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Assistive Technology for Self-Managing Behavior for those with ADHD________________________

Assistive technologies (AT) can be used to help teach reading, writing and math. They can also be used to help people learn ways to change to their behavior. People with ADHD can use these tools to help them succeed at school and home. Before we discuss this further we must define ADHD and its treatments. This is done so that the reader can better understand the reasons why AT have a place in the treatment of ADHD.

ADHD________________________________________________

There are two ways to define ADHD listed here. One way is to identify the characteristics or behaviors of the individuals with ADHD. The other way is to describe the physiological problem within those individuals with ADHD. The latter will be given first because the author is not a medical doctor and will not discuss it beyond the following description. "ADHD is a neurological disorder that is attributed to the deficiency of a specific neurotransmitter called norepinephrine and/or its precursors, dopa and dopamine, in a particular set of brain circuits." (Strobel et. al, 2006). The defining characteristics of ADHD are impulsivity, hyperactivity, and inattentiveness. As DuPaul and White describe it there are three subtypes: those who are hyperactive/ impulsive, those who are inattentive, and those that display all three characteristics. While some have their preferred way to define ADHD no one is exactly sure of its cause. This includes Eli Lilly and Company, the makers of the ADHD non-stimulant medication Strattera, who states that, "the exact cause of ADHD remains unknown..."

Treatment of ADHD____________________________________

Is treatment necessary? Once again the debate over treatment isn't clear cut. Some argue that treatment isn't necessary, but rather what is needed is better discipline. While others say that `boys will be boys,' and it's just a phase they're going through. Then there are those want to medicate in order help the children. Finally, there are those that want to use behavioral management techniques to help the child gain the skills they need to overcome their disorder. What ever the viewpoint it is the opinion of most is that, "[t]he inattentive, impulsive, and hyperactive behaviors that characterize ADHD often lead to significant academic and social difficulties at home and school." (DuPaul, White, 2005). The first two are actually varied forms of the same treatment and so they will be briefly discussed here. Discipline is necessary in a child's life if they are to be successful at school, work and even play. Some non-diagnosed kids that are thought to have ADHD may only need more discipline, but diagnosed ADHD can only be put in check with discipline. This leads into the next form of `treatment,' which is to ignore it and it will eventually go away. Unfortunately this fails to help the child when they most need the help. Ignoring will not check any of the symptoms. Using discipline will check ADHD as a child, but as an adolescent and an adult that individual will continue to struggle with this disorder.

Medication- Most medications to treat ADHD are stimulants that help the brain

function as it is supposed to function. "Methylphenidate (Ritalin) is the active ingredient in the majority of stimulant medications prescribed in the U.S." (Zablocki, 2007). Some of these include Dexadrin (http://us.gsk.com/products/assets/us_dexedrine.pdf) , Focalin (http://www.novartis.com/products/pharmaceutical-ei.shtml) , and Vynase (http://www.adderallxr.com/) . Some opponents, such as Steven E. Nissen, believe that these stimulants are not appropriate for millions of people to be taking, and that our doctors should carefully reconsider before continuing with their prescription (2006). Then there are those through their studies that believe they are not overprescribed across communities in our country (Jensen et al., 1999). This argument is brought up because the author believes that it deserves further consideration and monitoring by all interested in treating those with ADHD. The only non-stimulant medication known to the author in use in the U.S. is Strattera (http://www.strattera.com/index.jsp.)

Behavior management- This is basically a way to empower the student with the

knowledge and skills needed to combat their disorder. There is no set way to do this, but the goal is always to have to student change their symptomatic behaviors to more productive, and positive behaviors. Teachers begin with regular progress reports to parents while students must begin to self-monitor their behavior. Reid and Trout describe two ways for a student to self-monitor: · One, which would, "...typically involve the use of a prompt to cue the child to self-assess whether or not they were "paying attention." · And two, which would, "...typically entail students performing an academic task (e.g., spelling practice), and then self-monitoring the amount of completion or accuracy of their work either during or following the task. (summer 2005). As a self-awareness of the behaviors build up some more the student can be given some more strategies to help them. This can be done with the teaching of academic and social skills focused on antecedent correlations to symptomatic behavior. When the student knows of certain situations where they know they have trouble behaviors they can avoid the situation if possible or make a conscious effort to sit still and pay attention. Eventually they will have the knowledge of when and where they have the most trouble and can then tackle those persevering problems. The process can possibly take years to reach the stage where the individual is really managing their own behavior.

What's Better: Medication or Behavior Management?_______

A study of 579 grade school children meeting the criteria for ADHD outlined in the DSM-IV was conducted by Connors and Epstein. Their study looked at the outcomes of medication treatment only , behavior treatment only, a combination of both or none of the above. They concluded that, "The composite was internally consistent..., reliable ..., and correlated. In an intent-to-treat analysis, Comb [combination of intensive behavioral treatment and medication management] was statistically significantly better than all other treatments..." (2001). While the use of medication treatment only was not significantly far behind in effectiveness the researchers' analyses concluded that a significant number of those that did not respond to medication only did respond to the combination of medication and behavior treatment. The significance of this study is that it validates the

authors belief in behavior management as an effective means to help treat those with ADHD.

Support for the Use of AT with Those with ADHD___________

Assistive technologies are tools that can help the person with a disability overcome the challenges caused by their disorder. A couple researchers that agree with the author's standpoint that AT are helpful for persons with ADHD are quoted below: Many aspects of technology appear to assist pupils with ADHD symptoms overcome their academic problems. (Solomonidou, & Garagouni 2004). ...[p]rompting a child with ADHD with reminders [from a prompting device] throughout the day would likely improve many of the memory problems so often observed in these children. (Epstein, & Willis, winter 2001).

What AT Are Available?________________________________

Computers are excellent tools in the teaching of the student with ADHD. Solomonidou and Garagouni used a computer and software in their study that showed academic success for the student with ADHD (2004). For a more in depth look at AT for educational purposes (http://cosmos.ot.buffalo.edu/t2rerc/pubs/ip/ET/index.htm) go to T2RERC. They facilitate technology development, and product commercialization that benefits people with disabilities. While academic learning is vital in the growth of children the author would like to focus on the AT that help the student change the beghaviors that hinder their learning. Epstein and Willis used a portable prompting device in their study. They state that, "...forgetfulness and following through on instructions pose major obstacles in everyday life [for the person with ADHD]" (2001). The device helped remind the student when they were supposed to be doing something in particular. Word prompts associated with tasks often forgotten were displayed on the pager as it vibrated. Organizers and planners such as Palm Pilots are AT suggested to help students with ADHD. WETA-TVs education website LDonline (http://www.ldonline.org) suggests that whatever device you do choose it is key, "...that the student and her family and teachers can all use and adopt [it] quickly." These devices can help the student feel responsible instead of feeling like their teacher is always picking on them with nagging reminders. Palm (http://www.palm.com/us/education/resourcelibrary/quickguides.html#specialneeds) handheld computers even offers suggestions and programs in a quickguide on their devices that help those with special needs. In an article from the Arbiter Online (http://media.www.arbiteronline.com/media/paper890/sections/20070419BizTech.html) (Sutherland, 2007) Boise State University Professor of Special Education Jack Hourcade says that, "The basic principle in identifying and implementing assistive technology is to first consider the unique challenges associated with that specific disability. For people with ADHD, those challenges primarily revolve around such issues as organization and attending to critical ideas and details." Here are a few of the recommendations that he has given out over his 30 year tenure at the university: Ear muffs, ear plugs or noise-canceling headphones

WatchMinder is an AT watch to give reminders and training for self-monitoring behaviors. The watch vibrates and will scroll a message. Ear-fitted timers and alarms PDAs For some of these items and many more AT go to ADD consults directory of products for people with ADHD- http://www.myADDstore.com Resources: http://cosmos.ot.buffalo.edu/t2rerc/pubs/ip/ET/index.htm). http://www.myADDstore.com http://www.ldonline.org References: Conners, C. K., & Epstein, J. N. (Feb. 2001). Multimodal treatment of ADHD in the MTA: an alternative outcome analysis. Journal of the American Academy of Child and Adolescent Psychiatry. 40(2), 159-67. DuPaul, G. J., & White, G. P. (November/December 2005). Intervention Strategies for Students with ADHD. Principal (Reston, Va.). 85(2), 26-9. Epstein, J. N., & Willis, M. G. (Winter 2001). Use of a technological prompting device to aid a student with attention deficit hyperactivity disorder to initiate and complete daily tasks: an exploratory study. Journal of Special Education Technology. 16(1), 19-28. Jensen, P. S., & Kettle, L. (July 1999). Are stimulants overprescribed? Treatment of ADHD in four U.S. communities. Journal of the American Academy of Child and Adolescent Psychiatry. 38(7), 797-804 Reid, R., & Trout, A. L. (Summer 2005). Self-Regulation Interventions for Children With Attention Deficit/Hyperactivity Disorder. Exceptional Children. 71(4), 361-77. Solomonidou, C., & Garagouni-Areou, F. (2004). Information and Communication Technologies (ICT) and Pupils with Attention Deficit Hyperactivity Disorder (ADHD) Symptoms: Do the Software and the Instruction Method Affect Their Behavior? Journal of Educational Multimedia and Hypermedia. 13(2), 109-28. Steven E Nissen (2006). ADHD Drugs and Cardiovascular Risk. The New England Journal of Medicine, 354(14), 1445-1448. Retrieved November 14, 2007, from Research Library Core database. (Document ID: 1017774831). Strobel, W., Arthanat, S., Fossa, J., Mistrett , S., & Brace, J. (June 2006). The industry profile on education technology: Learning disabilities technologies and markets. http://cosmos.ot.buffalo.edu/t2rerc/pubs/ip/ET/index.htm Zablocki, E. (January 2007). Longer-acting drugs now a mainstay in ADHD treatment. Managed Healthcare Executive. 17(1), 44, 46.

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