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Working with Pianists with Attention Deficit Hyperactivity Disorder

 Attention deficit hyperactivity disorder, or ADHD, is a common childhood disorder that piano teachers are likely to encounter during their career. This disorder can continue through adolescence and into adulthood. Common symptoms of ADHD may include extreme difficulty maintaining focus, paying attention, and regulating emotions and behavior, as well as hyperactivity. 1

Attention deficit hyperactivity disorder is a fairly large class of disorders that has three main subcategories:

  1. Predominantly hyperactive-impulsive
  2. Predominantly inattentive
  3. Combined hyperactive-impulsive and inattentive


SYMPTOMS OF ADHD

The telltale signs of ADHD are inattention, hyperactivity, and impulsivity. Of course, all young children are inattentive, hyperactive, and impulsive to some degree. But children with ADHD exhibit these behaviors with more severity and frequency. A child must have symptoms for six or more months and have a greater degree of severity than other children of the same age to be diagnosed with ADHD.

Children who have symptoms of inattention may be easily distracted, miss key details, exhibit forgetfulness, and frequently switch from one activity to another. Such children may also have difficulty focusing on one thing, become bored with a task prematurely, have difficulty organizing and completing a task or learning something new, and be inconsistent with turning in school assignments. Children with symptoms of inattention may not seem to listen when spoken to, seem to daydream, exhibit difficulty processing information as accurately as do others, and have difficulty following instructions.

Children who exhibit symptoms of hyperactivity may fidget and squirm on the piano bench, talk continuously, move about a space quickly, or touch or play with anything in sight. 

Children who exhibit symptoms of impulsivity may be particularly impatient, blurt out inappropriate comments during lessons, and show their emotions without a normal amount of restraint. These children may also have difficulty waiting their turn and interrupt the conversations and activities of others at a greater than normal level. 2

Attention deficit hyperactivity disorder can often be mistaken for other problems. Parents and teachers may miss the fact that children have ADHD because they may be quiet. Children with an inattentive form of ADHD may sometimes sit quietly and appear to be working but may not be paying attention to what they are doing.

Attention deficit hyperactivity disorder is one of the most common childhood disorders, and it frequently continues through adolescence into adulthood. It affects about 4.4 percent of American adults age eighteen and older and affects about nine percent of American children aged thirteen to eighteen years. 3 Boys are at four times the risk of ADHD than are girls. Recent studies have shown that the number of children being diagnosed with ADHD is increasing, but the reasons why are not clear. 4

TREATING ADHD 

The treatments currently available for ADHD tend to focus on reducing symptoms and improving functioning. These types of treatments include medication, psychotherapy, behavioral training, or a combination of these treatments. Although many of the symptoms of attention deficit hyperactivity disorder can be improved, there is no cure.

A few different types of psychotherapy are used for treating ADHD. Behavioral therapy attempts to help a child change his or her behavior. Behavioral therapy may involve practical assistance such as helping a child organize tasks, complete schoolwork, or work through difficult emotions. The positive or negative feedback given by parents or teachers can be considered a form of behavioral therapy that can include clear rules, expectations, chore lists, and structured routines. 5

TEACHING STUDENTS WITH ADHD

Organizing instruction, planning the lesson, and rewarding focused work are important in teaching any student. The importance of this type of organization for piano lessons with students with ADHD, however, cannot be overstated. 

Teaching techniques that tend to help students with ADHD focus and maintain their concentration at the beginning of a lesson may include signaling the start of the lesson with an aural cue. In the context of a piano lesson, a "theme song" played by the teacher may prove effective. Listing the activities to be covered during the hour on an easily visible chalk or pen board may help students maintain their focus and prepare for a sequential style of learning. At the beginning of a lesson, tell students clearly and quickly what they're going to learn and what your expectations of them are. Perhaps most important, establish eye contact with students who have ADHD in order to create a sense of focus, trust, and instructional investment from the first minute.

During a lesson, keep instructions simple. Be sure that you are using the fewest words possible to get an instructional point across. Continually vary the tempo of the lesson, including many different kinds of activities. Students with ADHD typically thrive with rapid, intensely paced games that involve competition. A subtle cue can be established in order to remind the student to stay on task. In the context of a piano lesson, this cue may be touching the student lightly on the shoulder, placing a special sticker on his or her book, or playing a tune lightly in the upper registers of the keyboard. Consider allowing a student with ADHD the option of taking breaks during a piano lesson. At the end of a lesson, summarize key points and use the Socratic method to gauge how much of the lesson the student has internalized. Consider having the student write the assignment in his or her notebook, helping the student reiterate the instruction that has occurred.

The importance of clarity in the communication of expectations for effective home practice cannot be overstated. I have found that reserving a longer-than-average period of time at the end of the lesson for reviewing assignments is effective, as well as having students write down the steps they should take to practice in the coming week. It is most effective to give piano students with ADHD instructions one at a time, taking the time to repeat these instructions when they may be having trouble processing such information. Because symptoms of inattention and hyperactivity tend to increase over time, it may be useful to work on the most difficult material early in a lesson. Teachers should also consider creating outlines in advance of a lesson, in order to organize the information as it is delivered. A sample outline appears on the next page

1. Welcome! 

  • How are you?
  • What was the highlight of your week? 
  • What did you enjoy practicing this week? 

2. Sight Reading

  • Right hand alone 
  • Left hand alone 
  • Hands together 

3. Scales and Arpeggios 

  • Let's hear your scale homework from last week. 
  • Let's hear your arpeggio homework from last week. 
  • Let's learn this week's scale. 
  • Let's learn this week's arpeggio.

4. Pieces 

  • Bach 
  • Copland 

5. Review 

  • Please tell me what we worked on today.
  • Please write your assignments for this week's practicing in your notebook.

Attention deficit hyperactivity disorder can be a challenging diagnosis for students, parents, and teachers alike. With the right toolkit and approach, this diagnosis does not need to be a liability but, rather, can be channeled effectively and positively.

NOTES

1. National Institute of Mental Health, "Attention Deficit Hyperactivity Disorder." Accessed August 20, 2019. https://www.nimh.nih.gov/health/topics/attentiondeficit-hyperactivity-disorder-adhd/index.shtml. 

2. Manfred Döpfner, Christopher Hautmann, Anja Görtz-Dorten, Fionna Klasen, Ulrike Ravens-Sieberer, and BELLA Study Group, "Long-Term Course of ADHD Symptoms from Childhood to Early Adulthood in a Community Sample," European Child and Adolescent Psychiatry 24, no. 6 (2015), 665–673. 

3. Ronald C. Kessler, Lenard Adler, Russell Barkley, Joseph Biederman, C. Keith Conners, Olga Demler, Stephen V. Farone, et al., "The Prevalence and Correlates of Adult ADHD in the United States: Results from the National Comorbidity Survey Replication," The American Journal of Psychiatry 163, no. 4 (2006), 716–723. 

4. K. Blum, A.L. Chen, E.R. Braverman, D.E. Comings, et al., "Attention-deficithyperactivity disorder and reward deficiency syndrome," Neuropsychiatric disease and treatment, 4(5), (2008), 893–918. 

5. J. Russell Ramsay and Anthony L. Rostain, Cognitive-Behavioral Therapy for Adult ADHD: An Integrative Psychosocial and Medical Approach (New York: Routledge, 2014).

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