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Article published 9th June 2008

ADD/ADHD case histories

With thanks to Fintan J O’Regan, international expert in ADD/ADHD.

It is obviously difficult to assess the time and costs to support children with ADD/ADHD, but one thing is clear: learning difficulties accompanied by behavioural issues take up a great deal of both.

We are usually looking at two specific patterns of behaviour: children who cannot sit still, are highly impulsive and appear driven by a motor, and those who appear to be mentally somewhere else other than in your presence... the space cadets.

The cost of ADD

As in most businesses today, the most expensive resource in schools is personnel. Learning and behaviour difficulties engage vast amounts of personnel time in terms of specialist teaching (often one-to-one provision), additional learning support staffing and a range of time-consuming meetings, conferences, phone calls, paper administration and communication with external agencies.

I recently spent most of a particular Tuesday on one issue, in which seven other adults, including the senior LEA educational psychologist, a social worker, the child’s headteacher, the classroom teacher, two learning support teachers, the careers adviser and the parent also needed to be involved.

This is not a unique scenario: on a day-to-day basis throughout the UK vast resources are absorbed in planning, managing and teaching children with ADD/ADHD.

Within mainstream schools children with ADD/ADHD will require varying amounts of support dependent in part on the nature of their difficulties, the type of school they attend and, to a very large extent, the training of the special needs teacher and the SEN skills/knowledge/attitude of the majority of the regular teaching staff.

Although many teachers, support staff and administrators are aware of the term ADD/ADHD, few see it as medical disorder rather than a behavioural issue. This to some extent is understandable: teachers at the ‘coal face’ will have to address the core symptoms of inattention, impulsivity, hyperactivity and often other behavioural/socialisation difficulties. As a group they are often quite defensive about behavioural issues with specific students, which, unlike learning difficulties, can often make individual teachers feel uncomfortable about how their management of particular students is perceived.

These typical examples might help to clarify the variability further.

Daniel

It’s 8.25 and Daniel’s brother and elder sister are waiting for him so they can go to school together.

But 4-year-old Daniel decides he does not want to wear his coat. He is crying and says he doesn’t want to go to school today. Pleading is ignored, as are threats. He will not put his coat on. The clock is ticking ... soon they will all be late for school. This has been a pattern of the last few days – Daniel difficult and disruptive, his mother tense with frustration.

Options are limited. Sending him to his room is not a possibility at this time, and Daniel probably even knows this. In the end the coat is forced on him and he’s dragged screaming down the street, howling all the way to school with his bemused and embarrassed brother and sister and a highly agitated and embarrassed mother. The next morning the same thing happens ... and the next ... Then Daniel’s mother tries the sticker chart formula.

For every morning that no complaints occur Daniel gets a sticker; 10 stickers he gets a present – and to make it fair the whole family goes out for dinner.

Daniel likes the concept. He wears his coat, he gets his sticker, he is able to self-regulate.

Ivan

Ivan was having a typical day: he just couldn’t keep still. He kept on fiddling with a pen which, once taken away by the teacher, was replaced by an elastic band. When it was flicked across the room and struck Sadie across the face she stood up yelling in the middle of the class.

The teacher Mr Flynn had had enough of this and of year 8c in general. ‘Out!’ he said to Ivan. ‘Off to the LSU. Go and see Ms Parker.’ Ivan didn’t mind as he quite liked Ms Parker and preferred the sanctuary of the learning support unit. But as he left the classroom he passed Mark and whispered something to him. Now Mark flew out of his seat and ran after Ivan out of the classroom. The two of them began pummelling each other in the corridor. Before Mr Flynn could move, five other students had rushed out of the classroom to watch the action. Mr Flynn pulled the two boys apart, with Ivan laughing and Mark spluttering, still furious: ‘He cussed my mother, Sir!’

Simon

Instead of being at homework club after school 13-year-old Simon was spotted outside on the street on his skateboard. The teacher asked him to come inside and join the others. Simon appeared flustered and disorientated and was finding it hard to settle at his desk. Also his skateboard kept getting in his way. Simon, though badly disorganised, was usually a most passive and generally compliant student. After watching him struggle to get started, the teacher said that he would remove his skateboard until later. It came as a tremendous shock to the teacher when Simon’s response was to jump out of his seat in a furious temper, yelling, ‘If you do that you’ll be sorry!’ The room became a deadly hush. After his outburst Simon now sat slumped, spent in his chair.

When the teacher approached him Simon put his hands over his ears and started sobbing, saying, ‘I’m such a bad kid.’

The costs of ADD/ADHDH

It is obviously difficult to assess the time and costs to support children with ADD/ADHD, but one thing is clear: learning difficulties accompanied by behavioural issues take up a great deal of both. As in most businesses today, the most expensive resource in schools is personnel.

Learning and behaviour difficulties engage vast amounts of personnel time in terms of specialist teaching (often one-to-one provision), additional learning support staffing and a range of time-consuming meetings, conferences, phone calls, paper administration and communication with external agencies.

I recently spent most of a particular Tuesday on one issue, in which seven other adults, including the senior LEA educational psychologist, a social worker, the child’s headteacher, the classroom teacher, two learning support teachers, the careers adviser and the parent also needed to be involved. This is not a unique scenario: on a day-to-day basis throughout the UK vast resources are absorbed in planning, managing and teaching children with ADD/ADHD.

Within mainstream schools children with ADD/ADHD will require varying amounts of support dependent in part on the nature of their difficulties, the type of school they attend and, to a very large extent, the training of the special needs teacher and the SEN skills/knowledge/attitude of the majority of the regular teaching staff.

Although many teachers, support staff and administrators are aware of the term ADD/ADHD, few see it as medical disorder rather than a behavioural issue.

This to some extent is understandable: teachers at the ‘coal face’ will have to address the core symptoms of inattention, impulsivity, hyperactivity and often other behav- ioural/socialisation difficulties. As a group they are often quite defensive about behavioural issues with specific students, which, unlike learning difficulties, can often make individual teachers feel uncomfortable about how their management of particular students is perceived.

Managing ADD/ADHD

A child with ADD/ADHD will find a school with a calm, encouraging and consistent approach, a well-structured routine, clear rules and expectations of standards of work in school and for homework, beneficial.

The best schools, whether mainstream or special, are those that: adopt a whole school-approach to managing behaviour and expectations; have great teachers who can maintain order and discipline yet enthuse, inspire and educate youngsters and work positively with parents. 

Fintan J O'Regan, explains how children with ADD/ADHD can be helped at home and in school.

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