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Between 5 percent and 12 percent of children around the world have attention deficit disorder/attention deficit hyperactivity disorder. In the United States, rates above 12 percent have been reported in certain areas.
While ADD/ADHD is not as prevalent in area schools as in other parts of the country, it's still something area schools must deal with, said John Street, director of the Central Nebraska Support Services Program.
CNSSP operates through an interlocal agreement with the Grand Island public schools and provides services through seven member districts -- Grand Island, Northwest, St. Paul, Centura, Palmer, Central City and Wood River.
Street discussed his agency's policy in working with school districts and their students with ADD/ADHD.
The ADD/ADHD facts are from www.chrisdendy.com.
Q: What is attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD)?
A: There is a distinction between the two. Attention deficit disorder can manifest itself with hyperactivity or without hyperactivity.
Hyperactivity is where you see the obvious physical movement with kids, such as not being able to stay in their seats, walking around, needing to be physically involved and moving all of the time.
With ADD, it's not being able to stay focused, not being able to follow consecutive directions and sequential types of things, having daydreaming types of behavior, not being able to maintain eye contact and a little bit more difficulty in making judgments.
They are the types of kids who misplace things, are unorganized, which would also be true with kids with ADHD, but they are more noticeable because they are physically engaged.
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Street said, in many cases, children with ADD/ADHD are bright students.
"They usually have an average cognitive intelligence," he said.
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Types of behaviors kids with ADD/ADHD show when they are in school:
n They are up and out of their seats.
n They aren't paying attention.
n They can't get work completed.
n They are disorganized. They are the kids who have their desks in a mess.
n They have things on the floor every which way.
n They have a tough time following lengthy verbal directions.
n They have difficulty following multiple-step directions.
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Street said these types of behaviors associated with ADD/ADHD can be noticed as soon as kids start in school.
"As soon as you see them in a structured setting. It's not nearly as noticeable when kids are out doing nonstructured activity, such as outside running around and involved with things that are of an interest to them," he said. "Really, you don't notice nearly as much until they actually enter into an instructional situation."
He said it can even be noticed in preschool because there are routines that are typical of kids that age and they are not able to make easy transitions or follow directions.
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Fact: Not all children with ADD or ADHD are alike. Because symptoms of ADD or ADHD may be mild, moderate or severe or combined with other conditions, adults will see variability in skills and maturity levels in students with attention deficits.
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Q: What kind of training do teachers receive for working with children with ADD/ADHD?
A: "Every building has someone who has been trained and has knowledge and expertise in attention deficit disorder," Street said.
"It can be the school psychologist, an educational consultant, a counselor or other teachers who have experience that assist colleagues who are struggling in establishing what will work for any given student.
"All kids are different. There may be some kids with similar characteristics of attention deficit disorder, but it really does make a difference in regards to the circumstances."
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Street said teachers are in the front line in identifying and working with kids with ADD/ADHD as sometimes the parents may not be aware of the child's disorder.
"But sometimes the parents are the referral source because they are having difficulties with their children's routines at home," he said. "But typically, it's the classroom teacher that initiates the concern associated with those kinds of behaviors that set that student apart from the types of behaviors that you might see typically in developing kids."
vFact: ADD and ADHD run in families. Forty percent to 50 percent of all children with ADHD have at least one parent with the condition, and 30 percent have a sibling with the condition.
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Because ADD/ADHD is determined by a medical diagnosis, Street said, when working with a child in school, a number of actions are taken to help the child:
n If a concern is expressed by the parents or a classroom teacher, there's a process to collect as much information as the school can from an educational setting for parents to take to their attending physicians.
n The school provides a collection of observations or a checklist that can be used by the parent and the medical community to determine whether the student can be diagnosed with attention deficit disorder.
n It can also involve doing one-on-one testing with the student to collect all this information.
n Then, as a composite, based upon parental information and the school's information, the doctor determines whether that child meets the symptoms and characteristics of attention deficit disorder.
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When the treatment options involve medication, Street said, the prescribed dosage the child has to take while in school is handled by the school nurse. The child is not allowed to have the medicine on their own.
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Q: What course of action does the school district have if the child's parent doesn't work with school officials and behavior worsens at school?
A: "If it has an impact on learning, we actually go through the process of making a referral for potential special education eligibility," Street said. "ADHD or ADD is part of a category that is identified as health-impaired under our special education rules and regulations."
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When a child is diagnosed with ADD/ADHD and on medication for the disorder, Street said, the school continues to follow up on the child's behavior in order to report it back to the parent and to the attending physician.
"They monitor whether the medication is having any positive impact on the child," he said. "The frequency is based upon what the doctor thinks is efficient. Typically, it is monthly."
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Once a child is diagnosed with ADD/ADHD, along with medication, there are some behavioral modification techniques that are used to help the child, Street said. They include:
n Organizers and planners. (They are used a lot.)
n Reminder notes.
n Cues, such as hand signals or verbal prompts.
n Making sure kids are following up on things they need to get accomplished for the next day.
n Home/school connection so the parent knows what is expected of the student.
n The parent portal on Infinite Campus on the school's Web site allows the parent to be engaged on whether kids are completing assignments, especially in middle and high school.
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Fact: The primary observable difference between children and teenagers is a reduction during the teen years in hyperactivity, which is often replaced by restlessness. In addition, girls may react more emotionally because of hormonal changes.
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Street said the biggest thing the school district wants to accomplish with children with ADD/ADHD is teaching them a set of skills so they can manage their own behavior.
The keys in achieving the goal of having kids with ADD/ADHD manage their own behavior, are:
n Recognizing what calms them down.
n Recognizing how to stay in a routine.
n Recognizing how to prioritize.
"Those are the important things, from an instructional standpoint, as they get older," Street said.
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Fact: Boys with ADHD outnumber girls approximately 3 to 1. The primary difference between girls and boys with ADHD is that boys are more aggressive.
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Q: With all the things the school does to assist children with ADD/ADHD, is it working?
A: "It seems to be working. We don't have a greater incidence of kids who are diagnosed with attention deficit," Street said.
"With interventions that have been successful, the symptoms dissipate, and they are not nearly as severe or significant as kids get older because kids understand what works for them and what doesn't. The biggest challenge is a medical treatment plan with kids being sensitive whether they need to take the medication or not, whether there are side effects to the medication. That is a common report from kids as well as parents.
"It's not a big problem in our school district," Street said. "There is more awareness of kids who have this difficulty. But if all the players are not on the same page, then kids aren't going to be successful. It's not a one-size-fits-all solution."
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