Helping Students with ADHD Achieve Success: Tips for Teachers

ADHD impacts approximately 5-10% of children, which means as a teacher, 1 in 10 students may present with ADHD symptoms. It can seem like a handful with students squirming, drifting off in space, and disturbing others around them. But it doesn’t have to be.

As a teacher you are in a unique position to help the student learn habits at school that will help them be successful in their home and with them as they move through the education system.  Assisting young people with ADHD to learn how to feel and think better about themselves, and to identify and build on their strengths can be an important step in helping them control their symptoms of ADHD. Students with ADHD need to learn how to cope with daily problems and control their attention as well as their impulsivity, teachers and parents need to work together to help students achieve this success.

Tips for teachers:

·         Encourage youth to ‘stop and think’. This could take the form of counting to 3 before asking a                 question, or writing the question down and asking it at the proper time.

·         Create a token reward system – where emphasis is placed on the positive outcomes of behaving           appropriately.

·         Help your students have a regular routine. Posting the routine, reminding them of homework at               the end of the day, use organizers to help them keep their days straight.

·         Post rules in the classroom where they are easy to see and adhere to. Out of sight, is out of                   mind.

·         Helping kids who distract easily involves physical placement, increased movement, and breaking             long work into shorter chunks.

·         Post the day’s schedule each day at the front of the room, and cross of items as they are done.             Young people with impulse problems may gain a sense of control and feel calmer when they know           what to expect.

·         Be brief when giving instructions. Breaking them into bite sized chunks by asking the student to               do one step, and then tell them the next step once the first is completed, will help all students, but           especially those with ADHD

·         Incorporate physicality into learning by giving students opportunities to act out stories, or sing                 songs. Providing them with outlets for their physical energy.

Students with ADHD are often easily distracted and can become that way even in mid-sentence. If you do not know what they are talking about, ask them to help you understand. When speaking with a student, it’s best to not assume you know what a young person is going through (unless you yourself have struggled with ADHD) and instead ask them to tell you what it’s like, and what they need from you to help them be successful.

Meet with parents and talk about their son/daughter’s treatment as well as tactics and techniques they use at home. If you can reinforce successful tactics at home and school, you create an increasingly familiar routine for the student. Rewards programs can extend beyond the classroom and into the home life if a parent and teacher can work closely.

Each student will be different, so developing a toolkit of strategies that you can use with each child will help you find the best fit for them. Make sure to talk to other teachers and parents, to share great ideas and success stories.

--Stan Kutcher, MD, FRCPC and Christina Carew, ABC

How do I talk to my teenager about suicide?

One of the issues that arise in discussions with parents about youth mental health is: “how do I talk to my teenager about suicide?" This is most often in the context of a media report about a youth suicide or a community or school experience of youth suicide. There is no “right” way to discuss this issue but there are some useful guideposts.

Be prepared to chat if your teen brings it up but do not be surprised if that does not happen. If you have concerns that your teen may want to discuss this you can address the issue in a gentle and “just putting it out there” manner. Saying something such as: “I was reading in the paper about the young person who recently died. Sounds like a tragic situation” can be an ice-breaker. Then if your teen is interested, they have an opportunity to discuss it with you. Sometimes they will be interested and sometimes they will not be interested. Or, they may bring it up at a later time, when they are ready.

If, however, you or your teen knows the person who had died, then this discussion should be explicit. This is now not an issue of “talking” to your teen, but an issue of grieving while at the same time acknowledging that death was by suicide. There can be a tendency to both avoid the issue of suicide or to over-focus on the issue of suicide. Try not to do either. 

Sometimes both you and your teen may need more support than usual (such as family and friends or religious communities). If this is the case, you can seek out services that are available through your local community health center or mental health care providers. A useful resource is the booklet “Have you lost someone to suicide?” which is available on this website here.

If you are concerned that your teen is having a mental health problem or may be depressed, it is a good idea when you are discussing this to bring the issue closer to home. There is nothing wrong with acknowledging that depression or a mental health problem increases risk for suicide and making that knowledge part of what you monitor when your teen is not feeling well. If you have diabetes you monitor your blood sugar and your diet. If you have depression you monitor your mood and thoughts about suicide.

-Stan

Parents Can Make A Difference

As a psychiatrist (and a parent of a child with ADHD), I want to reassure parents of children with (or exhibiting signs of) ADHD, it gets better when they receive the right intervention.

The best thing a parent can do is to be informed. The more you know about ADHD, the better you will be able to help your son or daughter with the challenges they face. There is no biological test that can confirm a diagnosis, so it is often a discussion between parents, teachers and health care professionals that determines the diagnosis of the child involved.

It’s important to remember that all children are not the same, and therefore can’t be treated the same. If you have a child that has ADHD, and one that doesn't, it’s challenging to remember that you can’t expect the same behaviors from both. When your child is fidgety, when it seems like they aren't listening, or they've forgotten something again -- if you know are aware these are their struggles, your response will be different to the situation. It’s often difficult to remember that this child isn’t bad (in relation to their brother or sister or other children), but that their ADHD causes them to be impulsive, inattentive or both.

As a parent, it’s important to help your child to be successful and to reach their maximum potential. Young people with ADHD responds better in well structure environments, you can help them with homework and chores, by creating a routine. As many children with ADHD have trouble sustaining attention, breaking items into small tasks with an immediate reward at the end has proved to be quite effective. Instead of suggesting your son clean his room, ask him to fold his clothes. The way to reward your child varies with age.  Charts have a better impact in smaller children, for older children or teens you can offer them pick out what’s for dinner, let them watch their favorite television show or spend extra time with favorite video game.

Increase your child’s self-esteem, this point is very important as many young person with ADHD has a low self-esteem. Focus on their strengths and things they do well.  For instance, individual sports and activities such as track and field, or swimming, are generally more fulfilling and successful then groups sports.

Help make the things they find most challenging easier. One of the best ways to do this is to help your child be organized. It can be helpful to tape lists to mirrors, doors and lunches. Calendars, timelines, agendas, alarm clocks can all be tools that can be helpful. And helping your teen get on a regular schedule can do wonders for their organization.

Make sure you spend quality time with your teen. Going for a walk with them is a great way to be able to connect with them and get some exercise. Sharing feelings, connecting with someone they trust, and getting regular exercise are great ways for your youth to have positive interactions and shed some pent up energy.

As a parent you can also help to make sure your youth is good to their body. Eating a healthy breakfast can decrease stress and improve performance at school and work. Caffeine and sugar rich drinks can increase anxiety and agitation. Ensuring your teen has a balance diet, and stays away from alcohol and drugs can help improve life balance.

Depending on the severity of your child’s ADHD, treatments will include therapy and sometimes medication. In combination with the above, you can get your child on the road to recovery and a successful life ahead.

-- Stan Kutcher, MD, FRCPC; Iliana Ortega-Garcia, MD, and Chrisina Carew, ABC

Youth have Say in Mental Health Research

A recent Australian media report describes an “innovative approach to mental health research”

This is a website where young people who have received mental health care can rate what they think was helpful to them. Good idea, but hardly new.

Our group in Toronto published an academic study on this question in the 1990’s in the Canadian Journal of Psychiatry. And, last year, the Institute for Families published its report of a national consultation involving youth, parents and researchers from across Canada in which the issue of what should be mental health research priorities in our country. This report was the outcome of shared consultations that may help identify national child and youth mental health research priorities for our national and provincial health granting councils.

Regardless of pride of place with the idea – it’s essential that young people and their families be involved in the identification of what should be researched. Those who provide clinical care and those who do research can only do what they do best when they are informed by those they work with – patients. I can still remember when one of my patients, a young girl with a manic episode told me that the mood rating scale I had given her to fill out made no sense – because it did not have a place to mark down depressed or low mood. When I changed the scale with her help we made the discovery that manic episodes in young people fluctuated widely in their mood levels. And when we applied this new measurement technique to scores of other young people we were able to describe for the first time, the now understood to be “classic” description of mania in teenagers: mixed rapid cyclic manic episodes. And that is only one example.

So what does this tell us? What good health providers have known for centuries. listen to your patients. Involve them respectfully as full partners in their care. Learn from them.

--Stan

Substance Use and Mental Health Care, Can They Co-Exist?

I remember once seeing one of my patients who had a psychotic illness. He was doing very well and was very engaged in his recovery process. Unfortunately, a “friend” of his was providing him with free and easy access to illegal drugs – mostly marijuana. This was having a negative impact on his well-being and about a week before our visit his employer had let him know that if he appeared to be “stoned” once more at work, that he would be let go. In our discussion, I raised the opportunity for him to attend a drug discontinuation group that we had been working with. It provided young people with a support system and framework to help them get off and stay off illicit drugs. Mike (not his real name) became annoyed when I suggested that. “I have a psychotic illness” he said, “I am not a drug addict”.

What Mike was voicing was in some way a stigmatizing perspective about people who struggle with drug misuse and abuse. This is the topic that another friend of mine just recently wrote about. It’s worth a read and you can find it here:http://www.huffingtonpost.com/dr-harold-koplewicz/is-drug-addiction-mental-illness_b_858815.html His point is well taken. There is a lot of stigma about drug use in young people and this stigma can get in the way of getting help. I agree.

This is why it is so important to make sure that we have both substance abuse and mental health care easily available in the primary health care system. A young person with either one or both of these problems should be able to get help without going into a stigmatizing separate program. We will know we have finally broken the stigma about substance abuse and mental disorders when anyone can go to their primary health care provider (general practitioner, nurse practitioner, psychologist, nurse, etc.), and get the help and the care that they need. Much as they now go for a sore throat, high blood pressure or diabetes treatment. 

That is our goal. It will take lots of work to get there, but it will be worth it.

-Stan

Reaching Out Can Make the Difference

Youth that are suffering from mental illness more often than not find it difficult to get through school. For some people, all they can think about is how they’re going to get through the day and keep it together. Sometimes things such as anxiety and depression can get in the way of success. The gravity of the anxiety and the depression can take a toll and negatively affect academic performance or social interactions.

For most of my life, I was an overachiever and always excelled in school. However, in years past, I dealt with anxiety and depression and found myself going in a downward spiral. It started in junior high and at first, it wasn't a big deal. A few missed assignments and my grades fell a bit. I knew I could do better but then I stopped caring. My grades dropped from excellent to mediocre. For a time period due to a loophole in the school system, I got away with skipping class without my parents finding out. I never thought I would ever skip class, but things happened and I started doing it more and more. I felt terrible whenever I was at school, so I thought “why should I have to go?” I had a minor intervention and things were fixed, at least for the time being.

So then high school rolls around and I moved to a different area, with a new school and a new start. At first, I was doing really well. However, I started heading downhill again. I had difficulty with school and my grades began to gradually fall. Due to my anxiety, I was afraid of approaching anyone, not even my teachers. I felt like I had nobody to talk to. My grades declined from the 90s to failing badly and barely even making the 50s. I was lost in a sea of students and I hardly spoke to any of my teachers if at all.

It was hard to spot a teacher who might have cared but one of my teachers who knew me and knew what I was capable of saw what was happening and started talking to me. Confronted by this particular teacher, I couldn't keep it together and she brought me to the guidance counsellor. It was difficult at first to get me talking but eventually I did… and it felt like a huge weight off my shoulders to let all the thoughts and emotions out. It took a while to figure out how to make things better but it was a great leap forward for me. When I couldn't bring myself to speak, a teacher reached out to me.

So what I want to tell teachers is this: sometimes, all it takes is the simple act of reaching out, and you could make a really big difference for that person. When you look at the sea of students, please reach out and make a difference for those who might be lost in the system.

--Karl Yu

Karl Yu is a grade 12 student in Halifax, Nova Scotia and will be attending University this Fall. He has been an active member of the Youth Advisory Council for the Sun  Life Financial Chair in Adolescent Mental Health.  The Chair works directly with youth to provide easy-to-understand materials about mental health and the brain.  The materials are offered free to parents, families, physicians and anyone who wants them. Visit teenmentalhealh.org for more information.

Karl's blog has also been published on: http://www.ourkids.net/blog/the-simple-act-of-reaching-out-makes-a-difference-10108/

Moving the Mental Health Agenda Forward in Canada

There was some large scale news reported in the Globe and Mail recently:http://www.theglobeandmail.com/life/health-and-fitness/bells-10-million-donation-hailed-as-mental-health-game-changer/article579559/. Kudos to Bell Canada for stepping up and making a huge (yes, 10 million dollars is a lot of money) donation to CAMH in Toronto. This is also yet another public statement from corporate Canada as to its awareness of and support for mental health. And this is very much appreciated.

Now comes the next very important part. How to ensure that this interest is not merely a reflection of the “flavor of the moment” and how can this translate into substantive and sustainable improvements in mental health and mental health care for all Canadians?

Some of this responsibility will of course need to be undertaken by CAMH, as they are the recipient of this largess. Some of this responsibility however will need to be undertaken by those who work in other parts of Canada, parts not as fortunate as Toronto, but where innovative and life-altering work is being done and new directions are being forged. 

Perhaps the generosity of Bell will rub off on other corporations. Perhaps the innovation and improvements that this generosity will help develop at CAMH can be used to encourage and support other parts of Canada as well – so that research conducted and lessons learned there can swiftly and effectively be used to improve the lives of all Canadians. Perhaps all provincial/territorial governments will realize that more and more effective investment in mental health is needed. Perhaps mental health will make it to the table in the discussions in the upcoming national Health Accord (I hope that we will have another Health Accord).

Who know? What is clear however is that the generosity of Bell and the innovative changes un

--Stan

Nova Scotia and its mental health plan: how is it going?

Nova Scotia is once again developing a mental health plan. I have been active in mental health in the Province since 1995 and have seen at least half a dozen or more Provincial and Regional planning processes addressing mental health over that time. Some “wag” once said that if the number of mental health plans sitting in the Department of Health where laid end to end then we would have a pathway of good intentions leading from Province House to the Elephant and Castle.

While I cannot vouch for the accuracy of that comment I can certainly resonate with the emotions behind it. And in a recent story on this issue the Chronicle Herald newspaper reported a similar concern by a participant about the current process: “"These are the same issues that have being going on for 25, 30 or 40 years now," one person said. "What’s going to be different?"  

That is an excellent question. 

The issue frankly is not that we do not know what to do. The previous Bland Report had a number of excellent recommendations that have not yet seen the light of day in Nova Scotia. The newly available document from the MHCC provides a useful call to action. The Evergreen Framework provides a set of values and strategic directions that could be easily incorporated by the Province in addressing child and youth mental health now. The World Health Organization has produced realms of useful documents/materials ranging from the MHPP monographs to the mhGAP. Recently released mental health documents from British Columbia and Ontario have excellent components that could easily be modified for use in NS.

And the list goes on.

The issue is doing, and making sure that what is done is based on what we know and supported by strong and independent evaluation of what we are doing so that we can change things that are ineffective or inefficient and replace them with actions that are effective and efficient. 

We also need to ensure that the appropriate funds are in place to permit necessary action to happen. The mental health budget for Nova Scotia is woefully inadequate. No plan will be useful if it is not properly resourced. 

So what will happen? Follow the money!

-Stan

New Brunswick and its new mental health plan: how will it go forward?

Now that the federal election is over I can turn my attention fully (or as fully as I can get it) back to our very important mental health in youth work. And my attention has been caught by the following article: “NB Unveils Mental Health Plan”

The Minister of Health announced the new plan which is supposed to put people at the center of interventions (I assume these include prevention, early identification, treatment and ongoing system improvements) and identified an additional 12.6 million dollars to help do that. 

Now that sounds like a lot of money but apparently it is to be spread out over 7 years. So lets see what that translates into: about 1.8 million per year. If all of that money is put into human resources that can meet mental health needs of people then that will result in a good improvement in service availability. If however, much is put into administration there will be little to show for that investment. Some also must go into training as we know that substantive concerns about diagnostic and treatment capacity, especially in the primary health care system exist: not only in New Brunswick but across Canada. Some must also be spent on evaluation and quality assurance. How else are we going to know if the investment results in improvement at the personal, family and the system level?

So what will happen in New Brunswick to improve mental health care in that province? Follow the money!

-- Stan