Microsoft word - m5 a2 special needs - adhd - fleischmann english - practical guidance.doc
Problems of Children with ADHD Otakar Fleischmann University of Ústí nad Labem, Czech Republic
Part 1: Practical Guidance and Didactical Approach
Background and Key Words:
ADHD (attention deficit hyperactivity disorder) is a neurobehavioral developmental disorder affecting about 3-5% of the world's population. It is most common in children
with an incidence of about 8 to 9 percent of primary age school boys and 2 to 3 percent of girls. Boys show more unrest and are more often diagnosed then girls. Over 70% of children with ADHD met criteria for the disorder in adolescence.
The problems for children with ADHD are mainly difficulties with behaviour control,
attention deficit, problems in social adaptation, problems with self-concept and self-esteem. When we see the higher percentage of boys with ADHD compared to girls and a
not very optimistic perspective in the direction of antisocial behaviour it is evident that we should focus our treatment mainly on boys.
Mainly because of hyperactivity, impulsivity and attention deficit children with ADHD have problems with self-control, understanding verbal and nonverbal signals from other
people, keeping rules, completing tasks, keeping order and with interpersonal interaction etc. They are often over stimulated and due to mainly negative feed back they
demonstrate poor motivation and attitudes that leads them to self-defeating patterns of behaviour and using self-defence strategies such as aggression.
Key words: Hyperactivity, impulsivity, hyper excitability, attention, adaptation,
interaction, self-esteem, feedback, aggress. Similar topics:
Antisocial behaviour, aggression, motivation disturbances.
Number of participants:
9-11 years old boys Aims:
• To teach boys to read other people’s verbal and nonverbal expressions.
• To help boys to learn their own behaviour control.
• To choose the more desired behaviour.
Several intervention approaches are available to cope with children with ADHD. We can
use two important methods of treatment- medical and psychological. Medical treatment (e.g. Methylphenidat- Ritalin; Atomoxetin- Strattera) ranges from
basic treatment and psychological treatment to subsidiary treatment. Psychological treatment works to people with ADHD accept themselves despite their disorder and to
help them to develop better relationships. Psychological treatment is focused by clients mainly on:
• exploring self-defeating patterns of behaviour;
• understanding how to change or better cope with the disorder
In terms of psychological treatment we can take two perspectives to the problem - behavioural therapy and social skills training.
Behavioural therapy (BT) helps - rather than simply helping children with ADHD to understand their feelings and actions – it directs them to change their thinking and
coping and thus it may lead to changes in behaviour. The support might be practical assistance, like help in organizing tasks or schoolwork or dealing with emotionally
charged events. The support might also be in self-monitoring one’s own behaviour and giving self-praise or rewards for acting in a desired way such as controlling anger or
thinking before acting. Social skills training can help children with ADHD to learn new ways of behaviour. In social skills training we discuss and model appropriate behaviours important in developing and maintaining social relationships, like waiting for a turn, sharing toys,
asking for help, sitting quietly during mealtimes, responding to teasing etc., then give children a chance to practice. Social skills training can help the child to develop better
ways to play and work with other children, to keep roles, to eliminate conflicts with teachers and parents.
There are a number of techniques for managing children’s behaviour. Here are two
1. System of rewards and penalties
This system of rewards and penalties can be an effective way to modify a child’s
behaviour at school and at home. The parents or teacher in cooperation with each other identify a desirable behaviour that they want to encourage in the child—such
as asking for a toy instead of grabbing it, or completing a simple task. The child is told exactly what is expected in order to earn the reward. The child receives the
reward when he performs the desired behaviour and a mild penalty when he doesn’t. A reward can be small but it should be something the child wants and is eager to earn. The penalty might be some activity which children do like and we
eliminate it (e. g. watching TV, playing computer games etc.). At school we prefer to work with rewards which could be represented by positive points.
2. Using “time out” or isolation
In school or particularly at home we can use of “time out” or isolation. This
involves sending the child to a chair or bedroom when their behaviour becomes too unruly or out of control. During time out, the child is removed from the
agitating situation and sits alone quietly for a short time (about 5- 10 minutes) to calm down without any possibility to read or play, they should think about the way
they have behaved and try to understand how it affects them and others. Parents should also give the child “quality time” each day, in which they share a
pleasurable or relaxed activity. During this time together, the parent look for opportunities to notice and point out what the child does well, and praise his or
her strengths and abilities (Halgin, Whitbourne, 1994; Oltmanns, Neale, Davison, 1995).
Emotions performance This exercise is to teach boys how to deal with emotions- how to read and express them
which is important for building positive relationships. First ask the boys to discuss different emotions and their meanings. This helps them to understand more deeply the
emotion and its characteristics. The second part of the exercise is to create a painting which represents their ideas about a feeling or an emotion. They should think about how
it might be represented in terms of colour and shape. The work created shows the difficulties in expressing and reading different emotions- some are easy, some more
Discussion about emotions, characterizing positive and negative emotions, what are the
differences between them. “When you speak to other people or they speak to you, you often perceive different feelings and emotions. What could they be?” (Pleasure, fear, anger, sadness, .)
Step 2: Each boy paints one positive and one negative emotion on the cards and inscribes them.
Give the boys time to prepare a short role-play of the chosen emotion, consulting with
the teacher/practitioner to ensure it is appropriate. They cannot use words to express their emotion – only facial expressions and gestures.
Step 5: Perform the short presentation.
The boys try to guess the emotions performed and evaluate each performance. They should describe their own feelings, the attributes typical to a particular emotion, which
situations are matched with a particular emotion and behaviour identified with a particular situation.
Step 7: Repeat the activity choosing a different emotion at random.
It is important to keep some principles specifically for boys with ADHD. It mainly means
we prefer to work in small steps. Each step is short and clearly defined and we provide feedback. We should interact with each participant and we give a positive evaluation after finishing each task.
2. How are you able to eliminate a disturbing and undesirable behaviour?
Variations (Continuation): I am the leader
Let us now come away from the premise that most boys with ADHD feel socially excluded. Every child would like to be the centre of attention sometimes. This exercise
gives them an opportunity to stay the centre of attention without using disruptive behaviour. The exercise is full of actions too and demands attention from the other
participants. During the game boys learn to observe the behaviour of others and it may lead to discovering a new skill in their performing colleague - he is funny, he is good at
it, he is a good actor. Exercise description: All boys sit or stand, making the circle with one of them in the middle - he is the centre
of attention. The boy in the middle makes different movements and makes noises and sounds that the others must imitate. He has limited time for the show, when the time is
over another boy comes to the centre of the circle. At the end the boys discuss what they liked, what was difficult for them, what they felt etc.
Recommendation: Together with each exercise educators should continuously reinforce desirable behaviour by providing more frequent and immediate feedback including rewards and praise.
There are some general principles which can be useful for most children with ADHD:
1. Rewards should dominate over punishment. They should be directed at the
particular behaviour and at boy’s personality (you are helpful, smart, .). Punishment should be directed only at the boy’s behaviour not himself (e.g. That was an unkind thing to say… not… you are very unkind).
2. Setting up the rules (there should be a limited number of rules, they should be
understandable, appropriate and achievable).
3. Help the boy manage a large task step by step. Praise him as each step is
4. Give the boys a timetable so they can see their routine every day, from waking up
to bed time, which includes schoolwork, homework, play time and other activities.
The schedule should be placed somewhere visible. If a schedule change must be made, make it as far in advance as possible.
5. Have a place for everything and keep everything in its place. This includes
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