Cant Learn, Wont Learn: Behaviour Management for Children with ADHD

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Cant Learn, Wont Learn Behaviour Management
for Children with ADHD

• Fintan J ORegan MA
• DC educational services
• 0207 834 0033
• fjmoregan_at_aol.com

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ADHD

• The DSMIV lists 3 ADHD types
• Predom Inattentive Type (PIT)
• Hyperactive Impulsive Types (HIT)
• Combined Type (CT)
• Core Symptoms Attention span
• Impulsivity
• Hyperactivity
• To consider the impact on School, Peers, Home
  and Cultural Expectations

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Response Inhibition?

• Got to say it
• got to say it now..

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Prevalence and Demographics

• 5 of school age population of which less than
  1 are diagnosed
• Ratio of boys to girls 41 in the HIT/CT, 11
  in the PIT category
• IQ generally in the average range

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Additional Diagnostic Features in Girls
While boys hyperactivity decreases at puberty
girls symptoms typically increase at puberty
Mood swings, emotional reactivity Addictive
behaviours a greater risk in girls Increase in
anxiety and depression
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Causes of ADHD?

• Brain abnormalities Structural
• Electrical,
• Chemical
  
• Heredity
• Brain Injury or trauma
• Other medical conditions
• Environmental Toxins

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What is the core deficit that children with ADHD
experience ?

• The Core Deficit that many children with
  ADHD experience is a thick barrier between
  themselves and lifes consequences
• M.Gordon 1992

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Are Children with ADHD always inattentive and/or
Impulsive/Hyperactive ?

• Their behaviour will vary according to the
  degree to which rules are managed, the amount of
  structure and support for compliance and the
  degree to which the child is interested in the
  activity
• Mike
  Gordon 1992

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The long term outlook

• ADHD frequently persists into adolescence and
  adulthood
• A number of environmental factors together
  with IQ complications and age at diagnosis can
  modify the outlook
• With a comprehensive approach to management
  even those with severe ADHD can usually be
  effectively helped
• The positive features of ADHD should always
  be appreciated. These can be accentuated by
  effective management
•  

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Where does ADHD fit into the SEN agenda

• Not in the old or revised Code of Practice
  can the term ADHD be found although Paragraph
  7.60 in the Behavioural Emotional and Social
  Difficulties Section of the code makes specific
  references to
• interventions for schools to support pupils
  who are hyperactive and lack concentration.
•  

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Likely progression unless identified

• Age 7 Key Stage 2, low Self esteem
• Age 11 Key Stage 3, Disruptive Behavior,
  Learning Delay, Poor Social Skills
• Age 14 Key Stage 4, ODD, Challenging
  Behavior, Criminal Behavior, School Exclusion,
  Substance Abuse, Conduct Disorder, Lack of
  Motivation, Complex Learning Difficulties

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Conduct Disorder

• Aggression to people/animals
• Destruction of Property
• Deceitfulness or theft
• Serious Violations of rules

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Oppositional Behaviour

• Argues with Adults
• Refuses and Defies
• Angry and Defensive
• Spiteful and Vindictive
• Possess a counter- will the more pressure
  we apply the greater the opposition

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Exclusion issues

• Most exclusions are for verbal abuse of staff
• 83 of 10,000 permanently excluded pupils in
  the UK in 2001 were boys aged between 13-15
• Within the 10,000 cases above
• 20 of excluded pupils were in care
• 34 were from one parent families
• 
  TES May 2003

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Assessment

• Medical evaluation
• Parent interview
• Teacher interview
• Child interview
• Rating Scales
• Computerised testing
• Achievement testing
• Intellectual testing

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Inclusion

• Every human being has an entitlement to
  personal, social intellectual development and
  must be given an opportunity to achieve his/her
  potential in learning
• Educational systems should be designed to
  tale into account these wide diversities
• Those with exceptional learning needs
  and/or disabilities should have access to high
  quality and appropriate education
• Every human being is unique in terms of
  characteristics interests, abilities, motivation
  and learning needs
  NASEN 2000
•  

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Management options

•        Educational accommodations
• Skills Reinforcement
•        Behaviour Mod Rewards/Sanctions
•  Social skills training
•        Individual Counselling/RJ
• Alternative curriculum pathways
• Medication
•        Parent communication
•          Alternative treatments dietary
• adaptation, mineral supplements

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Teaching and management

SRF
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School Structure

• A commitment to teach and manage ADHD children
  from the SMT
• All Teaching and Support staff trained in
  recognition, teaching and management of ADHD
  students
• Positive and realistic academic and
  socialisation expectations within School
  Behaviour policy outlined at the start with
  parents in the loop.
• In some cases an individualised programme
  designed outlining key academic goals in core
  subjects, socialisation and behavioural targets.
  IEP created and applied by all

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Structure ctd

• Clearly state expectations/ objectives in key
  rules i.e.
• .
• Students are expected to produce their best
  work of their ability
• No Physical/Verbal Aggression
• Eating, drinking, use of phones confined
  to external areas
• Timekeeping, Safety issues
• Immorality i.e. stealing, lying etc..
• Parents and students involved in rules
  procedures, copy sent home and signed by students
  and parents
•  
•  

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Additional provision

• Specialist 1-1 reinforcement in reading,
  writing/spelling/ creative language
• Study skills and use of materials
•   Typing, Laptop skill, Calculator Skills
•   Teaching the language of Math/Sci
•   OT work on Fine or Gross Motor Skills
•   Use of Headphones
•   Art, Music, Drama, IT options
•   Use of Video, Tape recorder, Interactive
  Whiteboards
• Team Teaching by use of LSAs

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Behaviour Modification

• Reward/Privilege/Merit systems such as
  daily/weekly goal charts, stickers, points,
  etc..tied to valuable goals and
• outcomes for students
• Work Station options and alternative Attention
  training systems
• Stop, Think, Do related BM systems
•   Time out systems such as 123 Magic
•    
•    Longer term agreed contracts

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Behaviour Modification ctd

• Study Halls/Detention
• Temporary revision of schedule
• Use of in-school suspension/issolation
• Use of possible parental support/supervision

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Medication Options

• When ?
• Only after comprehensive evaluation
• When a child is significant risk of harming
  himself or others
• When earnest attempts at non-medical
  interventions have proved insufficient
• When the child is at risk of emotional and/or
  academic failure
•  

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Medication ctd

• Which?
• Stimulants Ritalin SF and SR,
• Equasym, Dexedrine, Adderall, Concerta
• Antidepressants Tofranil, Norapramine and
  Stattera
• Other options Clondiine, Risperidone,
  Anti-convulsants, Tic medications

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PublicityMeds
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Socialisation Issues

• Mentoring
• Coaching
• Art/Music Therapists
• Counselling
• Nurture Groups
• Dealing with issues such as Relationships,
  Self Esteem, Appropriate interaction with others
• Lying, Stealing, Academic Expectations,
  Future options etc

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Parental Involvement
  Frequent telephone contact Frequent parent
teacher conferences Daily report cards  
ADHD children can place a great deal of pressure
on family relationships especially if they also
have ODD. Behavioural modification
strategies are important. This does not
necessarily require psychiatric inputs.
Parents must try and look after themselves
In persistently difficult situations the
possibility of unrecognised parental ADHD and ODD
should be considered.
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What of the future?
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Potential
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In summary

• 1. Is the behaviour premeditated or not
  premeditated
• 2. Management SRF
• 3. Set realistic expectations
• 4. Create options for fidgeting, distraction,
  calling out, student needs option to escape
• 5. Say what you mean and mean what you say

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In summary

• 6. Whole school policy to cover areas such as
  break, sports etc
• 7. Combination with multiagencies
• 8. If not working change (every kid has their
  price)
• 9. 65 BM should be done by NVC
• 10. Make it work for you and keep things in
  perspective