B. Other Health Impairments: Attention Deficit Hyperactivity Disorder

1. Introduction to the Lesson: OHI

In this lesson, we will focus on attention deficit hyperactive disorder since it is the most common OHI among the gifted population.  At the end of the lesson, we will give you additional resources.  You should check other resources, especially your own district resources.

2. Definition

According to IDEA, Other Health Impairment is defined as:

Other health impairment means having limited strength, vitality or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that:

(i) is due to chronic or acute health problems such as asthma, attention deficit disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, and sickle cell anemia; and
(ii) adversely affects a child's educational performance [34 C.F.R. 300.7(c)(9)].

Various mental health issues can fall under the “emotional disturbance” category. They may include anxiety disorder, schizophrenia, bipolar disorder, obsessive-compulsive disorder, and depression. (Some of these may also be covered under “other health impairment.”)

ADHD

According to the DSM-5, Attention deficit hyperactivity disorder (ADHD) is characterized by a pattern of behavior, present in multiple settings (e.g., school and home), that can result in performance issues in social, educational, or work settings….symptoms are divided into two categories of inattention and hyperactivity and impulsivity that include behaviors like failure to pay close attention to details, difficulty organizing tasks and activities, excessive talking, fidgeting, or an inability to remain seated in appropriate situations.  ADHD may begin in childhood and continue into adulthood. ADHD symptoms, such as hyperactivity, impulsiveness and inattentiveness, can cause problems at home, school, work, or in relationships.  To qualify for a diagnosis, symptoms should occur by age 12 and be present in more than one setting (home and school).  There are three types of ADHD (Understood.org)

• Predominantly Hyperactive-Impulsive Presentation
• These students struggle with impulse control. Typically they don’t have much trouble with inattention.
• This type is identified the most.  It’s often easier to spot signs of this type of ADHD. Kids who have it may struggle to sit still in class and manage their behavior.
•  Kids who have this type of ADHD have symptoms of hyperactivity and feel the need to move constantly. They also struggle with impulse control.  Typically, they don’t have much trouble with inattention.
• Predominantly Inattentive Presentation
• These students are easily distracted and have difficulty paying attention but don’t have much trouble with impulsivity or hyperactivity.  This is sometimes unofficially referred to as attention-deficit disorder (or ADD).
• Kids with this type of ADHD may “fly under the radar” because they may not be disruptive in class. In fact, they may appear shy or “daydreamy.”
• Combined Presentation
• This is the most common type of ADHD. Kids who have it show significant problems with both hyperactivity/impulsivity and inattention.

Symptoms of ADHD typically first appear between the ages of 3 and 6.  The average age of ADHD diagnosis is 7 years old.  Today, about 4 percent of American adults over the age of 18 deal with ADHD on a daily basis (ADHD Facts addrc.org).  According to the ADD Resource Center, children living two times below the poverty level have an increased risk of having ADHD; children from primarily English speaking households are at 4x times the risk; males are at 3 times the risk of females.

3. Gifted with ADHD

For a student with ADHD's perspective and a success story watch this young woman's Ted Talk. She has also created many inspiring and informative YouTube videos under the name "How to ADHD." Click on the title to open in YouTube to access closed captioning.

Matthew Kutz, a 13-year-old student  said that, "Being ADHD means you see things other people miss. When you see a peach you see a piece of fruit, while I see the color, the texture, and the field where it grew. Being ADD, when I read a book about marine life, my mind allows me to travel with the fish and imagine life beneath the sea—or I can read a book about astronomy and dance among the stars."

Some strengths gifted learners with ADHD might have include:

Strengths

• Advanced vocabulary
• Strong sense of humor
• Highly creative
• High energy
• Wide interests
• Background knowledge
• Intense curiosity
• Strong memory for things that interest them
• Idea peopl

• Can hyperfocus when interested

Gifted children, with and without ADHD, have the ability to immerse themselves in the task and work for long hours (hyperfocus) without much external reinforcement.  The difference, however, is that the gifted student with ADHD must be highly motivated, or the task must be intrinsically rewarding or they will not persist (Loveck, 2004, Kaufman, et. al., 2000).  This ability to hyperfocus, the falling into “flow” (Csikszentmihalyi, 1996) is what makes creative work so satisfying to so many gifted children, whatever their other problems.

Challenges

Some of the challenges faced by students with ADHD can be:

• More active and restless than other children
• Poorly sustained attention -- distracts others or self
  
• Finds it hard to change tasks, settle down 
• Struggles to finish work -- often shift from one uncompleted activity to another
• Impulsivity and poor delay of gratification -- alienates peers
• Lacks organizational skills
• Impaired adherence to commands to regulate or inhibit behavior in social contexts
  
• Often talk excessively
  
• Tendency to procrastinate and are forgetful
• Difficulty with written expression
• Has low self-esteem

• Diminished persistence on tasks not having immediate consequences

This image is from an article from a mom with 5 children with ADHD...her daughter said that having ADHD was like sitting in a room with a thousand TVs and her mind jumps from screen to screen not knowing what to watch.

ADHD is like:

Having no filter - A neurotypical person has a gatekeeper that controls input...sorts it, determines what is important...For the child with ADHD there is NO filter - EVERYTHING is important, nothing is sorted...One of our students said it was like all of his apps are opening and he can’t close any of them.  NEED to separate and breakdown things to focus on one thing at a time.

Always Being overstimulated - ADHD kid is constantly bombarded with stimuli.  NEED to get away from the stimulus, go to a quiet room...use fidgets

Experiencing many episodes of "I Forgot" - problems assessing, retrieving and using memory is one of their biggest frustrations. Kids with ADHD blurt out, why do you think that? If they don’t tell you right then and there, they will forget what they want to say as their mind has moved on.  Need Checklists, sticky notes, parking lot, email, and text reminders.

Having too many thoughts to think - the mention of one word or thought opens up a million more.  Need to journal, keep the writing brief to help them just remember as there are too many thoughts to put down

Challenges in Executive Functioning

ADHD is a disorder that involves the executive functions of the brain. As was covered in the Part 1 course, the executive functions of the brain are a system that organizes, plans, modulates, and integrates both everyday and original work (Lovecky, 2004).  Executive functions are like the conductor of an orchestra, enabling each separate instrument to play well and coordinating all the instruments together (Brown, 2000).  Executive functioning is much more than simply cleaning out one’s locker or using color-coded folders. It’s about one’s ability to accomplish goals (Gladstein, 2013).  They are the mental processes that help us to organize, plan, prioritize, focus attention, and handle multiple tasks successfully. They enable us to self-regulate. These are common everyday challenges for a child with ADHD. However, according to Understood.org although “many kids who have ADHD do struggle with executive functioning…it’s also possible for a kid to have executive function issues without having ADHD, or having ADHD without executive functioning issues.”

Based on research by Cramond (Baum and Owens' To Be Gifted and Learning Disabled, 1994, p. 62), it is recommended that an evaluator:

• Be open minded to the possibility that characteristics of ADHD have overlap with characteristics of creativity and giftedness
• Identify under what conditions the key behaviors are intensified or reduced
• Have an understanding of gifted characteristics (including creativity) as well as ADHD
• Conduct in-depth interviews with the student, parent and educators who know the student well
• Utilize ADHD rating scales as well as creativity checklists

4. Meeting the Challenges

When addressing intervention strategies there is a difference between strategies that are effective for average students with ADHD and the gifted child with ADHD.

Whereas simplifying tasks for average students with ADHD is known to be effective, we need to provide complexity and more intriguing tasks for the gifted child with ADHD.

Shortening time to complete tasks is generally good for a child with ADHD, but with 2e students we need to adjust work time based on the complexity of the task

So,

Average Student with ADHD

• Simplify tasks
• Shorten work time
• Decrease stimulation

Gifted Student with ADHD

• Provide complexity and more intriguing tasks
• Adjust work time based on complexity of task
• Works better with a high level of intellectual stimulation 

For 2e students -- Strategies: Build on Strengths

• Ensure students know their areas of strength, not just their weaknesses.
• Have “go-to” projects in area of students' interest to encourage them to finish essential work; then allow them time to work on those projects as an incentive.
• Reinforce creativity in process and products; teach creative thinking skills and creative problem solving.
• Celebrate the achievement of realistic short-term goals.
• Ask student to become a “resident expert” in area of interest.
• Help student explore college and career opportunities.

Strategies to Support Attention and Organization – Build Executive Function Skills

Since the gifted child with ADHD struggles with executive function skills, it is critical that we help them self monitor/self regulate. To do this we need to provide explicit instruction having students use self talk to produce self awareness, visualize past experiences that have (and have not) worked, and modulate their future behaviors. Asking themselves questions like these below can prove to be effective.

Executive functioning is essentially self-monitoring. Use explicit instruction to teach students to:

• Self-direct attention to produce self-awareness.
• “Am I behind in my planning?”
• “Am I disorganized?”
• Visualize past experiences.
• “What worked or didn’t work in the past?”
• “What actions do I need to change?”
• Engage in self-talk to modulate their future behaviors.
• “What specific elements do I need to research for my project and why?”

• Use visual schedules.
• Cue and re-cue often.
• Provide rubrics, outline and graphic organizers for assignments.
• Use intermediate deadlines for long-term projects.
• Take the time to help student write assignments in planners.
• Pay attention to where the student is in proximity to the teacher and model peers.
• Help students learn how long tasks take.
• Help students set realistic goals
• Use technology

Strategies: Activity and Hyperactivity

• Provide opportunities for purposeful movement (e.g., sharpening pencils, running errands).
• Give quiet objects to occupy hands (fidgets, Koosh balls, self-adhesive Velcro strips under desk or tabletop).
• Encourage stretching exercises to ease the urge to move large muscles.
• Allow student to sit on the floor in a place that will not distract others.
• Use hands-on activities as much as possible

Strategies: Curriculum for Gifted with ADHD Learners

The goal of programming for twice-exceptional students is to maximize success while minimizing failure and frustration. As far as strategies to adjust curriculum for these learners we need to:

• Use curriculum compacting to minimize repetition and recognize student mastery of concepts and skills.  This frees up time for student to work in area of interest
• Supply ample advanced-level resources in areas of interest as well as in curriculum areas.
• Use research-based acceleration strategies as needed to minimize boredom.
• Integrate higher-level thinking activities into content and lessons.
• Provide content extensions that emphasize depth, complexity, and novelty.

Some General Selected Accommodations for Learners with ADHD

• Positive behavior supports
• Extra time to process information and complete work
• Reduce distractions (especially when focus is extra important, such as when testing)
• Frequent breaks
• Break work into smaller chunks
• Repeat information and instructions
• Structured and consistent environment
• Planning and organization
• Checklists and schedules (visuals are more effective than words)
• Reminders for careful work completion
• Provide opportunities to be active
• Praise for persisting with challenge

5. Potential Resources

Click on the title to open the resource.

Important resources will be  CDE's Special Education OHI website with extensive resources and your own district's website.  This is your opportunity to investigate what online information and resources your district has provided to families, educators, and specialists.

Our course's shared folder with more resources.  

Again, we encourage you to check for resources in your district and consider other online resources you might find.

All the videos and websites listed on this page are optional resources for your use.  For any video, once the video begins, you can click on the title for it to open in a different window on YouTube.

Center for Disease Control and Prevention: Attention Deficit/Hyperactivity Disorder

Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)

Child Mind: What’s ADHD (and What’s Not) in the Classroom

Misunderstood Minds - Try as many simulations as you would like, but we recommend that you try the Auditory Activity first.  When they pause the presentation to do the simulation, it should take about 5-7 minutes to finish.  So, how did you do? Think about being in a class of 27 to over 30 students ... Not an easy task

“ADD Traits in Famous and Talented People ... a scrapbook”. (A blog identifying famous people whose strengths were developed because of, or in spite of, ADHD-type behaviors.)

“My ADHD Teaching Strategies That Benefit All Students."

Some ADHD Stats -- Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) https://chadd.org/about-adhd/general-prevalence/

Books to Consider...

Smart but Scattered by Peg Dawson and Richard Guare

Tools of the Mind: The Vygotskian Approach to Early Childhood Education by Elena Bodrova and Deborah Long

For students:

Learning Outside the Lines: Two Ivy League Students with Learning Disabilities and ADHD Give You the Tools for Academic Success and Educational Revolution by Jonathan Mooney, David Cole, and Edward M. Hallowell

Other Website Resources

Understood.org

ADDitude

Harvard Center for Child Development

Stacey Turis, author of adhdsuperhero blog

www.everydayhealth.com

Cynthia Z. Hansen

References and Resources (Optional or bookmark for later reference)

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. Washington, DC, American Psychiatric Association.

Baum, S., Olenchak, F. R., & Owen, S. Gifted Students with Attention Deficits: Fact and/or Fiction? Or, Can We See the Forest for the Trees? Gifted Child Quarterly 1998. 42(2) 96-104

Cramond, B. (1995).  The Coincidence of Attention Deficit Hyperactivity Disorder and Creativity.  (Research monograph RBDM9508). Storrs, CT: The National Research Center on the Gifted and Talented, University of Connecticut. Retrieved from  http://www.gifted.uconn.edu/nrcgt/nrconlin.html#9508

Baum, S., Olenchak, F. R., & Owen, S. Gifted Students with Attention Deficits: Fact and/or Fiction? Or, Can We See the Forest for the Trees? Gifted Child Quarterly 1998. 42(2) 96-104

Cramond, B. (1995).  The Coincidence of Attention Deficit Hyperactivity Disorder and Creativity.  (Research monograph RBDM9508). Storrs, CT: The National Research Center on the Gifted and Talented, University of Connecticut. Retrieved from  http://www.gifted.uconn.edu/nrcgt/nrconlin.html#9508

Neihart. M. (2004). Gifted children with Attention Deficit Hyperactivity Disorder (ERIC Digest #E649). http://www.ldonline.org/article/gifted children with Attention Deficit Hyperactivity Disorder

Webb, J. T., et  al. (2005) Misdiagnoses and dual diagnoses of gifted children and adults: ADHD, bipolar, Asperger’s, depression, and other disorders.  Scottsdale, AZ: Great Potential Press

YouTube: Neuroscience and ADD in Gifted Children, Dr. Layne Kalbfleish, October 27, 2011

YouTube: ADHD as a Difference in Cognition; Not a Disorder, Stephan Tonti,

Foley-Nicpon, M., Rickels, H., Assouline, S. Richards, A. Self-Esteem and Self-Concept Examination Among Gifted Students with ADHD, Journal for the Education of the Gifted. 2012, 35(3), 220-240

Gladstein, M. (2013).  Executive functioning, self-questioning, and student success.  2e Newsletter, 57, 4-6.

Kaufman, F., Kalbfleish, M.L., & Castellanos, F.X.  (2004), Attention deficit disorders and gifted students: What do we really know? NRC-Gt Newsletter, Fall, 2004.  Retrieved from http://www.gifted.uconn.edu/nrcgt/newsletter/fall00/fall004/html

Lovecky, D. (2004). Different minds: Gifted children with ADHD, Asperger syndrome, and other learning deficits. London: Jessica Kingsley Publishers.

Misunderstood Minds, http://www.pbs.org/wgbh/misunderstoodminds/attention.html

Foley-Nicpon, M., Rickels, H., Assouline, S. Richards, A. Self-Esteem and Self-Concept Examination Among Gifted Students with ADHD, Journal for the Education of the Gifted. 2012, 35(3), 220-240

Gladstein, M. (2013).  Executive functioning, self-questioning, and student success.  2e Newsletter, 57, 4-6.

Kaufman, F., Kalbfleish, M.L., & Castellanos, F.X.  (2004),  Attention deficit disorders and gifted students: What do we really know? NRC-Gt Newsletter, Fall, 2004.  Retrieved from http://www.gifted.uconn.edu/nrcgt/newsletter/fall00/fall004/html

Lovecky, D. (2004). Different minds: Gifted children with ADHD, Asperger syndrome, and other learning deficits. London: Jessica Kingsley Publishers.