Sight Word Easter Egg Hunt

I’m not sure who loves game-based literacy activities more – me or the kiddos! Today we enjoyed hunting for Easter eggs with sight words inside. Each student was assigned a colour so that everyone would get a chance to find eggs. Assigning colours also allowed me to put specific words inside each egg to target each of their needs. Once they read me the word I replaced the plastic egg with gum, chocolate, and candy-filled eggs. It was a win-win for all involved!

Smiling faces after the sight word Easter egg hunt!

Research Paper: Overlooking Childhood Trauma when Diagnosing Attention-Deficit Hyperactivity Disorder (ADHD)

Abstract

This paper explores the connection between trauma and ADHD, in terms of symptomology and etiology. Current diagnostic assessment methods for ADHD are inadequate for those who have experienced trauma. A call for more integrative, trauma-focused screening methods when diagnosing and treating ADHD is recommended.

Keywords: Acute Stress Disorder, adverse childhood experiences (ACEs), Attention-Deficit Hyperactivity Disorder (ADHD), childhood trauma, comorbidity, complex trauma, Disinhibited Social Engagement Disorder (DSED), evidence-based treatments, interpersonal trauma, Posttraumatic Stress Disorder (PTSD), Reactive Attachment Disorder (RAD), trauma screening

Introduction

Attention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that manifests in early childhood and presents as predominantly inattentive (ADHD-PI), predominantly hyperactive-impulsive (ADHD-HI), or combined type (ADHD-C). The severity ranges from mild to severe based on the number of symptoms present across two or more settings, as well as the impairment these symptoms have on the individual’s overall functioning (American Psychiatric Association [APA], 2013). Mash and Wolfe (2019) note that the prevalence of an ADHD diagnosis is “about 5% to 9% of all children and adolescents 4 to 17 years old in North America” (p. 244). The DSM-5 reports rates of 5% in children due to lower worldwide occurrences (APA, 2013). However, despite varying prevalence rates, ADHD is reported in every country that studies it, across all socioeconomic statuses (SES), and amongst males and females at a 2-3:1 ratio respectively (Mash & Wolfe, 2019). ADHD is considered to be a pervasive, lifelong disorder with varying patterns of behavior and intensity based on developmental levels (Mash & Wolfe, 2019). Since ADHD is a common referral problem, it is imperative that the diagnostic screening and assessment tools used are both valid and reliable.

When diagnosing ADHD, it is important to ascertain whether the symptoms are developmentally appropriate or a result of another medical, mental, or neurodevelopmental disorder (APA, 2013). This poses a challenge because approximately “80% of clinic-referred children with ADHD have a co-occurring psychological disorder” (Mash & Wolfe, 2019, p. 244; Canadian ADHD Resource Alliance [CADDRA], 2018), with the DSM-5 highlighting Antisocial Personality Disorder (ASPD), Autism Spectrum Disorder (ASD), Conduct Disorder (CD), Disruptive Mood Dysregulation Disorder (DMDD), Intermittent Explosive Disorder (IED), Major Depressive Disorder (MDD), Obsessive-Compulsive Disorder (OCD), Oppositional Defiance Disorder (ODD), Specific Learning Disorder (SLD), and anxiety, personality, psychotic, substance use, and tic disorders as potential comorbid or differential diagnoses (APA, 2013). In addition, Bipolar Disorder (BP), Intellectual Developmental Disorder (IDD), Reactive Attachment Disorder (RAD), and neurocognitive disorders are included as differential diagnoses to be considered (APA, 2013). Accounting for potential comorbid and differential diagnoses, ensures an accurate diagnosis and treatment plan. While the DSM-5 includes many comorbid and differential diagnoses for consideration, a growing body of research highlights the need for trauma screening when diagnosing ADHD due to the relational course and symptomology.

Traumatic events may be termed in the literature as complex trauma (Conway, Oster, & Szymanski, 2011; Pottinger, 2015), interpersonal trauma (Mash & Wolfe, 2019), and/or adverse childhood experiences (ACEs) (Conway et al., 2011; Brown et al., 2017). Like ADHD, trauma does not discriminate: “in 2017, there were 59,236 child and youth victims (aged 17 years and younger) of police-reported violence in Canada… overall, 33% of children and youth victims had been subjected to violence by a casual acquaintance and 18% by a stranger” (Burczycka, Conroy, & Savage, 2018, p. 4). This is a reduction from the 85,440 substantiated cases in 2008 (Klien, Daminai-Taraba, Koster, & Campbell, 2015). These types of violence included complex and interpersonal forms of trauma, such as neglect, sexual assault, and physical and emotional abuse. These experiences in childhood can lead to diagnosable trauma- and stressor-related disorders such as Acute Stress Disorder, Disinhibited Social Engagement Disorder (DSED), Posttraumatic Stress Disorder (PTSD), and Reactive Attachment Disorder (RAD) in 10-20% of cases (APA, 2013). However, whether diagnosable or not, trauma has a negative impact on childhood development. Based on the 1998 ACEs study, 11-23% of adults have experienced childhood trauma that can “impede an individual’s ability to integrate sensory, emotional, and cognitive information” and present as hyperarousal (Conway et al., 2011, p. 61-2). Having ACE scores increases “a child’s risk for toxic levels of stress, which in turn might impair neurodevelopment, behavior, and overall physical and mental health” (Brown et al., 2017, p. 349-50). Unfortunately, while childhood trauma is far-reaching, this is not often the case for trauma screening.

The ADHD and Trauma Connection

Within the research, the connection between trauma and ADHD has been established. For instance, Ford et al. (2000) found a strong correlation between ADHD and trauma; 25% and 11% of individuals with ADHD experienced physical and sexual abuse respectively and rates of trauma rose to 91% with comorbid ODD. Weinstein, Staffelbach, and Biaggio (2000) also found a correlation between sexual abuse and ADHD. In 2006, Endo, Sugiyama, and Someya found that 14-46% of children with ADHD had experienced abuse. Similarly, Briscoe-Smith and Hinshaw (2006) found that 6 to 12 year old girls with ADHD had experienced higher rates of abuse than the general public – 14.3% to 4.5% respectively. They found that the girls with ADHD who experienced abuse often presented with externalizing symptoms and combined type ADHD. Rucklidge, Brown, Crawford, and Kaplan (2006) surveyed adults with ADHD using the Childhood Trauma Questionnaire and 56% of the individuals with ADHD self-reported childhood trauma. Conway et al. (2011) studied 79 children ages 8 to 18 from Hispanic and African-American backgrounds in an urban psychiatric hospital and found that those with ADHD experienced trauma at higher rates than the general public. Perry and Mackinnon (2012) purported that developmental adversity is a risk factor for the expression of ADHD. In 2013, Biederman et al. studied children in a pediatric setting and found that children from families with higher levels of interpersonal conflict had disproportionately higher rates of ADHD.

While these comparisons were based off of DSM-IV-R assessment criteria, recent studies using DSM-5 diagnostic criteria continue to connect ADHD to trauma. Klein et al. (2015) studied Canadian children in child protection services and found that they “are diagnosed and treated for… ADHD at higher rates than the general population” due to symptom overlap (p. 178). Fuller-Thomson and Lewis (2015) had Canadian adults self-report past childhood physical abuse, sexual abuse, and domestic violence. They found that the first two adverse experiences elevated odds of an ADHD diagnosis in both women and men, whereas domestic violence elevated odds of an ADHD diagnosis in women only. Brown et al. (2017) used a sample of 76,277 children ages 4 to 17 and found that ACE scores and ADHD were associated. Furthermore, they found a gradual relationship between the number of ACE scores and the severity of the ADHD presentation (Brown et al., 2017). In their brain neuroimaging research, Park et al. (2017) found that childhood trauma “strongly predicts the development of ADHD and influences biological processes in offspring” (p. 184). Thus, a clear relationship among trauma and ADHD continues to be substantiated in the literature, yet relatively overlooked in current DSM-5 diagnostic criteria and assessment practices.

Shared Etiology and Symptomology in ADHD and Trauma

ADHD and trauma share similar etiologies and symptomologies. While neurobiological factors rather than psychological factors are often the focus for ADHD and vice versa for trauma, a more integrative approach is preferred. Looking at neurobiological factors, Mash and Wolfe (2019) note that “ADHD appears to be related to abnormalities and developmental delays in the frontostriatal circuitry of the brain and pathways connecting this region with the limbic system, the cerebellum, the thalamus, and the default mode network” (p. 256). Trauma impacts areas of the brain connected to stress, such as the limbic and neuroendocrine systems (Mash & Wolfe, 2019). Similar deficits can be observed in the prefrontal cortex and in gray and white matter abnormalities. Spitzer, Schrager, Imagawa, and Vanderbilt (2017) studied children with PTSD and found that they had “reduced N-acetyl aspartate (NAA), indicating loss of neuronal integrity, in the medial prefrontal cortex… implying a common neuroanatomical etiology” with ADHD brain patterns (p. 345). Similarly, Perry and Mackinnon (2012) found that neglect can lead to an underdeveloped prefrontal cortex and reduced gray matter, leading to externalizing behaviors of impulsivity and reactivity or internalizing behaviors of withdrawal. Park et al. (2016) found white matter anomalies in children with ADHD and in those who had experienced childhood trauma. Furthermore, Park et al. (2017) researched catechol-o-methyltransferase genes on inhibitory deficits in children with ADHD and found “a genetic influence on the association between childhood trauma and the severity of inhibitory deficits in children with ADHD” (p. 183). While an in-depth exploration of brain functioning is beyond the scope and sequence of this research paper, it is important to note the brain connections between childhood trauma and ADHD that may result in similar behavioral presentations.

Psychological factors that are shared amongst ADHD and trauma include low SES, parental separation and divorce, parental mental illness, maternal substance use during pregnancy, and birth complications (Brown et al., 2017; Conway et al., 2011; Dubowitz et al., 2011; Gul & Gurkan, 2018; Mash & Wolfe, 2019; Richards, 2013). Mash and Wolfe (2019) recognize that “family problems may lead to greater severity of symptoms and to the emergence of co-occurring conduct problems” (p. 256), even though ADHD is generally not thought of as being caused by psychosocial factors. Furthermore, stigmatization and lack of family supports and resources can lead to mismanagement and misdiagnosis of symptoms (Fuller-Thomson & Lewis, 2015; Pottinger, 2015; Richards, 2012).

Symptoms of trauma, especially those related to PTSD, often mimic ADHD-like symptoms of hyperactivity and inattention. For instance, internalizing and externalizing behaviors such as inattention, distractibility, disruption, fidgeting, hyperactivity, restlessness, impulsivity, irritability, and poor emotional regulation may be observed in both cases (Briscoe-Smith & Hinshaw, 2006; Conway et al., 2011; Dahmen, Purtz, & Herpertz-Dahlmann, 2012; Endo et al., 2006; Ford et al., 2000; Klein et al., 2014; Park et al., 2017; Perry, 2007; Rucklidge et al., 2006; Spitzer et al., 2017; Szymanski, Sapanski, & Conway, 2011; Weinstein et al., 2000). Spitzer et al. (2017) found that when children cannot rely on a caregiver they adapt in ways that seem disruptive and “may present with signs and symptoms similar to ADHD” (p. 345). ADHD is listed as a differential or comorbid disorder in DSED due to similar impulsivity symptoms (APA, 2013). However, DSED is not listed as a differential or comorbid diagnosis for ADHD despite symptom overlap.

It has been argued that the externalizing symptoms of ADHD are easier to identify than the re-experiencing or avoidance symptoms related to PTSD and trauma, especially in young children (Ford et al., 2000; Klein et al., 2014; Spitzer et al., 2017; Szymanski et al., 2011; Young, Kenardy, & Cobham, 2011). The symptoms can impact relationships, academic performance, and executive functioning (Mash & Wolfe, 2019; Pottinger, 2015). In their study of Canadian children in the welfare system, Klein et al. (2015) found that the anxiety and hypervigilance response to trauma can mimic the hyperactivity and impulsivity found in ADHD. Furthermore, trauma-related avoidant behaviors can present like inattention in ADHD (Spitzer et al., 2017; Szymanski et al., 2011; Weinstein et al., 2000). When both disorders are present, trauma can exasperate symptoms since issues with coping and listening can further create a dysregulated affect (Szymanski et al., 2011). Because the symptoms of trauma and ADHD are closely related, a clinician may miss the signs of trauma and attribute behaviors solely to ADHD.

Evidence-Based Treatment

While the two disorders share behavioral symptoms, the treatment methods and approaches differ. The cost of ADHD in the United States varies between 12 to 17 thousand USD per person due to medical and educational needs (Klein et al., 2015; Mash & Wolfe, 2019). Thus, it is important that the treatments used are evidence-based and tailored to an accurate diagnosis so that they are both helpful and cost-effective. Treatment of ADHD often involves parent management training (PMT), educational and environmental interventions, and/or stimulant medications, such as dextroamphetamine, amphetamine-dextroamphetamine, and methylphenidate (CADDRA, 2018; Conway et al., 2011; Mash & Wolfe, 2019; Richards, 2013). Pharmacotherapy treatment is a common approach backed by the Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) study,but in complicated situations medications should be used in combination with psychoeducational interventions (Klein et al., 2014; Mash & Wolfe, 2019). ADHD treatments focus on treating the behavioral symptoms, whether through stimulant medications and/or environmental adaptations.

Treating trauma, on the other hand, focuses on the root cause(s) first and the specific behavioral symptoms second. These evidence-based treatments include Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), psychotherapy, parent management training through the Triple P Program and Project Safe Care, and/or serotonergic antidepressants for PTSD specifically (Conway et al., 2011; Mash & Wolfe, 2019; Spitzer et al., 2017). The most common approach for PTSD treatment is TF-CBT, which incorporates elements of exposure therapy, narrative writing, role-play perspective taking, parental involvement, family communication, parental training, psychoeducation, safety, and relaxation, self-regulation, and stress management skills (Mash & Wolfe, 2019; Pottinger, 2015; Weisz & Kazdin, 2017). For those diagnosed with RAD or DSED, parenting classes, environmental changes, and counselling are the preferred methods over psychopharmacological treatments (Mash & Wolfe, 2019; Perry & Mackinnon, 2012). In addition, building on protective factors such as family and social supports (Perry & Mackinnon, 2012), connecting families to support resources (Dubowitz et al., 2011), and Duty to Report protocol in childcare professions can support trauma treatment.

At best mistreatment could lead to ineffective approaches; at worst mistreatment could lead to potential harm. For instance, Klein et al. (2015) note concerns such as “prolonged exposure to unhelpful medications, stigmatization, a feeling of being misunderstood and opportunity cost in treating other problems” (p. 183). Furthermore, mistreatment neglects “the underlying emotional, personality, and interpersonal issues” that the child may have (Conway et al., 2011, p. 6). Richards purports that treating children who have experienced trauma with stimulant medication “runs the risk of colluding with an external environment which needs to change, and effectively ‘silencing’ the mechanisms a child is using to communicate that ‘all is not well'” (2013, p. 496). Because ADHD treatments focus on the behaviors, using these treatments with those who have experienced trauma does little to help the child and may overlook the relational and familial problems (Richards, 2013). Briscoe-Smith et al. (2006) found the following:

There are children with ADHD for whom abuse appears to be overlooked diagnostically, either as an etiological factor or an exacerbating variable. If such trauma is not addressed, symptoms associated with it may go unchecked and may even become worse as the child develops. The usual interventions for ADHD (behavioral modification procedures, stimulant medications) may not be the appropriate treatments for traumatized children. (p. 10)

Furthermore, if ADHD-based treatments are used without trauma supports, “symptoms and functional impairments may persist” (Klein et al., 2015, p. 181). Misdiagnosis and thus, mistreatment is predictive of negative outcomes.

If a child has ADHD but also a history of trauma, it is important not to treat each in a vacuum. Not only would the developmental course be more severe (Biederman et al., 2012; Brown et al., 2017; Ford et al., 2000; Szymanski et al., 2011), but both the trauma and ADHD symptoms would require monitoring. Brown et al. (2017) note that “cumulative exposure to traumatic experiences is associated with worse overall ADHD symptom severity” and may explain why solely using ADHD treatments does not work (p. 353). Ensuring safety and trauma symptom stabilization is recommended before treating the comorbid ADHD (Biederman et al., 2013; Perry & Mackinnon, 2012). While children who experience trauma may require medications and behavioral management strategies as part of their treatment, especially when comorbid ADHD occurs, a typical approach would be therapeutic or caused-based, followed by medications or behavior-based treatments. Further research on specific, research-based trauma and ADHD treatments is needed (Briscoe-Smith et al., 2006). Pottinger (2015) has adapted trauma-based strategies to support clients with comorbid ADHD but continued work in the field would be beneficial to ensure validity and reliability.

Moving Forward with Trauma Screening

ADHD and childhood trauma are closely related; thus, it is integral to have screening tools and methods that differentiate between the two. Unfortunately, despite research, trauma screening is not mandatory when exploring an ADHD diagnosis. Spitzer et al. (2017) found that only 44% of general practitioners screened for trauma. Furthermore, Brown et al. (2017) note that “although it has been shown that children exposed to ACEs can manifest many of the disruptive behaviors, impulsivity, and executive dysfunction characteristics of ADHD, comprehensive evaluation for traumatic stressors is not routinely performed during ADHD assessment” (p. 350). They found that only 2-4% of general practitioners routinely screened for ACEs and for one third, trauma screening was not part of their practice. The Canadian ADHD Practice Guidelines briefly mention exploring trauma histories but no specific screening tools are recommended (CADDRA, 2018). The DSM-5 recommends excluding other mental disorders and Reactive Attachment Disorder (RAD) is included as a differential diagnosis with differences in the amount of symptoms shown and attachment styles (APA, 2013). However, research by Szymanski et al. (2011) and Conway et al. (2011) shows that there is diagnostic ambiguity and confusion with determining differential diagnoses. This may be because each child differs in their behavioral presentation. Moving forward, trauma screening should become commonplace to ensure accurate diagnosis, proper care, and cost-effectiveness of treatments.

If trauma screening is to become best practice, having the appropriate tools is necessary. Currently, a pediatrician or family physician would work with an educational psychologist to diagnose ADHD (CADDRA, 2018). Often it is the caregiver or educator whom makes the initial referral and acts as a main source of screening information (Klein et al., 2015), because they have firsthand experience with the child. Since there are no definitive diagnostic tools for ADHD, clinical judgement and triangulation of assessments from multiple sources is necessary. These assessments may include parent and teacher rating scales, such as the Conners Comprehensive Behavior Rating Scales-3 (Conners CBRS-3), Vanderbilt ADHD Diagnostic Rating Scales (VADRS), ADHD Rating Scale, SNAP-IV Teacher and Parent Rating Scales, and Child Behavior Checklist (CBCL) (CADDRA, 2018; Gupta & Kar, 2010). It is important to note that none of these rating scales are intended to diagnose or screen for trauma (Spitzer et al., 2017; Weinstein et al., 2000) and rater-bias may occur (Gupta & Kar, 2010). Furthermore, Brown et al. (2017) report that:

Current rating scales and checklists focus primarily on presenting behaviors and do not query about psychosocial and environmental factors, such as exposure to traumatic stress, which might play an important role in ADHD symptom onset and progression and if identified, can help clinicians determine helpful components of multimodal therapy. (p. 350)

From a best-practice standpoint, the connection between trauma and ADHD should lend itself to clinical consideration of both concerns even when a diagnosis of ADHD seems obvious.

Moving forward, clearer diagnostic guidelines, mandatory trauma screening protocol, and more education on the relationship between trauma and ADHD would be beneficial. Furthermore, including trauma as a comorbid or differential diagnosis to ADHD would help foster accurate diagnoses. Multi-agency collaboration between child protection workers, educators, psychologists, pharmacists, and doctors may help support accurate diagnosis of comorbid or differential ADHD and trauma. Asking direct questions about experiences of abuse and other trauma, probing further with similar symptomology, exploring developmental histories, observing children in their natural environments, and using rating scales in addition to written self-reports and medical exams is recommended (Mash & Wolfe, 2019; Ford et al., 2000; Richards, 2013; Weinstein et al., 2000). In addition, asking targeted questions about onset, duration, frequency, thoughts and feelings, environments, activities, family relationships, and the people around when certain symptoms occur is warranted to determine patterns of ADHD-like behavior from trauma-related symptoms. All children deserve an accurate diagnosis and treatment plan that deals with the complexity of their lives; we need an integrative, all-encompassing approach to diagnosing ADHD so that trauma will not be overlooked for any child with the misfortune.

Works Cited

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Biederman, J., Petty, C. R., Spencer, T. J., Woodworth, K. Y., Bhide, P., Zhu, J., & Faraone, S. V. (2013). Examining the nature of the comorbidity between Pediatric Attention Deficit/Hyperactivity Disorder and Post-Traumatic Stress Disorder. Acta Psychiatrica Scandinavica, 128(1), 78-87. doi:10.1111/acps.12011.

Briscoe-Smith, Allison M., & Hinshaw, S. P. (2006). Linkages between child abuse and Attention-Deficit/Hyperactivity Disorder in girls: Behavioral and social correlates. Child Abuse & Neglect, 30(11), 1239-1255. doi:10.1016/j.chiabu.2006.04.008.

Brown, N. M., Brown, S. N., Briggs, R. D., German, M., Belamarich, P. F., & Oyeku, S. O. (2017). Associations between adverse childhood experiences and ADHD diagnosis and severity. Academic Pediatrics, 17(4), 349-355. doi:10.1016/j.acap.2016.08.013.

Burczycka, M., Conroy, S., & Savage, L. (2018). Family violence in Canada: A statistical profile, 2017. Juristat: Canadian Center for Justice Statistics, 37(1), 1-56.

Canadian ADHD Resource Alliance (CADDRA). Canadian ADHD Practice Guidelines, Fourth Edition, Toronto ON: CADDRA, 2018.

Conway, F., Oster, M., & Szymanski, K. (2011). ADHD and complex trauma: A descriptive study of hospitalized children in an urban psychiatric hospital. Journal of Infant, Child, and Adolescent Psychotherapy, 10(1), 60-72. doi:10.1080/15289168.2011.575707.

Dahmen, B., Putz, V., Herpertz-Dahlmann, B., & Konrad, K. (2012). Early pathogenic care and the development of ADHD-like symptoms. Journal of Neural Transmission, 119(9), 1023-1036. doi:10.1007/s00702-012-0809-8.

Dubowitz, H., Kim, J., Black, M. M., Weisbart, C., Semiatin, J., & Magder, L. S. (2011). Identifying children at high risk for a child maltreatment report. Child Abuse & Neglect, 35(2), 96-104. doi:10.1016/j.chiabu.2010.09.003.

Endo, T., Sugiyama, T., & Someya, T. (2006). Attention-Deficit/Hyperactivity Disorder and Dissociative Disorder among abused children. Psychiatry and Clinical Neurosciences, 60(4), 434-438. doi:10.1111/j.1440-1819.2006.01528.

Ford, J. D., Racusin, R., Ellis, C. G., Daviss, W. B., Reiser, J., Fleischer, A., & Thomas, J. (2000). Child maltreatment, other trauma exposure, and posttraumatic symptomatology among children with Oppositional Defiant and Attention Deficit Hyperactivity Disorders. Child Maltreatment, 5(3), 205-217. doi:10.1177/1077559500005003001.

Fuller-Thomson, E., & Lewis, D. A. (2015). The relationship between early adversities and Attention-Deficit/Hyperactivity Disorder. Child Abuse and Neglect, 47, 94-101. doi:10.1016/j.chiabu.2015.03.005.

Gul, H., & Gurkan, C. K. (2018). Child maltreatment and associated parental factors among children with ADHD: A comparative study. Journal of Attention Disorders, 22(13), 1278-1288. doi:10.1177/1087054716658123.

Gupta, R., & Kar, B. (2010). Specific cognitive deficits in ADHD: A diagnostic concern in differential diagnosis. Journal of Child and Family Studies, 19(6), 778-786. doi: 10.1007/s10826-010-9369-4

Klein, B., Damiani-Taraba, G., Koster, A., Campbell, J., & Scholz, C. (2015). Diagnosing Attention-Deficit Hyperactivity Disorder (ADHD) in children involved with child protection services: Are current diagnostic guidelines acceptable for vulnerable populations? Child: Care, Health and Development, 41, 178-185. Doi: 10.1111/cch.12168

Mash, E.J. & Wolfe, D. A. (2019). Abnormal Child Psychology (7th Ed.). Belmont, CA: Wadsworth, Cengage Learning.

Park, S., Kim, B. N., Kim, J. W., Shin, M. S., Yoo, H. J., & Cho, S. C. (2017). Interactions between early trauma and catechol-o-methyltransferase genes on inhibitory deficits in children with ADHD. Journal Of Attention Disorders, 21(3), 183-189. doi:10.1177/1087054714543650.

Park, S., Lee, J. M., Kim, J. W., Kwon, H., Cho, S. C., Han, D. H., Cheong, J. H., & Kim, B. N. (2016). Increased white matter connectivity in traumatized children with Attention Deficit Hyperactivity Disorder. Psychiatry Research-Neuroimaging, 247, 57-63. doi:10.1016/j.pscychresns.2015.09.012.

Perry, B. D., & Mackinnon, L. (2012). The neurosequential model of therapeutics: An interview with Bruce Perry. Australian and New Zealand Journal of Family Therapy, 33(3), 210-218.

Perry, B. D. (2007). Stress, trauma, and post-traumatic stress disorders in children: An introduction [PDF File]. The Child Trauma Academy. Retrieved from: https://childtrauma.org/wp-content/uploads/2013/11/PTSD_Caregivers.pdf

Pottinger, A. (2015). The use of trauma counseling for children with Attention-Deficit Hyperactivity Disorder. International Journal for the Advancement of Counselling, 37(1), 17-27. doi:10.1007/s10447-014-9222-3.

Richards, L. M. (2013). It is time for a more integrated bio-psycho-social approach to ADHD. Clinical Child Psychology and Psychiatry, 18(4), 483-503. doi:10.1177/1359104512458228.

Rucklidge, J. J., Brown, D. L., Crawford, S., & Kaplan, B. J. (2006). Retrospective reports of childhood trauma in adults with ADHD. Journal of Attention Disorders, 9(4), 631-641. doi:10.1177/1087054705283892.

Spitzer, J., Schrager, S. M., Imagawa, K. K., & Vanderbilt, D. L. (2017). Clinician disparities in anxiety and trauma screening among children with ADHD: A pilot study. Children’s Health Care, 46(4), 344-355. doi:10.1080/02739615.2016.1193809.

Szymanski, K., Sapanski, L., & Conway, F. (2011). Trauma and ADHD – association or diagnostic confusion? A clinical perspective.” Journal of Infant, Child, and Adolescent Psychotherapy, 10(1), p. 51-59. doi:10.1080/15289168.2011.575704.

Weinstein, D., Staffelbach, D., & Biaggio, M. (2000). Attention-Deficit Hyperactivity Disorder and Posttraumatic Stress Disorder: Differential diagnosis in childhood sexual abuse. Clinical Psychology Review, 20(3), 359-378. doi: 10.1016/S0272-7358(98)00107

Weisz, J. & Kazdin, A. (2017). Evidence-based Psychotherapies for Children and Adolescents (3rd ed.) New York, NY: The Guilford Press.

Young, A., Kenardy, J., & Cobham, V. (2011). Trauma in early childhood: A neglected population. Clinical Child and Family Psychology Review, 14(3), 231-250. doi: 10.1007/s10567-011-0094-3

Legs Up The Wall

We have been learning about strategies to use when we are in the blue, green, yellow, and red zones. Yoga is a strategy we often use in the blue or yellow zones. One of our favorite poses is called Legs Up The Wall. In this position, students lay flat on their backs with their legs against a flat surface, like a cupboard or wall. Students can put their hands on their heads, by their sides, or on their body. Their legs can be straight up and down, bent into a butterfly pose, or open in a V-shape. The benefits of this pose include calming the nervous system, quieting the mind, reducing stress, releasing pressure and tension in the lower body, and inversion benefits without a lot of effort. It is quick and easy and students love it! One of my students told me about how she was practicing at home and her mom wondered what she was doing. While it may look silly, it is totally worth it!

Try with classical music for added calming benefits.

Amygdala, Hippocampus, and PFC on Grade 1 Terms!

My Grade 1s have been reviewing the five senses and applying this knowledge to the parts of the brain. We are learning about the amygdala (safety guard), hippocampus (memory), and the prefrontal cortex or PFC (decision maker). We did lessons on mindful seeing, listening, and touching.

Today the students had a lot of fun learning about mindful smelling and tasting. I put 9 food items in brown bags and numbered the bags 1 through 9. Students got to smell an item and track their guess on the whiteboard tables. At the end, I revealed each item and we discussed how our hippocampus reminded us of a time we had smelled a certain food. Some students were reminded of a person or place. We also discussed how the amygdala can signal us that it was scary to not be able to see the foods and that students had to make the decision to trust me. The students agreed that it was easier to do mindful seeing than mindful smelling. The next step was to have students taste the food. We discussed salty, sweet, savory, bitter, sour, and spicy foods and students got a chance to categorize the foods and explain why.

During mindful smelling, she easily identified pickles and connected the smell to family meals in the summer.
“This is sour, Ms. Gorham!” – Student

“Do you like it?” – Ms. Gorham

“I like that it makes me think of my family… but can I eat something salty?” – Student

Honestly, I was a bit worried about teaching parts of the brain to Gr. 1s but they have surpassed my expectations and are easily labelling the terms and learning about how they can use their brain and senses to explore the world around them!

Gratitude

My students have been learning about growth mindset and self-regulation. For Bell Let’s Talk Day on January 30th, we focused on gratitude. We discussed the things in our lives that we take for granted but are thankful for and in some instances, couldn’t or wouldn’t want to live without. The questions to guide our discussion included:

  • What are you grateful to have learned or be learning about?
  • What are you challenged by?
  • What is something that you use everyday and couldn’t live without? What toys are your favourite?
  • What person or thing makes you smile?
  • What do you like to smell, taste, touch, hear, see?
  • What do you appreciate in nature/outside?
  • What are you thankful for in your community, at home, at school, etc.?
  • What do you appreciate about yourself? About your friends?
I am Grateful for...

I’m pretty proud with what they came up with and the kind things they said to each other during the discussion. We learned that we can use words and a listening ear to brighten someone’s day – truly a lifelong lesson!

Multisensory Approach to Letter Formation

As per our school’s Learning Improvement Plan (LIP) focusing on student writing growth, I am embedding different modalities of letter formation into our phonics lessons. The students are enjoying a multi-sensory approach to writing: play-dough, chalkboards, whiteboard tables, wiki sticks, letter magnets, wooden pieces, etc. A new favorite is writing our letters with paint brushes in shaving cream. It is a really simple lesson that warrants student engagement.

A typical phonics lesson activity: Lakeshore letter-sound buckets for sorting initial sounds.

Shaving Cream Letters Lesson:

  1. Hold up letter cards and get students to state the letter name, sound, and action.
  2. Students copy the letter, starting at the top, with paint brushes in shaving cream. They form the lowercase and the uppercase for each letter.
  3. Students “erase” their letter with their brushes and repeat the process for the rest of the target letters.

Writing letter ‘v’ in shaving cream.

But What About the Mess?

I find that it is not as messy as it may seem. Each student needs to roll up their sleeves and be reminded not to eat, fling, or touch the shaving cream with their hands. We talk about how it smells good but would not taste good (you may want to note that it is NOT whipped cream). I get students to wipe off any excess shaving cream on the side of their tin (get baking pan tins with higher edges rather than baking sheet tins with lower edges) and then at the end of the lesson we use paper towel to clean the brushes before putting them in water.

Ready for the next letter!

The Benefits

The best part of shaving cream letters is that students do not feel pressure to form their letters perfectly. If they make a mistake, they simply can “erase” and try again! The teacher can observe the letter formation and remind students to hold brushes appropriately and start from the top during the lesson so the practice is meaningful. All students, especially those who dislike pencil-to-paper work, seem to buy-in to the novelty of shaving cream letters. No tears, busy minds at work, and smiling faces… seems like a win to me!

Classroom Safe Spaces

Creating a safe place for students in our classrooms is so important as it allows them to take a break, develop coping skills, work through their emotions, and ultimately, feel safe, regulated, and calm so that they can learn. Safe spaces come in all shapes and sizes and help a variety of learners. Here are a few of my examples:

I typically incorporate visuals of emotions from the social-emotional program(s) we will be learning that year (such as Zones of Regulation, Mind Up, Inside Out + Zones, Circle of Courage, etc.), good/poor choices cards, and breathing/calm down/yoga activities. I like to keep the space cozy and sensory-focused with sensory bottles and/or fidgets, noise-cancelling headphones, weighted and non-weighted stuffed animals and blankets, and a personal space like a comfy chair, cushion, couch, or tent. As the year goes on, students will identify a tool-kit of strategies that works for them that is available in the area. The idea is that they can use the area as needed, identify how they are feeling, and self-select (or accept) a strategy to regulate and get back to the task at hand. I find that having a safe space actually increases student learning time as long as explicit instruction about the area/strategies occurs. Best of all, students are more regulated and calm!

Our Favorite Learning Tools!

I asked my Grade 1s to share some of their favorite tools for learning! Here are their top picks:

Emotions/Classroom Community:

This year I combined Inside Out lessons with our Bucket Filling, good/poor choices, and Zones of Regulation emotional programming. I have found that the students are more engaged with the lessons and are able to relate better.. (this could be because we watch the movie together with some delicious popcorn!?). The “Let’s Talk About” book series is also a learning tool that we utilize.

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Zones of Regulation Curriculum by Leah Kuypers

 

Reading:

The Grade 1s enjoy Flashlight Fridays and using our slinkies to sound out words, our ropes to retell a story, and our mirrors to visualize our pronunciation of words and letter sounds!

 

 

Sight Word and Alphabet Learning:

The students love forming letters with magnets, salt, play dough, and shaving cream. Writing on our Buddha boards and chalkboards is always fun, too! Some alphabet and sight word games that they enjoy are: upper/lower match boxes with popsicle sticks, bowling, fishing, balloon pop, ball toss, golfing, toppling bunnies, scavenger hunts, fly swatter, cup stacking, bingo dabber, egg flip, and toppling towers sight word/alphabet games. We enjoy sounding out CVC words on our pool noodles and by jumping in our hula hoops. As a teacher, my favorites are the word walls and my Lakeshore rhyme and alphabet buckets with initial sound or word family toys/examples. The picture cards are also a great find! As always, I recommend the Florida Center for Reading Research for engaging, research-based phonics and phonological awareness games.

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The Beauty of Sign Language and Inclusion

This is beautiful. The amount of work for the community to come together is immense but it would definitely be worth it! This video also highlights the possibilities created when technology (cameras, Samsung services, Youtube, etc.) is coupled with traditional learning (sign language courses taken by community members). The possibilities of learning are endless. Better yet, the possibilities of creating an inclusive society are at an all time high thanks to technology! 🙂

Feedly Follows

I chose to follow Think Inclusive, Edutopia, Free Technology for Teachers, and Educational Technology and Mobile Learning. My interest in inclusive education and membership in ECMP355 drove my decision to follow these pages. Inclusive education and technology (and the marriage of these two things) are vast topics that I will spend my entire life learning about. Furthermore, I am passionate and interested in these topics.

Feedly

So far I have read these articles:

5 Strategies For Structuring An Inclusive Classroom Environment – In summary, it suggests that all students benefit from a multi-sensory approach to learning, “fair isn’t always equal” and holding students to different levels/expectations is reasonable and allows them to learn at their own level, stations and centers benefit all students, rules and expectations must be clear, and teachers must be flexible/able to “read the room.” I read this article because as a fourth year education student, I am hoping to create my very own inclusive classroom environment very soon. I couldn’t agree more with what this article is saying. I am a strong believer in using Gardiner’s multiple-intelligences and used this theory to plan lessons/activities in my internship at Mossbank School. I also used stations in my 3/4 health class and this was by far their favorite lesson (aside from when I took them skating to promote healthy exercise). It was a lot of work but the learning was so valuable and well-received by all that it was worth every second! Finally, I believe that the best quality I can bring to the table as a student support teacher/inclusive educator is flexibility. I need to be flexible to meet the needs of students, parents, and teachers.

7 Things Every Special Education Teacher Should Know About Themselves – Once again, as a fourth year ed. student I read this article in hopes of getting some insight about what I should expect in my first job (hopefully!) as a student support teacher. The article highlights the need for self-reflection, asking for help, acting/trying your best, being flexible, accepting your own imperfections/inability to keep up to the workload, and maintaining a positive attitude. I agree with these observations, although I am reluctant to admit that accepting my own imperfections/inability to keep up to the workload will be part of my job. This is something that I will have to work on. The three things that resonated with me the most are: “The worst thing you can do is nothing” – Temple Grandin, “attitude makes or breaks your day,” and “flexibility solves 99% of all problems.” I didn’t, however, agree with the belief that I should accept weight gain. I think it is important for educators to take time for themselves. If your job is getting in the way of your eating/sleeping/working out and other basic health necessities, I think it is time to take a step back and reflect. The airplane analogy of fixing your own breathing mask in a crash before helping someone else here may apply – you can’t teach your students if you’re dead. I plan to do the best I can at my job, while still maintaining my own personal physical/mental health. I’m an avid runner/biker/swimmer and take pride in my cleaning eating lifestyle; I want to be a role-model for children and for them to see me leading a positive lifestyle! Balance is key!

8 Examples of Assistive Technology in the Classroom – This article is a great one to tab and keep around for future reference. It acknowledges the benefits to inclusion: “The philosophy of inclusion promotes a sense of community. Children learn valuable social skills like empathy, problem solving, communication, taking turns, teamwork and more!” but also lists assistive technology/tools that can help you create that inclusive environment, such as Class Dojo. Inclusion doesn’t happen overnight and it is nice to see an article that lists the benefits but also acknowledges how to carry this philosophy out! See also: 13 Disability Resources on the Web You May Not Know About 

The 8 Most Atrocious Myths About Inclusive Education – Another great article to tab and keep around if those difficult conversations ever arise. The reality of being a student support teacher is that resistant behaviors will arise and these must be met with data/facts.. as well as, a cool head!

12 Things To Remember When Working With Challenging Students – The do’s and don’ts of working with those challenging students (which we all will)! I think the most important thing to remember is the children who need the most love show this need in the most unconventional ways. The article mentions getting to know your students, realizing they want your love, AND not letting them walk all over you. To me, that is the recipe for success and all three ingredients must be added or it will be thrown in the trash. Tough love!

Assistive Technology Increasing Inclusion in Classrooms and Beyond – This article discussed the importance of problem solving in inclusive education and looked at a Desktop Desk invention that was made for a student in a wheelchair. We can go a long way and see great success if we think outside the box! It is all in the mindset we let ourselves have! To read more about mindset and reflective questioning/listening read: Opinion: Open-Mindedness Needed for Inclusion to Thrive

Providing Structure Without Stifling Creativity – This article caught my eye because in ECE 325 we were talking about how to balance exploration and play/child directed learning with our human instinct/desire of structure and teacher curriculum planning. This is something that I am just beginning to grapple with and it is one of my personal goals to take advantage of more “teaching moments.” I find this balance to be one of the hardest.  Maybe if I allow for choice in the set structure students will  be able to learn in a creative environment? Maybe I just need to throw out my watch? I am interested in how other educators deal with this tension; please comment below!

What Is Autism? A Definition By Nick Walker – I chose to look at this article because it is always good to refresh  my basic knowledge about varying abilities. Autism is a genetically based human neurological variant that starts in utero. It is a pervasive development disorder and 1-2% of our population is diagnosed on this spectrum,. Early diagnosis and information/research is needed. Autism is characterized by language development, social interactions, behavioral, and sensory issues. However, it is a broad spectrum and no one should be defined/categorized into these rigid boxes. Autism is different for each person because all people are unique!

Happy reading! 🙂