The Need for Increased Teacher Awareness of
ADHD & Sensory Integration Dysfunction
EDA6061
By Bernadette Harris
November 22, 2008
ADHD and SID are real and present in classrooms across America, but it doesn’t seem that institutions and educator programs have prepared our teachers sufficiently in methods and interventions, or even an in depth understanding of what these challenges are. Universities prepare educators in classroom management, curriculum presentation and a minute introduction to educational psychology of standard students. Some programs go the extra mile and add training for working with non-English speaking students. Few, if any, address effective training for meeting the needs of a vast number of what will make up their classrooms when they enter the field of education. As leaders, it is time that we took measures to fill the learning gap for our educators, and arm them with the tools they need to ensure success of these students in their classrooms.
Background / History of ADHD
The term ADHD (Attention Deficit Hyperactivity Disorder) is not novel to teachers and school administrators across the nation. It has become almost epidemic in elementary age student populations, as, according to Honos-Webb (2005), 3 to 5 percent of all school aged children have been diagnosed with ADHD (p.1). Its rates have increased by 400 percent since 1988 (Stein 1999 p. 3), but it is said to be confined to the United States! As Furman (as cited in Honos-Webb, 2005, p. 1) in Germany, Italy, France and England combined, only one child is diagnosed for every 250 diagnosed in the United States.
For the benefit of those who are less familiar with ADHD, its two major dimensions, according to the American Psychiatric Association (as cited by Honos-Webb, 2005, p.2), are inattention and hyperactivity/impulsivity. This is characterized by easy distractibility, frequent careless mistakes, talkativeness, organizational problems, difficulty focusing on a single isolated task, and difficulty following directions. Those with a great deal of impulsivity and hyperactivity often find it difficult to stay seated or still for extended periods of time and may leave their seat often, fidget with items in their hands, tap, or even have to work standing up! It should also be noted that ADHD can be just ADD, with the aforementioned symptoms with regard to inability to focus, organize, stay on task and follow directions, but without the tendency toward hyperactivity and impulsivity behaviors (Wheeler & Carlson, 1994).
Many children with ADD/ ADHD often also find it difficult to participate in sports and seem to often have lower athletic ability than those without ADHD.
According to the National Institute of Mental Health, because so many of the behaviors prevalent in ADHD children appear deliberate, (such as not following directions, impulsivity and excessive talking, inability to focus and complete tasks) they are often a source of frustration to their parents and educators.
Interestingly, unlike other physiological and psychological problems, such as learning disabilities, low I.Q, speech pathology, etc, there does not exist a test for ADHD. Instead, physicians rely on parents and educators to complete surveys addressing behavioral tendencies of children with ADHD and the frequency that the child demonstrates these tendencies. The child might also be seen by a psychologist for a battery of testing to eliminate other possible disorders such as bipolar personality disorder, low IQ, processing deficits, as well as a battery of other possible physical and psychological problems. It is identified by a difference in the frontal lobes of the brain.
Once the child is diagnosed, they are usually prescribed one or more of a variety of medications designed to help the child control their behaviors and focus more effectively. According to the American Academy of Pediatrics, the most effective of these medications seem to be the stimulants such as Ritalin, Dexedrine and Adderall. Pharmaceutical companies in recent years have also discovered some natural non-stimulant medications that are effective in some children as well, such as Strattera. Although the medication alone can provide amazing results for children, it is often a “hit and miss” in finding the correct one that the child responds to. In addition, behavioral modification plans and psychological counseling are recommended as a comprehensive form of treatment and found to be much more effective than just medication alone.
So what does that all have to do with me, the educator? I think it is important for teachers to have a better understanding of the disorder as well as some other interesting facts about students with ADD/ADHD.
In addition to the very frustrating constraints that ADHD has on a student’s ability to focus, organize themselves, and therefore learn, many brain image tests of children with ADHD have found that they have a heightened intuitiveness and creativity (Honos-Webb 2005, p. 95). Unfortunately, due to the fact that they usually have a series of negative experiences and conflicts in their school setting year after year, they tend to lose their self-esteem and motivation to succeed. They will then try to deflect attention to their shortcomings by becoming increasingly distractive to those around them. This is why it is critical that educators avoid reacting negatively to these students and instead find creative ways of increasing their motivation and keeping them striving to achieve.
Many of these students are not qualified for special services in the education system because they do not have learning disabilities or processing deficits of the conventional sense. Therefore, they do not come to our classrooms and schools with Individual Education Plans that give us a framework for knowing what types of modifications and accommodations we should make for these children. This is where the need for increased training and information comes in. Teachers need to be educated in the intricacies of the most effective methods for helping these students achieve their goals. Pulling them away from the group and sitting them in the most remote corner of the classroom where they can’t disturb the rest of the students who are ‘there to learn’ is just not enough! These children deserve the same opportunities, the same reinforcement and the same energy and attention from their teachers; in fact, they need more!
Background/ History of Sensory Integration Dysfunction
The second piece of this research is a less widely known disorder called SID (Sensory Integration Dysfunction). It affects children’s behavior, ability to learn, move, relate to others and their self-esteem (Kranowitz 1998, p.3). It can come with either major or minor symptoms, depending on the child, and is interestingly similar in many ways to ADHD!
SID is defined as “the inability to process information received through the senses” (Kranowitz 1998, p.8). It was discovered by A. Jean Ayres, PH.D., an occupational therapist in the 1950’s and 60’s. It begins in the central nervous system, which controls our ability to analyze, organize and integrate messages from our senses. A dysfunction here means that the child can’t respond to sensory messages consistently, therefore affecting their ability to learn! In the term ‘learning’, we are referring to learning to follow directions and expectations, motor skill learning, and academic learning. One of the most prevalent facets in the learning dysfunction is the child’s inability to “read” verbal and nonverbal cues. They also may be able to interpret or “read” the cues, but cannot change their behavior or stop themselves!
**This is where I have found the greatest connection between SID and ADHD to exist. A very wise physician once gave me the following analogy to explain the inability for self control in an ADHD child:
Two children are sitting in their third grade classroom and the teacher has her back turned and is writing on the board. Child #1, who has ADHD, and Child #2 who does not, have both created elaborately crafted paper airplanes that they badly want to see soar across the classroom to one another’s desks. Child #2 picks up his airplane to throw it, realizes that the teacher will probably turn around at any moment and catch him releasing the airplane into the air, and even if she doesn’t, the other students will react in some way that will draw her attention to it. He decides it would not be the best choice and puts the plane away. Child #1’s plane is already out of his hand and has hit the teacher in the back of the head as he comes to his same realization!
SID follows the same rules, and to add even more complexity to the picture, the SID child may be able to read cues, organize and respond appropriately one day, but not the next! In order to make a diagnosis of SID in a child, they must exhibit sensory dysfunctions such as avoiding touch, movement unbalance or lack or coordination, motion sickness, body rigidity, over-excitability, inattentiveness, sensitivity to sounds or smells or tastes. They may exhibit some, few or many of the symptoms, but must exhibit them with frequency, intensity and duration in order for a diagnosis to be made.
What I found most interesting about these symptoms in my research is that most physicians do not address or test for these symptoms in their diagnosis of ADHD! There is not a place on the ADHD survey questionnaire that addresses these types of dysfunction, and instead only looks at the impulsivity and inattentiveness symptomology, although those are symptoms of BOTH ADHD and SID! Another interesting fact that I discovered is that most of the SID children seem to be diagnosed in their infancy and preschool years, and are identified mostly by dysfunction in fine motor skills and heightened sensitivity to sound, smell and touch, rather than the other symptoms associated with SID. It seems that in school aged children, all children exhibiting impulsivity and inattentiveness are being diagnosed and treated for ADHD, without exploring the possibility of SID.
Mixed Syndrome Kids
And who are the kids in the “syndrome mix”? Take a real live child…Add a double helping of ADHD and any one of the following and you have you have a syndrome mix child (Kutscher 2005, p.15).
• Learning disability
• Sensory Integration Dysfunction
• Anxiety/ obsessive-compulsive disorder
• Bipolar depression
• Auditory processing disorder
Children in the syndrome mix have as compounded disadvantage, since many of these problems, when paired together, exacerbate each other. “SI dysfunction, ADHD, autism and learning disabilities are separate but often coexisting disorders of the syndrome mix, which frequently elicit similar symptoms. A child might exhibit characteristics of ADHD or learning disabilities, but actually be suffering from SI dysfunction, and vice versa” (Kutscher 2005, p. 16).
Screening and testing for SID must be done by an occupational therapist, rather than a physician or psychologist. This can attribute to why there may be a lack of diagnosis of one piece of the puzzle for many children, since pediatricians and psychologists are not trained or qualified to identify SID, and occupational therapists are not trained or qualified to identify ADHD, learning disabilities and psychological disorders.
Interventions for SID Children
Depending on the type of dysfunction the child is found to have, there are many
interventions that can be made in the classroom environment to help these students learn. Tactile dysfunction, for instance, can be helped with the use of hand fidgets, textured seating pads, textured paper such as sandpaper for the child to trace figure eights and x’s across with their fingertip, sand/ water tables, and rocking chairs for when students are reading. To develop vestibular integration, a student can sit and read on a therapy or balance ball, or spend time on a swing each day. To develop fine motor skills integration, the children should form things out of clay, use scissors, buttons, beads, or work with puzzles. The ADHD child is extremely disorganized and “merely owning a planner is not going to be enough” (Hallowell & Ratey 2005, p. 49). The teacher will need to go the extra step of daily planner checking and signing, and other organizational interventions like creating a simplified system for turning in assignments.
Mixed Interventions & Teacher Creativity
Finding the right mix of modifications is where the true need for educator training and creativity on come into play. In the classroom, there are limits to how many different modifications can be made in a given day and setting. However, with some creative thought and ingenuity, this can be done.
Picture the classroom with group seating for all students. Desks are in groups of four or five throughout the room. On three of the chairs there are sensory integration seating pads, with specific textures as recommended by occupational therapists, for three students who have tactile dysfunction along with ADHD. These are the students that are very impulsive and frequently out of their seat without the seat pads.
Inside another student’s desk is an array of four or five different hand fidgets for him to hold onto when he does his math or writing, whatever is the most difficult for him to complete. He is a child who is very fidgety, has trouble focusing especially on auditory instruction, and always has something in his hands.
Another student has two large pieces of sandpaper taped to his desk. One has a figure eight and one has a curvy x on it. This child has dysgraphia dysfunction, and is also inattentive when he is asked to do any writing or any classwork that extends beyond five minutes. When he gets frustrated or tired of doing his work, he must run his fingertip across one of the shape at least three or four times and then return to his work.
In the rear of the classroom is a Language Experience Work center, which is a group of four tables. In the center of the tables there is a caddy holding a small bag of dry beans, a container of playdough, and some dry pasta, small squares of construction paper, glue and scissors. At any time throughout the day, such as during literacy centers, the teacher assigns certain students to go to this table and complete an activity such as using the dry pasta to spell out their spelling words, form letters out of playdough, cut out small shapes of construction paper and glue them in patterns on a sheet of paper, etc.
These activities as well as many others are taught at teacher workshops across the nation throughout the year. Often times they are presented by occupational therapists and experts in the study of ADHD and SID, along with other common disorders and learning disabilities.
We are no longer of the belief that students with these types of syndromes should be self-contained and locked away from their peers. They have gifts, talents and special needs. Educators have to expand their knowledge and understanding and be willing to adjust the setting and scope of their classrooms in order to motivate, stimulate and accommodate the variety of differences these children bring into their world.
Application to Florida Principal Leadership Standards
Standard 2 of the FPLS is Instructional Leadership. Some of the benchmarks under this standard include making provisions in your instructional program for students with special needs, identifying curriculum needs for different student populations, and ensuring that teachers get the help (training) that they need to improve teaching and learning. Part of meeting this standard as a leader means providing teachers with the resources they need to know how to prepare effective instruction for the population of students they will face that have so many of these problems. With the large percentage of students entering our schools in America with these disadvantages, we cannot assume that using only conventional methods and materials is going to achieve success. It is our job as leaders to create a school climate that embraces and is well prepared and educated in the formulation of success of students with special needs such as ADHD and SID.
References
DSM-IV-TR Workgroup. (2006). Attention deficit hyperactivity disorder. National Institute of Mental Health, Publication 3572.
Furman, R. A. (2002). “Attention deficit / hyperactivity disorder: an alternative viewpoint.” Journal of infant, child and adolescent psychotherapy 2, 125-144.
Hallowell, E. M. & Ratey, J. J. (2005). Delivered from distraction. New York: Random House.
Honos-Webb, L. (2005). The gift of ADHD. California: New Harbinger.
Kranowitz, C .S. (1998). The out of sync child. New York: The Berkley Publishing Group.
Kutscher, M. L. (2005). Kids in the syndrome mix of ADHD, LD, Asperger’s, Tourette’s,
Bipolar & more. London, UK: Jessica Kingsley.
Pelman, W. E. & Jensen, P. (2001). “Clinical practice guideline: treatment of the school-aged child with attention deficit hyperactivity disorder.” Journal of American Academy of Pediatrics, 108, 4, 1033-1044.
Stein, D .B. (1999). Ritalin is not the answer: a drug-free, practical program for children diagnosed with ADD or ADHD. San Francisco: Jossey-Bass.
Still, G. F. (2003). Some abnormal physical conditions in children: the Goulstonian lectures. available at http://www.nimh.nih.gov.
Wheeler, J. & Carlson, C. L. (1994). “The social functioning of children with ADD with hyperactivity and ADD without hyperactivity.” Journal of emotional and behavioral disorders, 2, 1, 2-12.
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