What is Add/Adhd? A Comprehensive Treatment Program For Add/Adhd

A Comprehensive Treatment Program For Add/Adhd

ADD stand for attention deficit disorder. However, add can be very problematic to the child, causing him or her to significantly underachieve in the classroom and experience low self-esteem.

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Behavioural characteristics of attention deficit disorder without hyperactivity (ADD)

• Easily distracted by extraneous stimuli
• Difficulty listening and following directions
• Difficulty focusing and sustaining attention
• Difficulty concentrating and attending to task
• Inconsistent performance in school work-one day the student may be able to do the task, the next day cannot; the student is “consistently inconsistent”.
• Tunes out-may appear ‘spacey’
• Disorganized-loses/can’t find belongings (papers, pencils, books); desks and rooms may be a total disaster area
• Poor study skills
• Difficulty working independently

The term ADHD is the current descriptive diagnostic term in the revised third edition of the American psychiatric association’s diagnostic and statistical manual (1987). It is the label used to describe the student who may have many of the above-mentioned characteristics in addition to many associated with a hyperactivity component.

Behavioural characteristics of attention deficit disorder with hyperactivity (ADHD)

• High activity level
• Appears to be in constant motion
• Often fidgets with hands or feet, squirms, falls from chair
• Finds nearby objects to play with/put in mouth
• Roams around classroom-great difficulty remaining in seat
• Impulsivity and lack of self control
• Blurts out verbally, often inappropriately
• Can’t wait for his/her turn
• Often interrupts or intrudes on others
• Often talks excessively
• Gets in trouble because he/she can’t stop and think before acting (responds first/thinks later)
• Often engages in physically dangerous activities without considering the consequences (for example: jumping from heights, riding bike into street without looking)l hence, a high frequency of injuries.
• Difficulty with transitions/changing activities
• Aggressive behaviour, easily over stimulated
• Socially immature
• Low self-esteem and high frustration

Note: not all symptoms apply to each child, and symptoms will vary in degree. Each child is unique and displays a different combination of behaviours, strengths, weaknesses, interests, talents and skills.

Once a child is identified and diagnosed with ADHD there are many ways to help the child and the family. The most effective approach is a multifaceted treatment approach which may include:

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• Behaviour modification and management at home and school
• Counselling family counselling is recommended because with an ADHD child in the house, the whole family is affected.
• Individual counselling to learn coping techniques, problem-solving strategies, and how to deal with stress and self-esteem.
• Cognitive therapy to give the child the skills to regulate his/her own behaviour as well as “stop-and-think” techniques.
• Social skills training (sometimes available in school counselling groups)
• Numerous school intervention (environmental, instructional, behavioural)
• Providing for physical outlet (e.g., swimming, martial arts, gymnastics, running-particularly non-competitive sports)
• Medical intervention (drug therapy)
• Parent education to help parents learn as much as they can about ADHD so they can help their child and be an effective advocate. Parent support groups are excellent sources of training, assistance, and networking. Most communities also have parenting classes and workshops dealing with a variety of helpful management strategies.

When pursuing any treatment, it is a good idea to ask the school nurse and other parents of ADHD children (perhaps through an ADD support group) for references. Seek out doctors and therapists who are knowledgeable and experienced specifically with treating children with ADHD. Medical treatment if often extremely helpful and cam make a major difference in treating children with ADHD. However, it is never to be used without the employment of behavioural, environmental and other interventions at home and school.

Physical activity is also very important, activities such as martial arts (particularly aikido) are commended because they increase the child’s ability to focus and concentrate.

If a child displays the symptoms of possible ADD/ADHD, school interventions should be implemented regardless of whether the child has been diagnosed with ADHD. School personnel may encourage the parents to pursue the evaluation for the purpose of determining how to best help and meet the needs of their child.

Preventing behavioural problems in the classroom through management techniques

The most critical factors for preventing behavioural problems, particularly for students with special needs (e.g ADD/ADHD, learning disabilities), include

• Clarity of expectation
• Teaching what is acceptable/unacceptable in your classroom
• Structure and routine
• Predictability, consistency
• Much practices, modelling and review of behavioural expectations and rules
• Clear, fair consequences
• Follow-through
• Teacher understanding, flexibility, patience
• Heading off problems with preventive tactics
• Teacher assistance on a personal level.

These children are in particular need of a classroom that is structured, not chaotic, they need to feel secure within the parameters of their classroom, knowing precisely what is expected of them academically and behaviourally.

Teach your rules

• Make rules few, clear, and comprehensive. Many teachers have students discuss, decide on, and write the classroom rules to give more ownership in classroom.

Example A:

1. Come prepared to work
2. Follow directions and stay on task
3. Keep hands, feet and objects to yourselves.
4. Be kind and courteous to others.

Example B:

1. Follow directions
2. Pay attention
3. Work silently during quiet time
4. Do your best work

• Explain the rationale for your rules, any time spent on teaching your rules and modelling all behavioural expectations is time well spent.
• Post rules (written or pictorial) in at least on visible spot. Teach with examples. Role-play rules in action. This is appropriate at all grade levels. Review and practice frequently throughout the school year.
• With every behavioural expectation you communicate (1) explain, (2) write it down (3) demonstrate it in action and (4) let students practices. Example: practice 12-inch voices. What does it sound like? Is this a 12-inch voice.
• Communicate rules and expectations to parents in writing

Positive reinforcement

There is no substitute for positive reinforcement in the classroom. It is the best behaviour management strategy and the one that builds self-esteem and respect. Catch students doing what you want them to do. Recognize and praises specific instances. Examples:

• I like the way Cathy remembers to raise her hand and waits to be called on. Thank you Cathy.
• Adam, I appreciate how quietly you line up.
• Joey, you did such a good job paying attention and staying with the group.
• It makes me so happy when we are all settled down, and ready to listen

Some examples of positive reinforcement in the classroom:

• Legitimate praise and acknowledgment are the best reinforcers
• Reward students with privileges (e.g, classroom jobs and responsibilities)
• It’s generally a good idea not to use the “big guns” (major incentive and rewards) unless they are needed in the classroom. Start with easy, small rewards and incentives
• Many students are motivated to work for tangible rewards (stickers, prizes, food)
• Other suggested reinforcers include:
• Choosing a game to play with a friend
• Earning free time
• Earning breakfast or lunch with the teacher
• Reading or looking at special interest magazine
• Using the computer alone or with a friend
• Listening to music with tape recorder and earphones
• Working with clay, special pens/paper, whiteboards
• Removing lowest test grade
• Leading a game, perhaps as captain of team
• Skipping an assignment of student’s choice
• Bringing to class/demonstrating something of the student’s choice
• Reducing detention time
• Chewing gum privileges at specified times

Classroom incentives

Classroom incentives are great motivators, here are two that work particularly well for many teachers:

• Students earn tickets or play money to be used towards a weekly, bi-weekly, or monthly auction of raffle. Students can use their accumulated tickets/money to buy assorted toys, items, or p
  

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  ivileges from their teacher.

• Marbles or chips are placed in a jar by the teacher when students are caught doing something well or behaving appropriately. When the jar is filled, the class earns a special party. (e.g, popcorn, pizza, ice cream), activity, or field trip of some kind.

Assertive discipline 

Have clear consequences for following and not following the rules. Use warnings with incremental consequences when students do not follow the rules. Give positive attention when students are behaving appropriately. Various classroom management system include the following:

Color-coded cards

This is a graphic system for monitoring behaviour which is used in many classroom. There are many variations of this system. It usually involves a pocket chart with an individual envelope or compartment for each student (identified by name or number). All students start the day with one color (e.g pink card) in their envelope. When there is an infraction of the rules-after warning-the color is change (e.g to yellow) resulting in a consequence such as five minute of time-out. With the next infraction, the card is changed to the next colour (e.g blue) resulting in stronger consequences. After another infraction, the red card appears, resulting in a more severe consequence.

With this system students start each day with a clean slate, for greatest effectiveness, allow your class to devise the consequences associated with each change of color. Teachers who do not want to post the cards for everyone to see may choose to pass out a pink card at the beginning of each day. As a student’s colour need to be changed, the teacher may go to the student’s desk and change the card with the student quietly and privately.

Some teachers use a variation of this system, they link each of their classroom rules to a certain colour. When a student breaks a specific rule, the teacher places a color card corresponding to the rule broken into the child’s pocket. In this way, students are clearly aware of what it is that they did inappropriately. The progressive consequences follow the change of card.

Numbered card 

Some teachers have students with behavioural monitoring needs go home each day with a number card.

5          –   very well behaved, great day!

4          –  good day.

3          –  so so day

2          – we had some trouble today

1          –   we had a very difficult day

Home/school communication

Many teachers send home some type of notification to parents as to how their child behave that day or week. Often teachers using the colored card system send home the final color card at the end of the day with each student (or only with those students in need of close home/school monitoring).

Many teachers send home some type of form or slip indicating how well the student behaved during the week. These notices are usually sent home every Friday or on Monday s for the previous week. It is the student’s responsibility to return the forms to school with their parent’s signature.

Response costs

Some teachers use a system of payment/fines (response cost) with students. Example: using plastic colored links (found in catalogs selling math materials), the teacher awards monetary value to the four colors of the links: yellow-penny, red-nickel, green-dime, blue-quarter. The teacher pays students for good behaviour (a) the whole class earns points and the teacher awards all students a certain value for their links; (b) individually, for on-task behaviour; (c) groups, for cooperative work assignments/projects. The possibilities are limitless. Students are fined for offenses such as: no homework, getting out of seat and off-task behaviour. Every week or every other week students get to buy small treats or privileges with their money (value of links)

How to avoid behaviour problem

Behavioural problems often occur when the students are undirected. Planning well and beginning instruction promptly are generally good deterrents to behaviour problems.

Try to greet students at the door as they arrive in class, offer directions as needed before they enter the room, a smile and hello is a nice way to start the day. Handing the students a brief assignment to work on as they enter the room is also a deterrent to behavioural problem.

The same applied for claiming students after recess, lunch, gym, art, or music. Be there on time, these transitional times are frequently the worst times for ADHD students.

Time outs and time away

Time outs or time aways for ADHD students are necessary in most cases. These children often can’t handle all of the stimulation in a classroom and become worked up and sometimes out of control. Time away from the group is often needed to calm them down and help them regain self-control.

Use time outs and time aways as needed:

• In the classroom, away from distractions
• Buddy or partner up with another teacher (preferably cross-grade) for time outs. Student is brought to the receiving classroom with an independent assignment to work on for a specified amount of time. This is usually a very effective system.
• In the counseling center.

Here are some tips for time outs and time aways

• Try directing the student to time out calmly and positively, example: Michael, I would like for you to sit with your hands and feet to yourself. If you can’t handle that, go back to the table, you can join us when you are ready to sit without touching others.
• Some teachers use a think-about-it chair for a specified amount of time, for example, 3 to 5 minutes to think about their inappropriate behaviour.
• Other teachers have students sit away from the class until they feel ready to join the class again. A typical rule of thumb is one minute of time out per year of age. So, a six-year-old may have about six minutes time out or away from the group.
• As a next step, other teacher send the students to sit outside the room, when the student feels that he/she can behave properly, he/she comes voluntarily inside the door, and waits there quietly until the teacher acknowledges him/her. The teacher might say something like: I am glad you’re ready to follow our rules. Please join us.
• If the student continues to be disruptive, the next step is often to be sent to the counselling center or another classroom for time away, and then the office.
• Teachers with access to telephones have good results since they can call home or the parent’s work place together with the student.

Note: Primary teachers should read section 21, what about kindergarten? This section contains many behaviour management suggestions successful with young students.

Caution: teachers need to be careful not to overuse time outs and to be sure that the child is aware of the behaviour that caused him/her to receive the time out.

Behavioural contracts

Write a contract specifying what behaviour is expected and what the reinforcement will be when the behaviour/task is completed. Behaviour modification methods are often effective with students and should always be tried. Be aware that effectiveness for ADHD students may be short-lived and your rewards/systems will need to be revamped frequently. Don’t be discourage, give it a try, involve your school counsellor for assistance. Of course, you will need parental involvement and support.

Proximity control

Stay close to students with attentional or behavioural problems, circulate in the classroom, a hand n the shoulder or a direct look with quiet reminder is effective. Students with ADD/ADHD should be seated close to teachers and next to or between well-focused students. Avoid seating them along the periphery. Often second row is better than first row for teacher-pupil eye contact. Avoid seating near learning centers, the door, windows, or others distactors.

The personal connection

Take students aside to talk about their behaviour, talk calmly and matter of factly. Give warnings and explain what the consequences of their breaking rules will be, then follow through.

Talk it out, when there is a problem, talk to the student about it in private conference, try (a) passive listening, hear the student out without interrupting; (b) acknowledgement responses, give verbal listening, respond, ask reflective questions, such as come sit with me… maybe we can find a solution, I am not sure I understand what you mean. Can you tell me more?

Try to state the problem in terms of the specific behaviour and avoid messages to the student that he/she is bad, restate the guidelines, limits, and consequences in a quiet, calm manner.

Parent contacts are crucial: elicit parental support through conferences, phone calls and regular, frequent reporting of behavior and work completion. Remember; with all parental contacts communicate that you care about the student. Always include positives and recognition of what student is doing right along with your concerns.

Appropriate behavior modelling

Use cross-age tutors or peers to model specific types of behavior that the student is having difficulty with. Take photos of students engaged in positive behavior (which can be photographed during role play) and display them in the classroom. Rather than hanging them in the room, you may show them when needed to remind about your expectations. It is very effective to have a photo of the student seated properly and appearing to be on-task.