Attention Deficit Hyperactivity Disorder (ADHD)
Overview (from SPARK)
ADHD is considered a neurobiological disorder and is characterised by the inability to sustain focused attention, impulsitivity and hyperactivity.
There are 3 types, based on the latest diagnostic criteria of the American Psychiatric Association, the DSM-IV:
The first and third types are most often and easily identified because these children tend to have symptoms that are highly noticeable. These are the ADHD children who are loud, always on the go, take risks, engage in dangerous behavior, and talk back to adults. The second group, which is often where females are placed, are the quiet daydreamers. They lose personal belongings, can't work alone, don't finish tasks, and are often lost in their own thoughts.
Researchers estimate that ADHD occurs in as few as 1% and as many as 20% of children under 18 years of age. The most accepted estimate is 3-5% of school-going children. That translates into 2 such students in a class of 40 in Singaporeís context.
Coping with students with behavioural problems
Here is a video about a class with behavioural problems, some possibly with ADHD, but not explicit. It also makes one think about how are we going to adapt our lessons when Allied Educators are placed in the classroom, to assist teaching (since the traditional Singaporean classroom is 1 teacher, 40 students).
http://www.teachers.tv/video/1412
What to do about it (From www.educational-psychologist.org.uk)
AT HOME:
Be consistent- don't say what you are not prepared to do and always do what you say.
Be positive - tell them what you want, not what you don't want . Praise your child when you catch them being good. Have clear routines for problem times e.g. bedtime. Remove obvious distractions when he or she needs to concentrate. Set aside some time to be on your own with your child to play /do something they choose/have fun.
AT SCHOOL:
AD/HD children respond best to clearly defined rules/rewards and sanctions applied consistently to the whole class. They need structure and routine and do not respond well to open ended self directed tasks. Work assignments need to be broken down into small, clear attainable tasks. Praise needs to be frequent, immediate and explicit: "Well done you did X well." Children need to be seated away from distractions.
AD/HD children need a high level of physical activity so find legitimate reasons for the child to move e.g. giving out books, collecting equipment, taking messages. Tasks need to be varied frequently e.g. a sitting activity to a a practical task to use of I. T. to delivering a message to discussion time. Gain eye contact before giving instructions and be concise. Use educational software whenever possible as this is highly appropriate for this type of child: there is no delay, it is interactive not passive, and the activities change rapidly.
Referral to Psychiatrist/Paediatrician
A multi-disciplinary approach is important in diagnosing and treating children with A.D/H.D. Drug treatment, usually Ritalin, can be used in severe cases. It is not a cure but can slow down the child's reaction time and give them time to reflect on the consequences of their actions. It also can enable to them to have more control rather than be driven by their overwhelming urge to react immediately. This allows other behavioural techniques to be more effective.
SOME POSSIBLE TARGETS FOR AN I.E.P.
1. Gradually increase the amount of time spent on task.
2. Complete task within a specified time, through use of a timer or watch e.g. set a clear task to be achieved in 5 minutes and give immediate reward on completion and then allow the child to change activity or move about. 3. Complete one task before starting another.
4. Remain seated for a specified time, but do not expect A.D/H.D. children to sit still for very long. These children actually need to move in order to boost their ability to concentrate and remain focused.
5. Listen to instructions and follow without need for repetition.
6. Adopt an appropriate way of asking for help, answering in class or contributing to discussions.
7. Develop a routine for checking that he/she has the correct items for a task.
8. Learn how to wait his/her turn.
9. Learn to set own realistic targets.
10. Learn to make logical plan before starting a piece of work.
HOW CAN A NON TEACHING ASSISTANT HELP?
1. Ensuring that the child recognises the signals to listen and pay attention.
2. Enabling the child to organise their ideas and equipment before starting a task.
3. Spotting and removing obvious distractions.
4. Helping the child to gain greater self control by providing a commentary on what is happening e.g." You need to wait until your name is called. Remember to finish that before you ask. Wait until the queue is shorter. What would happen if you did that? This is not a good time to ask." Evidence suggests that these children find great difficulty doing this themselves and need to be shown how to monitor what is going on. They can then begin to see the consequences of their behaviour.
5. Providing instant reward or feedback on completion of a task.
6. Developing social skills: turn taking, sharing, listening, considering others' feelings etc.
7. Providing repetitions and reminders to compensate for inattentiveness.