclusion is not applicable to all cases and has not generated any significant findings to support its claim.

Characteristics & Types of ADHD

What are the Characteristics and Types of ADHD?

According to DSM-IV, there are three basic classification of Attention Deficit Hyperactivity Disorder. These are inattention, hyperactivity, and impulsivity. However, the combination of these three basic characteristics along with other associated characteristics gives ADHD almost infinite variations in appearance (Flick, 2000).

The diagnostic criteria for Attention Deficit Hyperactivity Disorder are as follows:

A. Either (1) or (2):

(1) Six or more of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level.

 often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
 often has difficulty sustaining attention in tasks or play activities
 often does not seem to listen when spoken to directly
 often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
 often has difficulty organizing tasks and activities
 often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
 often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
 is often easily distracted by extraneous stimuli
 is often forgetful in daily activities

(2) Six or more of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level.

 often fidgets with hands or feet or squirms in seat
 often leaves seat in classroom or in other situations in which remaining seated is expected
 often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
 often has difficulty playing or engaging in leisure activities quietly
 is often “on the go” or often acts as if “driven by a motor”
 often talks excessively

 often blurts out answers before questions have been completed
 often has difficulty awaiting turn
 often interrupts or intrudes on others (e.g., butts into conversations or games)

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.
C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).
D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
E. The symptoms did not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or Personality Disorder).


Attention Deficit Hyperactivity Disorder, Predominantly Inattentive Type – if Criterion A1 is met, but Criterion A2 is not met for the past 6 months.

Attention Deficit Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type – if Criterion A2 is met, but Criterion A1 is not met for the past 6 months.

Attention Deficit Hyperactivity Disorder, Combined Type – if both Criteria A1 and A2 are met for the past 6 months.

Additional Characteristics

ADHD individuals do not have any problems with regards to their senses. Though, a new acquaintance might acquire an impression that an individual with ADHD is hearing impaired because of inattention.

 difficulty with fine-motor tasks, especially handwriting
 excel in gross-motor coordination, may become quite competent in some sport

 difficulty with working memory – trouble with remembering the details or materials needed for the given task at hand
 persistent obsessive thinking – problem with letting go of an idea in his mind

 may develop obsessive-compulsive routine later in childhood or during adolescence as an overcompensation to his/her being disorganized in early childhood
 aggressive behavior, often signifies presence of co-morbid condition such as oppositional-defiant disorder or conduct disorder
 poor self-concept and self-esteem
 often feel vulnerable, inadequate, and at times, even quite depressed
 in a state of low arousal and seek out more stimulation that can range from quite dangerous activities to those that simply stimulate the child to allow him to deal more adequately with a situation that is perceived as “boring” (e.g. classroom)
 daydreaming and tendency to fall asleep in class
 getting out of the seat, disturbing the class, or engaging in clowning behavior – attempts to adapt to his/her “sleepy state”
 moody most of the time

 often misread social cues
 impulsively exhibit socially inappropriate behaviors (i.e., blurting out something insulting to others)
 may be perceived as bossy and intrusive
 inconsistency – at times he may be cooperative; at other times, angry and defiant

 lack of organization in physical appearance
 often in various accidents related to poor coordination combined with impulsivity
 lack of organization in keeping track of important things
 tend to procrastinate

Co-Morbid Conditions

What Other Disorders Usually Accompany ADHD?

According to Dr. Flick, there are numerous psychological and medical conditions that are often associated with ADHD. These may often share symptoms with ADHD or may involve ADHD-like behaviors.

Associated Medical Conditions

Reaction to Some Drugs and Medications
There are drugs for numerous medical conditions that can cause ADHD-like behavior, impairment of attention, increased motor activity, or impulsivity to individuals without ADHD. On the other hand, these medications may exacerbate the behavior in children with ADHD. Some drugs that seem to have these effects are tabulated below.

Tourette’s Syndrome
This is characterized by sudden, involuntary, and recurrent specific movements and vocalizations. These “tic” movements typically include grunting, hissing, barking, whistling, sniffing, snorting, and clearing of the throat. ADHD appears to 50% of individuals with Tourette’s.

This disorder overrules the right-brain function of vigilance or wakefulness. It is characterized by sleep attacks and rapid eye movement at inappropriate times during the day, which is different from sleepy state that is often observed in ADHD children.

Anemia or the decrease in the number of circulating red blood cells includes symptoms of dizziness, drowsiness, headache, and awakening problems. According to Dr. Flick, studies have associated anemia with “personality disturbance, conduct problems, feelings of inadequacy, and immaturity.”

Fragile-X Syndrome
This is a chromosomal disorder which is the second most common cause of mental retargdation with mostly males being affected. Some symptoms of Fagile-X include impairments of interest, attention, and behavior. However, its association with ADHD can not still be generalized because only four cases were studied.

Movement Disorders
Movement disorder just like the characteristics of Sydenham’s Chorea, especially when accompanied by irritability and obsessive compulsive symptoms, could be confused with symptoms of ADHD.

Thyroid Dysfunction
Symptoms of hyperthyroidism like tremor, increased nervousness (overactivity), sweating, and rapid heart beat could also be mistaken for ADHD.

Sleep Apnea
Sleep apnea (SA) causes insufficient oxygenation of the blood and shows symptoms of loud snoring, pauses in respiration during sleep, daytime hypersomnolence, weight gain, disturbed sleep, and deficits in attention, motor efficiency, and psychomotor ability. Dr. Flick noted Findley’s report that problems in concentration, complex problem solving, and short-term recall are also symptoms of SA.

Sinus infections affect airflow through the nasal passages and may generate the same symptoms as sleep apnea. Decreased alertness manifested by poor attention and overactivity may also be expected.

Head Injury
Head trauma or injury due to external force may produce a weakened or altered state of consciousness. Head injured children and adolescents display attention problems and hyperactivity, aside from other cognitive skills and intellectual performance.

Associated Psychological Conditions

As noted by Dr. Flick, 1/3 to ½ of teens with ADHD will have additional behavioral/emotional problems. Other psychological disorders may have many symptoms that mimic ADHD behavior. These may appear independent or co-morbid with ADHD.

Adjustment Disorders
Adjustment disorder, or the growth of clinically significant emotional or behavioral symptoms as a reaction to a particular psychosocial stressor or stressors, may be taken into account when ADHD children experience significant stress in the classroom.

About ¼ of teens with ADHD experience anxiety. There are two co-morbid conditions of anxiety that are sometimes associated with ADHD. These are the Generalized Anxiety Disorder and the Post-Traumatic Stress Disorder (PTSD). Generalized Anxiety Disorder includes symptoms of impairment in one’s attention and concentration, and errors of misjudgment in one’s responding. While PTSD, or the delayed painful response to an unusual and severely upsetting event, features depression, anxiety, disturbance of conduct, withdrawal, and interference with one’s personal life, work, or academic adjustment.
As noted by Dr. Flick, ADHD and anxiety appear to be at the opposite ends of arousal continuum. It is very seldom for them to co-exist and when they do, it is found more often in the predominantly inattentive type of ADHD. What’s interesting about the two is their difference in somatic (?) reactions to states of emergency. Anxiety shows overarousal and confusion and ADHD displays optimal arousal state, calmness and a more effective reaction.

Depressive thoughts cause interference with thinking and sustained attention. Sleep difficulties and motoric restlessness similar to the symptoms of ADHD is also present in individuals with depression/dysthymia. Flick noted that 25% to 30% of ADHD adolescents may experience serious depression. The symptoms manifested include sadness, loss of pleasure, negative views of self, hopelessness, poor concentration and memory, confusion, changes in appetite and sleep, fatigue, increase in aches and pain, passivity, and indifference in activities.

Bipolar Disorders
Bipolar disorder of Manic Depression occurs when an individual experience depressive episodes and manic episodes alternately and swiftly, with only a brief return to normality in between. Hypomanic episodes, just like ADHD, show excessive activity, impulsivity, poor judgment, and denial of problems. ADHD is distinguishable through its early age of onset, its chronic rather than episodic pattern, and the lack of abnormally extensive and elevated mood. Intensified behavior problems with violent temper outbursts occur when ADHD and Manic Depression co-exists in an individual.

Mental Retardation
A child is considered to have Mental Retardation (MR) when his intellectual functioning/quotient (IQ) is 70 or below. This, together with mood disorder, pervasive developmental disorder, stereotypic movement disorder, and ADHD are associated with each other due to a general medical condition like head trauma.

Learning Disabilities
Attention plays an important role in learning. However it is insufficient enough especially if the cortical ability of the brain to process information is impaired just like the case of an individual who has LD. These learning problems are associated with the mental ability of a child in academic areas such as reading, math, spelling, handwriting, and language development. LD children may exhibit ADHD-like behaviors such as excessive motor activity and poor attention skills due to frustrations. Similarly, ADHD children may have LD because of their difficulty in focusing and sustaining attention.

Conduct Disorder (CD) and Oppositional Deficit Disorder (ODD)
In clinical settings, as noted by Dr. Flick, at least 2/3 of patients with ADHD also has oppositional deficit disorder (ODD) and conduct disorder (CD). When this co-morbid CD has an “early onset” (prior to age 10), individuals may manifest antisocial behaviors throughout their lifespan. In a “late onset” condition, on the other hand, the problem does not last as long and as pervasive as the first group and has a possibility that it will not continue past adolescence. Children and adolescents with this co-morbid condition are more likely to display more physical aggression to both people and animals, destruction of property, theft, violation of rules, driving problems, anti-social behavior, and drug abuse.
On the other hand, ODD displays a milder form of chronic behavior problems. This is the most frequent occurring co-morbid disorder with roughly 40% to 65% of those with ADHD. This is manifested by stubborn negativism, hostile and defiant behaviors, but without serious violation of the rights of others.

Obsessive Compulsive Disorder (OCD)
This disorder, according to Dr. Flick, is characterized by excessively persistent and disturbing thoughts with ritualistic behavior, mental activity, and irresistible motor behaviors. These characteristics affect one’s focus and attention. OCD may be more frequently associated with the predominantly inattentive type of ADHD.


What are the Processes and Instruments for Assessing the Exceptionality?

A series of assessments, observations across times and places, analysis of student work, and analysis of interview data from parents, teachers, and student comprise the identification process of determining ADHD in an individual. Culatta, Tompkins, and Werts laid out 9 sequential steps for assessment & identification following a referral. These are the following:

1. Administering and collecting rating scales from relevant persons
2. Orienting the family and the student to the evaluation
3. Interviewing the student
4. Administering normed tests such as IQ, achievement, and continuous performance tests
5. Conducting direct observations in several settings, including school, community, and home if possible.
6. Interviewing the parent(s)
7. Conducting medical evaluation
8. Integrating all the data
9. Giving feedback and recommendations to the team

These tests and assessments are conducted by a variety of experts and requires once overseer. On the other hand, the Council for Exceptional Children recommends a 6-step procedure in identifying ADHD in a child. These are the following:

1. Document behavior observed by both parents and teachers that is indicative of ADHD.
2. Re-evaluate tests such as group intelligence tests, group achievement tests, and vision and hearing tests to determine whether they are accurate measures of potential or whether poor performance may be the result of attention problems. A physician may be consulted to see whether an identifiable physical condition is causing inattention or hyperactivity.
3. Attempt classroom management to correct or control behaviors leading to poor academic performance. If such attempts are unsuccessful, request a referral for ADHD placement.
4. Conduct psychological evaluation to see whether the student meets criteria for ADHD placement. Administer individual tests and behavioral rating scales. Review medication recommendations.
5. Have the team, including the child’s parents, plan for the special educational needs of the child.
6. Implement the Individual Education Plan.

Some common instruments used for assessing ADHD in children include the following:

1. History – this is the developmental history of the child which is often provided by the mother or the caretaker/guardian.

2. Rating Scales

Conners Rating Scales (CRS) – this is the most comprehensive rating scales for the parent(s) and teachers. The Conners Parent Rating Scale Revised (CPRS-R) includes 8 sales and 2 indices: (1) Oppositional, (2) Cognitive Problems, (3) Hyper-active-Impulsive, (4) Anxious-Shy, (5) Perfectionism, (6) Social Problems, (7) Psychosomatic, and (8) DSM-IV Symptom subscales, plus the ADHD Index and the Global Index (formerly the Hyperactivity Index). As for the Conners Teacher Rating Scale Revised (CTRS-R), it contains 59 items parallel to CPRS-R except for the Psychosomatic Scale.

Behavioral Assessment System for Children (BASC) – this is a combined rating scale for the parents, the teachers, and for the referred individual. It covers behavior, cognitive, and emotional data that are not only descriptive, but are also a diagnostic aid.

Attention Deficit Disorders Evaluation Scale – Secondary-Age Student (ADDES-S) – this has a school version (60 items) for the educators and a home version (46 items) for parent reports. It categorizes behavior patterns in areas of (a) Inattention and (b) Hyperactivity-Impulsivity.

The Brown Scales – this is consists of 40 items grouped into five clusters, namely: (a) activating and organizing work, (b) sustaining attention and concentration, (c) sustaining energy and effort, (d) managing effective interference, and (e) utilizing working memory and accessing recall.

Learning Styles Inventory – just like the Brown Scales, this is is a self-report inventory. It measures the child or teen’s learning preferences.

3. Specific Objective Measures of Attention – this is a well-developed instrument that is usually computer based, where the normative data of a person’s performance is compared to one or more norms.

4. Cognitive Measures – this involves assessment of abilities, achievements, memory, visual-motor, language, visual-spatial, sensory, motor, executive control, and social-emotional skills.

5. Behavioral and Emotional Characteristics – this involves evaluation of problematic behaviors in children including the characteristics of ODD/CD.


Is ADHD Treatable?

Since the exact cause of ADHD is still unclear to human knowledge, there is still no accurate or stand-alone medication to cure the disability. However, there are various treatments considered for the symptoms of ADHD in an individual. Every child has his/her own special need so there is no single treatment for all ADHD children. The child’s need and personal history should be considered in addressing his/her disability.

Various medications have been used for decades in treating the symptoms of ADHD. The most commonly used and effective medications are known as stimulants. On the next page is a chart presenting some of the stimulants, their generic name, the “Approved Age” of children to use that drug, their common side effects, their duration of behavioral effects, and their pros and precautions.

According to the National Institute of Mental Health (NIMH), a small number of children cannot tolerate any stimulant, no matter how low the dosage. Antidepressants are usually medicated to children in this case. This group of drugs includes Tofranil®, Nopramin®, Pamelot®, Wellbutrin®. There is also a group called Antihypertensives, which includes Catepres® and Tenex®. On the next page is another chart that presents some of the Antidepressants and Antihypertensives.

According to Dr. Flick, there is no evidence that continued use of medications is harmful, especially if they are monitored. These medications help many children go on with their lives normally and become more successful in school, at home, and in play. And studies have shown that 80% of children who use medication for ADHD still need it as teenagers, 50% need it as adults.

The National Institute of Mental Health (NIMH) conducted a rigorous study known as the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (MTA) to evaluate different treatment approaches for ADHD. There are four treatment programs evaluated, namely:
(1) medication management alone
(2) behavioral treatment alone
(3) a combination of both
(4) routine community care
The results of this study showed that long-term combination treatments (# 3) and the medication-management alone (# 1) have more significant positive effects on ADHD children than the behavioral treatment alone and the routine community care.

Behavioral Modification
This form of treatment is important in managing the patterns of behavior of a child with ADHD. As said earlier, this can be applied, either alone or much better if with the combination of medication.

Skill Development
Skill development is not necessarily for entertainment or leisure of a child. It is carried out to shape, enhance, or establish certain skills that are often deficient in children with ADHD. These trainings are applied at home, at school, and in the clinic so as to give children more learning trials in different settings and situations.

1. Attention Training
Dr. Flick developed Attend-O™ Attention Training Games that represents a hierarchically arranged set of increasingly more complex tasks that involve attentional processes as complex as those encountered in real-life situations. On the next page is an example of the attentional games.

2. Behavioral Inhibition Training
In 1999, Dr. Flick developed the Behavioral Inhibition Training as extension of the Attention Training Games. Its exercises include clicking the mouse when the non-target (BLACK) was seen or heard instead of the target (RED).
Aside from Dr. Flick’s BIT, there are two computerized programs that work on the rehabilitation of an ADHD individual’s behavior. One of these is developed by Sanford and Browne in 1988, called Captain’s Log™ . Nicknamed as “mental gym”, it provides a series of cognitive training exercises in several critical areas, including modules for attention, visual-motor skills, conceptual skills, numeric concepts/memory skills, and a newly added attentional program involving visual scanning, concentration, and inhibition. The other is called NeurXercise™ developed by Dr. Marvin Podd in 1989. Some of its training and exercises may be extended at home or at school’s computers.

3. Social-Skill Training
In this training, therapists discuss and models appropriate behaviors important in developing and maintaining social relationships. ADHD students are trained to master the following skills:
a. listening and responding
b. showing interest by smiling and asking questions
c. greeting others
d. giving compliments
e. understanding body language and vocal tones
f. understanding personal space and appropriate touching
g. learning to join an ongoing activity
h. sharing and cooperating
i. ignoring teasing
j. managing anger appropriately
k. waiting for a turn

4. Organizational/Study Skills
Areas developed in the organizational/study skills concentrate on the skills needed by and ADHD student in succeeding in class or improving his/her academic performance. These include the following:
a. learning strategies
b. organization
c. reading comprehension
d. communication
e. note taking
f. homework
g. stress management
h. memorization
i. time/materials management
j. proofreading
k. test taking

5. Anger Control
There are a number of anger management trainings for children and teens with uncontrollable temper. The techniques used in these trainings include modeling, role-play, teamwork, personal assignments, self- and peer-evaluation, constant involvement in activities to promote understanding and change in inappropriate and unproductive thoughts and behaviors. The common questions asked to understand unseemly behaviors are
(1) what happened (e.g. somebody teased me)
(2) what did you do (e.g. fought the teaser, ran away, cried, etc.)
(3) what were the consequences (e.g. black eye, guidance counselor, etc.)
Understanding the cues that signal anger arousal and the triggers that provoke anger would greatly help the individual in setting techniques and reminders in reducing anger and would give opportunity in evaluating self to correct the undesirable behavior.

6. Stress-Management Training
Relaxation and stress-management training exercises, in general, have been proven helpful for anxiety, depression, anger control, sleep difficulties, and general health and well-being of an individual. There are several relaxation and stress-management trainings or exercises available in print materials that can be bought on bookstores or even on the net. These tips and activities apply not only for normal individuals but even to those with special needs.

7. Self-Esteem Training
One of the additional characteristics present in an individual with ADHD is having poor self-concept and self-esteem. It would be best if children and teens with ADHD undergo trainings in increasing one’s self-esteem. An interactive computer program developed by Nancy Chaconas and the Multi-Health Systems staffs, entitled HELP-Self-Regard™, teaches adolescents to identify and challenge self-defeating thoughts, to take action and accept responsibility, to develop effective use of words, to create personal affirmations, to develop mental visualization skills, to set goals, and to use relaxation techniques. This greatly helps adolescents with their self-image.

It was noted that endorphin levels are lower in the brain of ADHD individuals and stimulants and exercises proves to increase its level, thus, making the ADHD individual more calm, logical, and communicative. Aside from the fact that exercise improves cardiovascular functions and weight management of a person, it can also be beneficial in reducing hyper-activity, stress, and restless behavior and in increasing attention and concentration in children and teens with ADHD.

Coaching ADHD Teens
Just like in a basketball team, the “coach” in this program is the one who acts as a mentor, a cheerleader (or the number one fan that gives encouragement), a conflict mediator, and a person to turn to during crises. This program may give an ADHD teen unique experience as the mutual respect for the student-coach relationship develops. This course attempts to teach ADHD teens to learn independently, develop plans, and to set and achieve goals in high school and beyond.

For the Family and the ADHD Child
Adjustments are not only necessary for the child with ADHD but also for the family members he/she belongs to. Any skills and modifications taught to an ADHD child in school and in clinics will prove useless if there is no continuity at home. The home plays a vital role in coping and improving the behavioral patterns of a child.

Support Groups
Support groups usually give lectures on ADHD and most importantly provide venue for parents to share frustrations and success, obtain referrals to qualified specialists, and connect to other parents who have similar problems. These groups give them a feeling that they are not alone.

Parenting Skill Training
Parents are taught by therapists and specialists on the proper training for the management and modification of their child’s behavior. The techniques are as follows:

1. Token or Point Systems
Parents immediately reward their child if he did something good or showed a positive behavior. In this system, parents should clearly tell the child what are the positive behaviors that they expect from him and the little rewards he could get if he does good. This reward system encourages the child to be conscious of his actions and perform only the positive characteristics taught by his parents. Correspondingly, mild penalties should also be given if the child does otherwise to discourage him from doing it again.

2. Time-out or Isolation
Parents remove their child from an agitating situation and put him on a chair or in a bedroom alone and quietly to calm him down. This is the penalty system. The parent can also remove a token if the child demonstrates another unruly behavior.

3. Quality Time
Parents should spend time with their child each day in which they share a pleasurable or relaxing activity. This bonding moment gives the parents a chance to take note of the strengths and the weak points of their child, to praise him for his abilities, and to help him improve his weaknesses.

Where to Ask for Help

Where to Ask for Help when You Suspect your Child having ADHD?

In the Philippines, the best place to approach for inquiries and help about individuals with special needs is the academe. The top universities of the Philippines, especially their Education Departments surely have contact information to the best and leading specialists in the field of special education.

10 Concrete Ways

10 Concrete Ways that I Plan to Do for Individuals with ADHD

“Continuing Professional Education”

Scientists, doctors, and researchers continue with their studies and researches to satisfy their unbounded thirsts for knowledge. Every day, new development in a certain field arises. Along with this development come new questions and wonders to solve. Ideas and practices that were once exceptional and effective may now be inappropriate or incomplete.
As I have learned earlier in making this portfolio, ADHD is an old issue yet in understanding, it is still a budding affair. Continuing professional education like studying graduate programs and attending symposiums and seminars would be the best venue for a Special Education advocate to enhance knowledge on a subject matter.
As a SpEd advocate, I believe that it is my duty to keep myself updated on the latest discoveries and developments in the field of special education so as to provide a more effective service to individuals with special needs.

“Continuing Informal Education”

Latest ideas and discoveries are generally published in related journals. These journals track down developments in a field of study through the written articles in it. Keeping informed on the latest issues in ADHD, by reading journal articles and reports either via the internet or the dusty pages of publications in a corner of the library, is another best option in expanding learning.
I subscribed to some free online journals about health (e.g. Health Alerts) and also plan to search and subscribe to special education journals. These online publications usually sent alerts via e-mail so there will be no delays in receiving information.


After acquiring new thoughts and ideas through CPE and reading, it is best to pull these facts together to create meaningful information. This information will serve as guide for a SpEd advocate in giving help and service to individuals with special needs. This information would also be of better use if not kept on the shelves for the mites and worms to eat.
Sharing knowledge is one of the best approaches to advocating special education. And since we are now in the digital age, the internet is the best way of disseminating information. It is the best place to promote and support a cause. Maintaining a domain is costly and time consuming with all the processes involved in acquiring licenses and hosts. However, there are hosts on the net like Geocities that provide free hosting of websites. The negative side of this is the limited space allotted for your site plus the advertisements that they put on your page which slows down the downloading.
Lately, a new fad came up on the net. It is called blogging. A blog is a place where one can publish online his/her life, dreams, rants, and the like freely. It is a place where friends in different places and continents get in touch with each other by reading each others’ online diaries. It has ready made templates for the easy use of bloggers and can still be modified by those who know html or java script. Uploading and sharing information on a blog is as easy as peeling a banana.
This blog will be my venue for advocating special education, specifically on ADHD, to my friends, my friends’ friends, and the rest of the world. My blog is called because somebody has already used the name for a piece of junk.

“Community Awareness”

In the rural areas like my hometown in Laguna, the use of the Internet is leisurely spreading. If my neighbor has a 5-year old son with ADHD now, and the whole family is unaware of his condition, my blog would probably be obsolete before its contents reach them. And the child would probably be institutionalized already before he is even diagnosed of having ADHD.
As a Special Education advocate, I would visit the municipal center, public school administration offices, and local organizations to inquire if they conduct community awareness talks about special education and individuals with special needs. If they do not conduct such discussions and have no plans to do so in their plans and programs, I would propose to them the idea of promoting knowledge about individuals with special needs.
In a smaller scale, I can conduct my own community discussion about children and individuals with special needs in my barangay. This awareness would give them new light in dealing with special children and individuals appropriately. Hostility would no longer be their only resort in relating to individuals with ADHD. With the help of the barangay council and the Sangguniang Kabataan (SK), I believe that the talk would succeed. Consequently, expanding the talks to other barangays is another major step that I would take.

“Handouts/ Reading Material about SpEd and ADHD”

Discussion of special education and individuals with special needs is one thing. Written materials for the listeners and the town folks is another. These handouts, flyers or reading material which I plan to make in the local tongue would greatly help in spreading the word and the knowledge about special education and individuals with special needs. These materials would take the place of the speaker in educating the town folks even at their own homes.
The reading materials would include the description of the exceptionality, its causes or possible causes, and the way of interacting with individuals with special needs. I would make a comic version of these handouts because that would be much more ingenious and interesting to read. Or I could write and layout it the way Lampara Books advocate special education through stories for children. These reading materials might also be some sort of an invitation for the town folks to attend the scheduled discussions.

“Library Programs”

There are courses in the Library and Information Science curriculum about children and young adult literature. The courses were designed for future school librarians. However, these courses are not specific on dealing with special children, much more with ADHD. Future librarians were not taught on what modifications should be made to accommodate children with ADHD in the library. Since the librarians promote reading and the use of library resources to school children, they play important roles in dealing with special students. I believe that these future librarians should be equipped with the proper training and management for children with special needs.
With these, I plan to propose to the Institute of Library and Information Science the integration of Special Education in the curriculum of its undergraduate courses. Even if not an entirely new course or elective, at least tie it up with the courses on children and young adult literature.

“Promoting Libraries to Children with ADHD”

If encouraging children with ADHD to read and listen attentively in class proves to be a very difficult task, how much more inviting them to the quiet and orderly world of the library. I believe that the school library is a nameless but essential part in the behavioral development of students. It is also the seat of learning in a school which makes it a very important feature for students’ academic performance. And it probably is the least visited place of an ADHD child.
For normal kids, the library could be a fascinating and enjoyable place because of all the information it maintains. But for an ADHD kid, where no loud talking and running around is allowed, it could be the worse place on earth. Unless of course the library has a place where his learning is not limited to sitting properly and reading quietly, it could have been nothing but his place to take a nap.
I find it a challenge to promote library use to ADHD children. I want to learn more about the possible modifications available for libraries in order to adapt to hyperactive-impulsive clients. Therefore, it is my plan to research on this matter and probably submit an article about this to the Journal of Philippine Librarianship.

“Research Study”

Aside from the library modifications for ADHD students, I would also like to conduct an evaluation on how well school, clinic, and home programs for individuals with ADHD are doing right now in the Philippines. An evaluation of the existing programs’ effectiveness is the groundwork for further research that can be done in the area of behavioral modification in ADHD children.

“ADHD Organization”

I also plan to become a member of an organization that provides support to individuals with ADHD. This would be an ideal venue for specialists, doctors, and paraprofessionals, to learn more about the exceptionality. It is also the best place to source speakers for the community awareness talks that I plan to conduct in my hometown.

“Follow-up on My ADHD Tutee”

With the research I’ve done for this portfolio, I have learned some teaching methods and modifications appropriate for children with ADHD. And it gladdens me to know that I have done well during my sessions with my ADHD tutee. Since he is the root of all the reasons why I chose to study Special Education, I believe I owe him a visit and an affirmation because the last time I heard, he has been doing well with his schooling. Besides, I also believe that, with the short time we spent together learning with each other, we had developed that “student-coach” relationship. With the follow-up visit, I would be able to confirm if my appointments with him were really as fruitful as I suspected to be. And hopefully, I would be able to gain some more insights on his exceptionality.



Flick, Grad L. How to reach and teach teenagers with ADHD : A step-by-step guide to overcoming difficult behaviors at school and at home. New York : The Center for Applied Research in Education, ©2000.

Culatta, Richard A., Tompkins, James R., Werts, Margaret G. Fundamentals of Special Education : What Every Teacher Needs to Know. 2nd ed. New Jersey : Merrill Prentice Hall, ©2003. pp. 189-208.

National Institute of Mental Health. Attention Deficit Hyperactivity Disorder : A detailed booklet that describes the symptoms, causes, and treatments, with information on getting help and coping. 2003 rev. Date of access: January 10, 2005.

_____. ADHD Description Date of access: January 10, 2005

_____. ADHD. Date of access: January 10, 2005.

Amen, Daniel G. Adult ADD Symptom Checklist. Date of access: February 3, 2005.