Planning an
adult class for LD/ADHD students.
Carl Stuart
Stuart Science Series
Introduction.
ADHD (Attention Deficit Hyperactivity Disorder) is one of the
conditions that lead to learning disabilities (LD). However, an understanding
of ADHD/LD will enable one to manage and circumvent some of the hindrances
associated with the condition (Levin, 2011).
The focus of the class will be on ADHD/LD among adults. The
thesis statement for this paper is that an understanding of ADHD as a
neurobiological condition will enable the adult learners to manage it. This
will enable the learners to overcome the fear and diffidence associated with
ADHD.
Class outline.
The topic for the class is ADHD/LD and management modalities.
This will be an interactive session and the participants will be allowed to ask
questions about concepts that they do not understand before the class proceeds
to the next concept. However, all the other questions from the participants
must be reserved to the end of the class. At the end of the class, the
participants must understand the concepts outlined in the class objectives. The
class objectives are outlined below:
1. To define ADHD and other
related terms.
2. To describe the classification
of ADHD.
3. To describe the signs and
symptoms of ADHD.
4. To explain the association
between ADHD and LD.
5. To state the causes of ADHD.
6. To describe the pathophysiology
of ADHD.
7. To describe the diagnosis
criteria for ADHD.
8. To describe various management
modalities for ADHD.
9. To understand the context of
ADHD within the societal milieu.
Audience.
The audiences for this class are adult learners who suffer from
ADHD/LD. These special need learners have the unique features outlined
hereafter.
To start with, they are self-directed autonomous adults who have
an expectation that they will be involved in the lesson (Rubin, 2011).
Secondly, they have accumulated knowledge from life experiences, work and
previous education; and they expect to connect the subject matter to this
knowledge base (Weiner, 2011). Thirdly, they are goal-oriented and relevancy-oriented
individuals who expect the subject matter to assist them to attain their goals
(Rubin, 2011). Also, they are practical individuals who are more interested in
the practical applicability of the concepts they are learning (Weiner, 2011).
Hence, the class must have clearly defined elements and it should also be well
organized. The instructor must prove the relevance of the subject content to
their lives of the participants (Rubin, 2011). They must be allowed to
participate in the class, in order for them to extract the maximum benefits
from the class. Finally also need to be respected, and hence they must be
allowed to ask questions during the lesson (Weiner, 2011).
The audiences are slow learners who require the following
critical elements during the learning process: motivation, reinforcement,
retention and transference (Weiner, 2011). Motivation requires the instructor
to do the following: create an effective virtuous rapport with the learners,
establish an appropriate tone for the class, show concern for the class needs,
establish an appropriate level of difficulty for the learners, offer specific
feedback and reward the participants (not by offering financial rewards) in
order to ensure that the learners maintain an optimal level of interest and concentration
in the subject matter (Rubin, 2011).
Instructors must apply both negative reinforcements (to
promote extinction of inappropriate behavior) and positive reinforcements in
appropriate measures during the class. Reinforcement ensures that the consistent
positive behavior is maintained and it also augments retention of subject
matter (Rubin, 2011).
Instructors must place an emphasis on retention and practical
application of the learned concepts; and hence, they must encourage the
participants to practice what they have learned (Weiner, 2011). Transference is
the capacity of the learner to apply concepts learned in the class in new
settings (Rubin, 2011). The pragmatic benefits of the class must be
demonstrated to the learners by the instructor in order to ensure that there is
positive transference among the learners (Wiener, 2011). Positive transference
occurs when there is association (relating the new information to the
accumulated knowledge), similarity (how analogous is the new information to information
in the accumulated knowledge base), critical thinking elements (how beneficial
is the information in enabling one attain his/her goals) and an appropriate
degree of original thinking (Rubin, 2011).
Program
Planning.
The
description of the program plan is described hereafter. To start with, the
topic and class objectives must be identified and clearly stated. Next, the
information related to the topic and objectives should be systematically
organized in a logical order. The format of presentation of the systematically
organized information is selected. In this case, the information will be put
forward as a PowerPoint presentation. The topic will be taught in a classroom
setting; and hence, there is need to locate and reserve an appropriate lecture venue.
The
prerequisite for this program is that all the participants must have suffered,
or are suffering, or are a caretaker of an individual suffering from ADHD.
Participants are then informed about the lecture venue and the time that the
class will commence. Prior to the commencement of the class, there is a 10
minutes warm-up period. The warm-up period will allow the participants to
introduce themselves to each other and to the instructor; and the instructor
will also introduce himself/herself to the participants.
The
class then commences. The topic to be discussed is stated. Thereafter, the
class objectives are outlined to the participants. They are then asked to
actively participate in the class and ask questions about the concepts that
they do not understand. The topic is then taught to the participants. A SCANS
skills analysis of the participants will be carried out during the
participants’ active participation in the class. The following competencies will
be analyzed in this class: basic skills, interpersonal relationships, personal
qualities and thinking skills. At the end of the class, the participants will
be allowed to ask questions. After that, the instructor will ask the
participants several questions about ADHD/LD.
SCANS
skills is a policy formulated to ensure that the following four basic skills
are imparted in the learner: basic skills (listening, reading, writing,
speaking and mathematics), people skills (social, teamwork, negotiation,
leadership and cultural diversity), personal qualities (self-esteem,
responsibility and self-management) and thinking skills (creative thinking,
visualization, problem-solving and decision making) (Smith, 2011).
Class
design.
This
is an in-class learning activity and the class design conforms to a classroom
settings. The class design is outlined hereafter:
1.
Topic.
2. Objectives: broad and specific
objectives.
3. Definitions.
4. Classification of ADHD.
5. Signs and symptoms.
6. Association between ADHD and
LD.
7. Causes of ADHD.
8. Pathophysiology of ADHD.
9. Diagnosis criteria for ADHD.
10. Management modalities and their prognosis.
11. Context of ADHD within the societal milieu.
12. Summary.
13. Questions from participants.
14. Questions from instructor.
15. End.
This systematic class design allows for interactive
participation and active learning in the class (Beal, 2012). Systematization of
the information facilitates its subdivision into manageable pieces that will
avert information overload in the learners, maintain interest and concentration
among the learners; and also enable the instructor to narrow down his/her
emphasis to the essential applicable concepts (Rubin, 2011). For instance, an
ADHD patient knows that he/she must change the drugs he/she is using when a
liver disease develops during the course of treatment. Moreover, he/she
understand the signs and symptoms, and can thus recognize them in his/her
child/children; and, then take the appropriate actions.
This systematic information will be put forward as a PowerPoint
presentation to amplify aesthetic appeal and promote recall among the learners.
This presentation will be done in a classroom facility.
The transfer of learning is a continuous process that occurs
when contextual learning activities and behavior are related to prior knowledge
or experiences. It has two components: near transfer and far transfer (Rubin,
2011). Near transfer is related to two or more contexts that share a high
degree of similarity. Far transfer is related to two or more contexts that
share a low degree of similarity (Beal, 2012). Transfer is essential in
education as it enables the learner to associate the new concepts with the
prior accumulated knowledge; and in the process improve his/her living
condition/status (Rubin, 2011). The identical element theory of transfer of
learning is manifested in this class design. This theory states that the extent
of transfer of learning is directly proportional to the degree of similarity
between the new concepts being learnt and prior experiences (Beal, 2012). In
this class design, the learners are being taught about a condition that has
affected them, and hence they are able to associate the new information with
their prior experiences with ADHD.
Moreover, what is learnt about a particular subject facilitates
the attainment of the requisite goal in related areas (Beal, 2012). Hence, this
class design will enable the person suffering from ADHD to manage his/her
condition appropriately.
Transfer can either be positive or negative. Positive transfer
occurs when contextual learning in the classroom enables the learner to manage
ADHD; while negative learning occurs when this contextual learning leaves no
impact on the life of the learner (Beal, 2012). The class design aims to foster
positive transfer.
The class design incorporates a session whereby questions can be
asked by the participants. This question session enables the instructor to
clarify issues that the participants have not understood properly. This
reinforces understanding and retention of the learned concepts (Rubin, 2011).
The instructor will ask the participant questions relating to ADHD in order to
evaluate their level of understanding and capacity to apply the learned concepts
in new settings.
There are two learning approaches that are used in this class
design. The first approach is known as PQRST (preview, questions, reading,
summary and test). PQRST is based on effective communication skills of the
instructor (Rubin, 2012). The objectives of the class are to provide a preview
of the subject to be discussed, and it will also enable the learners to
formulate questions which they expect to be answered during the lesson. The
recitation and exposition of the concepts by the instructor will enable the
learners to understand ADHD and modalities of managing the condition. A clear
understating of ADHD will enable the learners to make a summary of the key
points.
The second approach is based on condensing information,
organizing summary and emphasizing the keywords and key concepts (Rubin, 2011).
The systematic information presented is derived from various dissimilar sources
and it has been amalgamated into a consistent, coherent and logical sequence
(devoid of superfluous information) that coveys the essential attainable
concepts. An organized summary assist in revision and recall. The keywords are
bolded, while, the key concepts are bolded and italicized to draw an attention
to them and this exploit facilitates quick recall and retention of the
essential concepts.
The class presentation (adapted to Microsoft word) is provided
below.
Attention Deficit Hyperactivity Disorder (ADHD).
I.
Objectives:
1. Broad objectives: To understand
ADHD and its current management modalities.
2. Specific objectives:
(a) To define ADHD and
other related terms.
(b) To describe the
classification of ADHD.
(c) To describe the signs
and symptoms of ADHD.
(d) To explain the association
between ADHD and LD.
(e) To state the causes of
ADHD.
(f) To describe the
pathophysiology of ADHD.
(g) To describe the
diagnosis criteria for ADHD.
(h) To describe various
management modalities for ADHD.
(i) To
understand the context of ADHD within the societal milieu.
II.
Definitions.
ADHD: It is a psychiatric, developmental (involving development
during childhood) and neurobiological (affecting the normal functioning of the
central nervous system) disorder characterized by periods of inattention (or
decreased attention) and impulsiveness (due to hyperactive) or a coexistence of
the two states (Levin, 2011).
LD (Learning Disability): A condition that impedes the acquisition of basic school skills
at a normal rate (Teitelbaum, 2011)..
Pathophysiology: Refers to aberrant changes that are caused by a disease or
disease processes (Levin, 2011).
Neurotransmitter: A chemical compound that relays information between two or
more adjacent neurons (Levin, 2011).
Co-morbidity: refers to the simultaneous coexistence of two or more diseases
in the body (Levin, 2011).
Serum: The resulting fluid component of blood after the removal of
clotting factors (Levin, 2011).
Prognosis: The outcome of the course of a disease. The disease either
disappears completely (good prognosis) or it worsens (bad prognosis) (Levin,
2011).
III.
Classification of ADHD.
ADHD is a disruptive behavior disorder that is
classified according to the preponderance of symptoms into three categories
(Levin, 2011):
(a) ADHD-I: predominantly inattentive type.
(b) ADHD-HI: hyperactivity-impulsivity type.
(c) ADHD-C: combined type.
The prevalence of ADHD among children ranges from 2-18% of which
1-36% persists into adulthood. The population suffering functional impairment
is probably higher because the stringent nature of the diagnosis criteria. It
is associated with the following co-morbidities: anxiety disorders, mood
disorders, excessive substance abuse and oppositional defiant disorder (which
manifest itself as aggressive antisocial behavior or conduct) (Levin, 2011).
IV.
Signs and symptoms of ADHD.
They are categorized according to the predominant symptom.
The following are the signs and symptoms of ADHD-I: inattention to detail with
resultant careless mistakes, difficulty in maintaining a consistent level of
attention, difficulty in completing tasks, problems harking to verbal
instructions, avoidance of mental tasks, difficulty in organizing, easy
distraction and forgetfulness(Levin, 2011).
The following are the signs and symptoms of ADHD-HI: squirms and
fidgets, excessive talking, inability to remain seated, inappropriate running
and climbing in the workplace, handwriting difficulties, dashing during work,
blurting out answers before the completion of the question, impatience,
inability to await one’s turn and constant interruption/intrusion into other
people’s activity(Levin, 2011).
ADHD-C involves a combination of signs and symptoms of ADHD-HI
and ADHD-I. ADHD manifestation in adults takes the following forms: reduced
academic performance (poor adjustment in colleges, underachievement and
drop-outs), decreased work productivity (frequent absences, unemployment and
frequent job changes) and strained social interactions (frequent divorce,
workplace conflicts, low self-esteem and poor interpersonal skills), frequent
road accidents when driving, increased substance abuse and non-compliance to
prescriptions which ultimately increases the overall healthcare costs(Levin, 2011).
V.
Association between ADHD and LD.
ADHD causes poor concentration levels, impaired recall,
inability to speak coherently, poor writing skills, impaired organization of
thought processes and aversion to mental tasks (Levin, 2011). Meanwhile,
effective learning skills are dependent on efficient communication skills,
excellent writing skills, organized thought processes, superb recall and
anticipation of progressively difficult mental tasks (Teitelbaum, 2011). Hence,
ADHD impairs all the mental faculties and physical attributes necessary for
effective learning, and thus there is a resultant learning disability.
VI.
Causes of ADHD.
The exact causes of ADHD are currently unknown, but 8 factors do
contribute to it. These factors are:
(a) Genetics: This is based on monozygotic
(from a single ovum) twin studies which have shown high heredity patterns for
ADHD among twins (Levin, 2011).
(b) Evolution: Genes responsible for ADHD remained
in the gene pool because women were attracted to risk-loving males (Levin,
2011).
(c) Environmental: Exposure of the fetus to
alcohol and cigarette smoke components have been shown to cause ADHD after
birth. Lead poisoning during the perinatal and infancy period has been shown to
cause ADHD (Levin, 2011).
(d) Diet: Ingestion of food containing Sodium
benzoate (a food preservative) has been shown to cause ADHD-HI (Levin, 2011).
(e) Social: Events that cause disruption of
the social fabric such as divorce, adoption, crime, war and riots has been
shown to cause ADHD (Levin, 2011).
(f) Impaired neurobiological development
causes neurobehavioral aberrations and ADHD (Levin, 2011).
(g) Social construct theory: Proponents of
this theory state that the diagnosis criteria is what determines if a person
suffers from ADHD or not; and, thus ADHD is an invented psychiatric disorder
(Levin, 2011).
(h) Low arousal theory: People who have
low arousal threshold exhibit hyperactive behavior when they are stimulated by
any environmental stimuli. Lack of stimulation thus leads to inattention
(Levin, 2011).
VII.
Pathophysiology of ADHD.
ADHD is caused by left frontal lobe dysfunction. This
dysfunction causes a disintegration of the frontosubcortical system activities
and functions. This system co-ordinates and integrates cognitive and motor
functions of the body; and hence its disruption causes a disengagement of this
vital co-ordination and the resultant symptoms of hyperactivity and inattention
starts to manifest itself externally(Levin, 2011).
The frontosubcortical system is made up of the caudate
nucleus, anterior cingulate cortex, lateral prefrontal cortex and the putamen.
The dysfunction is thought to result from hypodopaminergia (a condition where
the dopamine concentration in dopaminergic neurons is low) within dopaminergic
neurons (neurons that release dopamine as their primary neurotransmitter), and
this condition results in reduced cerebral glucose metabolism thus adversely
affecting provision of energy to functional cerebral systems (Levin, 2011).
Dopamine is a neurotransmitter that causes stimulation
within the central nervous system (brain and its associated cranial nerves) and
its deficiency results in symptoms similar to depression (Levin, 2011).
VIII.
Diagnosis criteria for ADHD.
The Utah criteria is used for preliminary adult ADHD diagnosis.
These criteria have three prerequisites: childhood and adult criteria must be
met before a positive diagnosis is made; exclusion of transient inattentive
symptoms and diagnosis is made only after all the other psychiatric conditions
have been excluded (Newark, 2011).
It is imperative that a person seeks evaluation for ADHD
alongside his/her child/children if the following signs and symptoms are noted:
disorganization, inability to complete tasks, lack of concentration and reduced
productivity (Newark, 2011).
The adult criteria used are: attention deficits, motor
hyperactivity and any two of the following symptoms; labile affect (manifested
by an emotionless facial expression), excessive emotional activity, frequent
temper outbursts, impulsivity and disorganization (Newark, 2011).
The
preliminary ADHD diagnosis made using the Utah criteria is confirmed by patient
interview (which facilitates the collation of information and categorization of
the type of ADHD), neuropsychological assessment (using Weschler IQ tests,
Controlled Word Association Test, Stroop task and Trail making tasks), rating
scales and laboratory and/or radiological examinations(Newark,
2011).
The
common rating scales used are ADHD Rating Scale-IV, Brown ADD (attention
deficit disorder) Scale for Adults, Adult ADHD Self Report Scale and Conner’s
Adult ADHD Rating Scale (Newark, 2011).
The
common laboratory examinations done are serum lead content (as this indicates
lead poisoning), full and differential blood count (due to the fact that lead
poisoning alters the differential blood count) and serum vitamin B12 levels (to
indicate the presence of anemia which results from hypodopaminergia) (Newark, 2011).
The
common radiological examinations are EEG (electroencephalograph), Sleep study
(to examine cerebral functions) and CT (computer tomography) scan (Newark, 2011).
The diagnosis of ADHD must be done by a qualified psychiatrist
who will be able to prescribe the appropriate medications and other
non-pharmacological (not related to drugs) treatment modalities (Newark, 2011).
IX.
Management modalities and their prognosis.
There are two common management modalities: Pharmacological and
non-pharmacological. The pharmacological treatment is further divided into two
categories: stimulants and non-stimulants (Newark, 2011).
According to the low arousal theory, an adequately managed
stimulation by stimulant drugs will overcome the inattention and avoid
hyperactivity, thus leaving the patient in a normal state (Levin, 2011). The
common stimulants used are methylphenidate and amphetamines. The starting dose
of methylphenidate is 5mg (milligram) taken thrice per day; and then it is
gradually increased for the next 5 weeks to a maximum of 100mg/day. The common
trade names for methylphenidate are Ritalin (Ritalin LA is the extended release
formulation), Strattera and Concerta XL (Newark, 2011).
The extended release formulation of methylphenidate is preferred
to the short-acting daily doses. Methylphenidate has a good prognosis due to
its effective therapeutic response. However, methylphenidate must not be used
by persons suffering from other psychotic disorders, hypertension, heart
failure, seizures, hyperthyroidism (excessive concentration of thyroid hormone
in the blood which leads to aberrant body metabolism and heat intolerance) and
previous myocardial infarctions. In these cases, amphetamines substitutes for
methylphenidate (Newark, 2011).
Non-stimulants are used by patients who have existing co-morbid
conditions. The most commonly used non-stimulants are tricyclic
antidepressants, atomoxetine and bupropion. Atomoxetine is used as a
substitution for methylphenidate in patients who develop liver diseases during
the course of treatment. It is usually taken twice per day (morning and
evening) (Newark, 2011).
Non-pharmacological treatment is categorized into three:
Cognitive-behavioral therapy, family or group therapy and support groups
(Newark, 2011).
The complimentary approach to management of ADHD utilizes fish
oil which has nutrients that aids in the maintenance of cognitive function
(Newark, 2011).
X.
Context of ADHD within the societal milieu.
It is imperative for a person who has been diagnosed with ADHD
to inform his/her family, friends and employers about it. Nowadays, stigma
associated with ADHD is virtually non-existent in the society. The preliminary
and definitive diagnosis report of ADHD by a certified and qualified
psychiatrist will enable the patient to get the following benefits: social
insurance payments mean tested payments, doctors-only medical cards which
enable the patient to access long-term illness scheme, drug payment scheme,
subsidized occupational therapy and social services (Levin, 2011).
Pertaining to legal matters, the patients have access to
subsidized legal aid which helps him/her to prepare for the future and to write
a will. The patient is also protected from discrimination by anti-discrimination
legislation and employment equality legislation. The patient is also assisted
to obtain vocational training, rehabilitative training and employment support
(Levin, 2011).
The patient is also encouraged to join support groups which will
enable him/her deal with challenges associated with ADHD (Newark, 2011).
XI.
Summary.
ADHD is a psychiatric, developmental and neurobiological
disorder characterized by periods of inattention and impulsiveness or a
coexistence of the two states. It causes LD. It is classified according
to the preponderance of symptoms into three categories: ADHD-I, ADHD-HI and
ADHD-C. Genetics, social disruption, environmental factors, diet, low arousal
theory, impaired neurobiological development, social construct theory and
evolutionary factors do contribute to the development of ADHD. The underlying
pathophysiology of ADHD is hypodopaminergia. Preliminary ADHD diagnosis is made
using the Utah criteria while definitive diagnosis is made after patient
interview, neuropsychological assessment, rating scales and laboratory and/or
radiological examinations have been done. The most effective treatment for ADHD
utilizes methylphenidate. Other drugs used are amphetamines and atomoxetine.
There are anti-discrimination laws protecting ADHD patients, and social support
groups to cater for their various challenges.
XII.
Questions from the participants.
XIII. Questions
from the instructor.
(a). Describe the classification of ADHD?
(b) Describe the signs and symptoms of ADHD?
(c) Explain the association between ADHD and LD?
(d) Describe the pathophysiology of ADHD?
(e) Describe the diagnosis criteria for ADHD?
(f) Describe the various management modalities for ADHD?
XIV. The End.
Recommendations and conclusions.
In conclusion, the systematization of ADHD information has
facilitated its subdivision into manageable pieces that can be learned by the
learners without loss of interest. Also, it has enabled the instructor to
narrow down his/her emphasis to the essential applicable concepts. The class
design promotes a positive near transfer of learning. The class design has a
session for questions, and this session facilitates understanding and retention
of the learned concepts. The approaches of learning have facilitated a
consistent and coherent presentation of facts which enables a clear
understating of ADHD. This promotes transfer of knowledge, augments recall and
facilitates transference among the learners. It is recommended that the above
class design be taught in a classroom setting using a PowerPoint presentation.
Also, it is recommended that each title should be in a separate slide and the
two consecutive ADHD slides should be separated by a unique tantalizing picture
of an individual who overcame ADHD.
Summary.
The learning process enables the participants to understand new
concepts which they can apply in the betterment of their lives. For instance,
an understanding of ADHD/LD will enable
the learners to overcome the fear and diffidence associated with ADHD. An
interactive session will enable the participants to ask questions about
concepts that they have not understood. Such an interactive session will enable
the instructor to meet the special needs of the participants, while
concurrently assessing their SCANS skills. The systematization of information
facilitates the learning process. Moreover, the learning process is facilitated
by the excellent communication skills of the instructor. Positive transfer of
learning, retention, positive transference and promotion of critical thinking
are the desirable effects of any learning process.
References
Newark,
J. (2011). Management of Adult Attention Deficit Hyperactivity Disorder
(ADHD). Journal of Clinical Psychiatry, 17(3),
893-917.
Beal,
P. (2012). Prerequisites of an effective class design. Journal of Higher Education, 45(9),
654-678.
Smith,
D. (2011). SCANS skills analysis. Journal
of College Education, 78(5), 531-567.
Weiner,
M. (2011). Adult learners in the classroom setting. Journal of Adult
Education, 39(8),
289- 315.
Rubin,
R. (2011). Adult learners in the Education Sector. Auckland, New
Zealand: Oxford
University Press.
Levin,
W. (2011). Understanding Attention
Deficit Hyperactivity Disorder. San Francisco:
Jossey-Bass.
Teitelbaum,
Y. (2011). Effective learning skills. Journal
of Pedagogy, 87(3), 595-607.
