AD/HD
Management
Managing AD/HD is not simply about diagnosing the disorder and treating
it with a single therapy. Managing AD/HD can be very complex, especially
if the child has other problems. It therefore requires input from a
range of different resources to ensure that all aspects of the child’s
life are kept in mind. This may involve:
• Managing AD/HD in the classroom
• Structuring the home
• Administrating medication
• Other therapies
Managing AD/HD in the classroom
The issue of integration/inclusion has had a huge impact on the
developments in thinking and practice in the education of pupils with
special educational needs both in Cyprus and overseas (Ministry of
Education & Culture, 1999). Inclusive education has been given support
by the 1989 United Nations Convention on the Rights of the Child and the
1993 United Nations Rules on the Equalisation of Opportunities for
Persons with Disabilities (Ainscow, 1998). Further impetus was given by
the Salamanca Statement and Framework for Action (Farrell, 2001).
Teacher Training and knowledge of AD/HD
The notion of inclusive education means that teachers must now seek ways
to instruct all pupils in the classroom (Brownlee& Carrington, 2000).
Every child has an individual pattern of strengths and weaknesses and
therefore teachers should aim to the best of their ability to find ways
of providing appropriate access to the curriculum for every child
irrespective of ability. However, to ensure this is successfully
achieved teacher programmes should not only have compulsory special
needs taught modules but also require the students to experience
special/inclusive education in practice (Garner, 2000; Garner, 1994;
Brownlee& Carrington, 2000).
Further, schools should provide in-service training for their staff to
further staff expertise and knowledge of special needs and to equip them
with a range of teaching strategies that enable them to identify and
deliver an effective education to these pupils.
Teachers can help children with AD/HD in the class by providing:
Individual
Education Plan
After the child’s strengths and weaknesses have been determined, it is
essential that an individual education plan (IEP) is designed by skilled
members of staff using relevant reports (e.g. an assessment by an
educational psychologist) and teacher and parent input. An IEP should
include the nature of the child’s learning difficulty, the targets to
address these difficulties including the strategies, resources and
time-scale for them to be achieved. IEPs may include targets that
involve: spelling, reading comprehension, maths, study skills, etc. The
IEP is essential as it has clear, specific, relevant and achievable
educational targets. These targets provide a focus for the teacher,
shared common goals for all staff involved, motivation to increase
parental and child involvement, and a monitoring system. IEPs also
establish a procedure for raising attainment for all pupils (Todd,
Castle & Blamires 1998).
Sensible Seating
By being placed in a position with as little distraction as possible
(away from windows and hallways) is essential. It is preferable that
AD/HD children be near the teacher, without feeling as though they are
being punished. Children with AD/HD require more specific and more
frequent feedback on their work performance; is much easier for the
teacher to provide frequent feedback when they are placed in the front.
It is essential that children with AD/HD sit between two or three quiet
pupils. Students with AD/HD tend to do well in small group work such as
completing projects.
Structure
Children with AD/ HD respond better in an environment that is highly
structured because the child knows what is expected of them and that
they are being closely monitored. A visual representation of the day’s
schedule will enable a pupil to function better and more independently.
Such environments help them to pick up cues and re-direct themselves to
a task or activity when they lose their attention. This in turn builds
organisational skills. The child needs to be informed prior to any
changes that might be required during the school programme as they find
it difficult to cope. Letting them know in advance enables them to plan
out what to do. Children with AD/HD tend to get in more trouble during
times with little structure or supervision (Rief…..).
Written Backup
Written backup for verbal directions, such as notes on the board and
individual daily checklists, enables pupils with AD/HD to keep focused
and on task. Many children with AD/HD have a tendency to be visual
learners, so verbal instruction with written back up aids comprehension.
Listening
Children with AD/HD benefit from concise, clear instructions with as few
sub-parts as possible. Emphasising key words in listening activities is
essential. AD/HD children should be encouraged to repeat task
requirements back to the teacher, preferably in their own words.
Visual backup
As pupils with AD/HD have greater difficulty in following verbal
instructions it is essential that they are provided with visual backup
to enable them to follow the lesson. A multi-sensory teaching
environment is ideal and includes alternative presentation means such as
videos, pictures, and overhead projectors. Further hands on activities,
like experiments, are even better. Teachers need to be interesting
themselves, using dramatic gestures and varying their tone of voice.
Rewards
Praise and rewards need to be of high frequency; rewarding the child in
a way that the gratification will be immediate is vital with AD/HD
children. Small and immediate rewards are more effective than long-term
or delayed rewards. ‘Catch the pupil being good.’ Notice when he/she is
compliant, succeeds, or is ‘just there.’ Be prepared to reward the pupil
at the moment by saying things like, ‘I like the way John is raising his
hand to ask me something.’ Rewards should include social praise, as well
as treats and privileges. Working on the computer is a more effective
reward than sweets. Rewards should be negotiated with the pupil and
rotated frequently to avoid loss of interest. Teachers should develop a
reward menu. Rewards should not be overlay elaborate as children with
AD/HD are easily distracted (Flick, 1998; Rief…..).
Timing
Both rewards and sanctions must be given quickly to be effective. A few
hours later or the next day, the child may well have forgotten what
he/she has done to deserve that treat!
Social Skills
If the child has difficulty with social skills and appropriate
behaviour, it is essential to analyse what skills are lacking and coach
or teach the child these skills. For example, teach the child to
organise a game by explaining the rules.
Rules
Rules and boundaries in behaviour need to be clearly set out. They
should be posted on the classroom walls. The teacher needs to be firmly
in control of the class, whilst being sympathetic and warm. Difficult
interactions with pupils should be marked with brevity, calmness and
quietness. Reprimands, where necessary, should be quiet and accompanied
by direct eye contact. Mild reprimands for being off-task will be most
effective when they involve a reminder of the task requirement.
Therefore it is better to say ‘Get back to page 5 of your math book,’
rather than say ‘get on with your work.’ Teachers should ignore minor,
inappropriate behaviour. Academic products of performance such as work
completion are preferred targets for intervention, rather than specific
behaviours, such as remaining in seat. This stresses the need to focus
on positive, desirable outcomes rather than negative, unwanted behaviour.
Modifying School Work
Tasks should be broken down into a small number of short steps.
Initially tasks should be relatively short. In this way the pupil does
not feel ‘overwhelmed’ and will complete the task in far less time. The
length and complexity of tasks should increase only when the pupil has
shown success with shorter assignments. Teachers should avoid repetitive
tasks.
Positive Directions
Phrases such as ‘I’ve told you one thousand times’ should be avoided.
Always give task requirements as if you are giving them for the first
time, in a calm and measured way. Children with AD/HD respond best when
being told what to do, rather than being told what not to do. Being told
‘don’t do….’can put ideas into the child’s head or may just leave the
child wondering what he should be doing instead.
Building Self-Esteem
There is substantial evidence demonstrating that a pupil’s level of
achievement is affected enormously by how the child feels about
him/herself. Self-esteem is positively correlated with achievement. Many
children with AD/HD have a very poor self-image as they do not achieve
often in comparison with their peers. As a result they often feel like
failures and/or incompetent. Teachers and parents, however, have the
power to improve a child’s self-esteem. They can achieve this by
praising every effort made; giving them opportunities to take on
responsibilities (assigning them to be a school prefect); encouraging
them to be the spotlight in activity that they are good at such as
swimming, art work, etc. and encouraging them to help others in areas
that they feel confident (Miller,…; Alban-Metcalfe & Alban-Metcalfe,
2001).
Homework
Developing a reward system for homework completion in liaison with the
teacher is recommended, as completing tasks independently can be very
difficult for a child with AD/HD. Teachers need to ask children with
AD/HD to check in their school bags for their homework. They often do
not submit their homework even though they have done it because they did
not pay attention when asked to turn it in. Teachers should allow
children with AD/HD to present knowledge through tape and the computer
processor if it helps them to better sequence or concentrate their ideas
(Pentecost, 2000; Greenbaum & Markel, 2001).
Home School Links
Teachers should work in partnership with parents for effective and
consistent programmes to be followed both at school and home. Therefore
there must be an open line of communication between the two for the
benefit of the child. Teachers should inform parents frequently on their
child’s progress and difficulties (Greenbaum & Markel, 2001; Flick,
1998). For further information on how to successfully teach children
with AD/HD please see the ‘ADD-ADHD: A Guide for Teachers’.
Structuring the Home
Successfully parenting a child with AD/HD requires special expertise.
The first step requires parents to understand the nature of their
child’s AD/HD. Secondly it is essential that parents learn to
distinguish which behaviours the child is unable to control and when
their child is unwilling to control their behaviour. Differentiating the
above behaviours makes life easier at home and elsewhere. Parents will
know when bad behaviour is a function of AD/HD and when it is simply
naughtiness. This in turn ‘allows’ the parents to constructively develop
their child’s weak areas (Pentecost, 2000; Greenbaum & Markel, 2001;
Flick, 1998). For further information on home behaviour management
please see the ‘ADD-ADHD: A Guide for Parents’.
Administering Medication
The use of medication for treating AD/HD is not new; it began over 50
years ago. Stimulant medication was first used in 1937, however, it was
used to a larger degree starting in around 1957 when methylphenidate
(Ritalin) was approved. Controversy exists till present regarding the
use of medication for the treatment of AD/HD symptoms; some people
believe that these drugs are addictive and dangerous while others argue
that the social and educational advantages of medication outweigh any
disadvantages (Flick,1998).
For many children with AD/HD, medication is an important part of
treatment. Medication seeks to enhance normal brain function, treating
the core symptoms of inattention, hyperactivity and impulsivity by
correcting brain dysfunction. This in turn increases enthusiasm to
learn, maintains self-esteem and improves interpersonal relationships
making home and school a secure and nurturing environment
(Alban-Metcalfe & Alban-Metcalfe, 2001; Flick, 1998; O’Regan, 2002).
Stimulants are quick acting, staring to work in about ½ hour and wear
off in 3-5 hours. These are usually given in two to three doses a day.
Other types of medications can last for 12 hours requiring a once a day
dose. It is suggested that medication is only taken during school hours,
as this is the time that student needs to be focused. However, if there
are problems of behaviour and socialisation, medication could be given
throughout the week (Greenbaum & Markel, 2001).
Studies have shown that children who are treated with stimulants have
improved in academic performance; concentration; self-esteem; working
memory; aggression and forming better peer relationships. Medication can
continue for as long as parents and teachers see significant benefits (O’Regan,
2002; Alban-Metcalfe & Alban-Metcalfe, 2001).
Side effects are infrequent and can usually be avoided. The most common
side-effects include: stunted growth; itchy skin; sleeplessness;
reduction in appetite; abdominal pain/headaches; sleep difficulties;
rebound effects when the medication wears off at the end of the day,
such as increase hyperactivity; and tics which may be controlled by
additional medication (Jones, 2000; Alban-Metcalfe & Alban-Metcalfe,
2001).
According to Alban-Metcalfe & Alban-Metcalfe (2001), there is no
evidence that indicates addiction to, or substance abuse of stimulant
medication by AD/HD individuals.
Medication should not be considered as bringing about a cure but rather
as controlling a dysfunction. Medication should be considered as part of
an effective treatment in combination with educational programmes,
behaviour modification and counselling strategies (Alban-Metcalfe &
Alban-Metcalfe, 2001; Flick, 1998; O’Regan, 2002).
Other Therapies
Families with children with AD/HD are subjected to extreme ongoing
stress that is beyond the realm of normal day to day experience. It is
therefore essential that AD/HD is viewed in the context of the family.
Family therapy addresses the impact of AD/HD on all family members;
parents, siblings and the child with AD/HD. Educating and treating all
members of the family system promotes family wellness (Wodrich, 1994;
Flick, 1998).
Where children with AD/HD have other associated problems, co-morbid
disorders such as impaired motor co-ordination, occupational therapy
assessment is required to identify specific types of exercises and
instructions to improve these problems. Similarly speech and language
therapy may be required to help children with AD/HD that are late in
onset of talking and have other difficulties in speech (O’Regan, 2002).
Cyprus Dyslexia Association North Cyprus Dyslexia Association ADD-ADHD Support KAYAD
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Last Updated 9/2/2006