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NICHCY
BRIEFING
PAPER
By Mary Fowler

(Attention Deficit Disorder - 1991)
The Basic Components For ADD Management



Education about the Disorder

Parents and teachers need to be aware of the symptoms of ADD and how those symptoms of ADD and how those symptoms impact the child's ability to function at home, in school, and in social situations.  Once the adults in the child's life understand that the child cannot help many of his/her problematic behaviors, they will be able to structure situations to enable the child to behave appropriately and achieve success.  Remember, the child who has difficulty with attention, impulse control, and in regulating physical activity needs help and encouragement to overcome these problems.

Behavior Management

Children with ADD respond well to rewards and structure.  The child does best in an organized environment where rules and expectations are clear and consistent, and when consequences for meeting the demands of a given situation are set forth ahead of time and delivered immediately.  Thus, the child's environment needs to be ordered and predictable.  Frequent and consistent praise and rewards for appropriate behavior such as completing tasks on time or being polite and courteous encourage the child to repeat such desirable behavior.

The main principle behind all behind all behavior management strategies is to increase the child's appropriate behavior and decrease inappropriate behavior through the use of consequences.  The best way to influence behavior is to pay attention to it.  The best way to increase a desirable behavior is to reward it.  Ignoring an undesirable behavior will decrease it's frequency.

There are many books on behavior management written for the lay person.  Below are some guidelines for behavior management.
  


Guideline 1, Behavior Modification Charts

Children with ADD usually require a formal program for managing their behavior.  Most often, such a program centers around behavior modification charts.  parents, teachers, and other important adults in the child's life will need training in how to implement and use these charts effectively.

Charts are designed to provide the child with a clear picture of what behaviors are expected.  The child then has the choice to meet those expectations.  Parents or teachers provide feedback to the child about his/her choices by delivering consequenses.  Charts provide high motivation and enable the child to develope an internal sense of self-control  --  specifically, that he/she can behave appropriately.

There are two basic types of chart programs:
  

Token Economy:
Here the child earns tokens (stickers,stars, etc) for appropriate behavior.  Tokens can be exchanged for various rewards.
Response Cost:
In this chart program, the child is given tokens for free.Tokens are withdrawn for inappropriate behavior (e.g., out of seat, off-task, etc).
The most effective programs use both types of chart systems and work on a give and take basis.  In this combination system, the child is given a tokan for behaving appripriately and loses a token when misbehaving.

When creating and implementing a behavior modification chart, you may wish to follow these suggestions:
  

Make a list of problematic behaviors or ones that need improving.
Select the behaviors to be modified.  The parents (or teachers), with input from the child, review the list of problematic behaviors and select 3-5 to wirk on at a given time.  The behaviors charted should be ones that occur daily, such as going to bed on time, doing homework, or getting ready for school on time.
Design a reward system (Token Economy, Response Cost or a combination).  The parents and teachers need to pay attention to the child's behavior throughout the and provide frequent rewards when the child behaves appropriately.  At the end of the day, tokens can be exchanged for rewards.  such as extended bed time, playing a game with Mom or Dad, or a favorite snack.  Remember, a reawrd is only effective when it has value to the child.  Rewards might have to be changed frequently.
Guidline 2, Punishment

Children with ADD repsond best to motivation and positive reinforcement.  It is best to avoid punishment.  When punishment is necessary, use it sparingly and with senitivity.  It is important for parents and teachers to respond to this child's inappropriate behavior without anger and in a matter of fact way. These children need to be taught to replace inappropriate behavior with appropriate behavior.

Guideline 3, Time-Out

When the child is misbehaving or out of control, time-out is an effective way to manage the problem.  Time-out means the child is sent to a place predetermined location for a short period of time.  A place out of the mainstream of activity is best;  for example, one particular chair may be specified as the "time-out chair."  The time-out location should not be a traumatic ploace, such as a closet or dark basement.  The purpose of time-out is to provide the child with a cooling-off period wherein s/he can regain control.

An important aspect to time-out is that the child no longer has the priviledge to choose where s/he would like to be and how time is spent.  In general, teh child stays in time-out and must be quiet for five minutes.  Preschool-aged children are usually given two or three minutes in time out.  For toddlers, 30 seconds to a minute is appropriate.
 

Medication

Medication has proven effective for many children with ADD.  Most experts agree, however, that medication should never be the only treatment used.  Stimulants are the medication most widely used prescribed for ADD.  These drugs (e.g., Ritalin, Dexadrine, Cylert) are are believed to stimulate the action of the brain's neurotransmitters, which enables the brain to better regulate attention, impulse, and motor behavior.  Ritalin is the most widely used stimulant medication.  In most cases, Ritalin has few and mild side effects.  Anti-depressant medications are also used in children who cannot take stimulant drugs.

The parent's decision to place a child on medication is a personal one and should be made after a thorough evaluation of the child has taken place and after careful consideration by both the parents and the physician.  The prescribing physician should explain the benefits and drawbacks of this form of treatment to the parents.  Doses are generally administered gradually, so that the child receives the lowest dose needed to achieve the best theraputic benefit.  Parents should monitor closely how their child responds to the medication.  Such monitoring generally includes feedback from the child's teacher'(s).  Parents should communicate with the physician as often as is necessary to determine when medication has reached the proper level for the child, and to discuss any problems or questions.

Appropriate Educational Program

Many children with ADD experience the greatest difficulty in schoolwhere demands for attention and impulse or motor control are virtual requirements for success.  Though most children with ADD do not have a learning disability that interferes with the psychological process of learning, these children often are unable to perform to their level of ability in school.  Their poor performance and academic failure usually result from uncompleted tasks, asignments completed but not handed in on time, disorganization, and not following directions.  Behavioral difficulties such as hyperactivity, low frustration tolerance, and outbursts of temper also prevent many of these children from adapting to the classroom regimen.  With help, these children can and do succeed in school.  (NOTE:  Some children with ADD, however, do have learning disabilities.  Any evaluation should screen for the co-existence of learning disabilities or other disabilities and ADD).

Children with ADD do best with a teacher who is knowledgeable about the disorder and willing to problem-solve to help the child overcome his/her difficulties.  A classroom where activities are highly structured and where the teacher uses lots of motivation and hands-on instruction are similarly helpful to children with ADD.  Teachers and parents need to communicate frequently.

There are numerous interventions which can be used effectively with the ADD child.  Here are a few guidelines:
  


1.
 

2.

3.

4.
 
 
 
 
 
 

5.
 

 


The classroom enviroment needs to bee structured and predictable, with rules, schedules, and assignments posted and clearly spelled out.

It is best to seat the child close to the teacher, away from distractors.

Directions should be clear, simple, and given a few at a time.

The curriculum will need to be modified in accordance with the child's organizational skills and his/her ability to attention and concentrate.  For example, can be structured into easily completed parts;  the length of assignments can also be shortened or the child can be given extra time to complete tasks.  The child's progress during tasks can monitored.  Including organizational and study skills in the daily curriculum is another helpful modification, as is coordinating the ammount of work between subject areas.

Behavior management (e.g.  positive reinforcement) is also necessary.  Behavior charts, used in combination with other educational interventions, often produce positive results.
 

How Can I Help My Child Improve Self-Esteem?

Most undiagnosed and untreated children with ADD suffer from low self-esteem.  Many will show signs of being mildly depressed.  These feelings stem from the child's sense of personal failure.  For the child with ADD, the world is often an unkind place.  Negative feedback in the form of punishment or blame tends to a constant in this child's life.  Early diagnosis and treatment help to stem the feelings of poor  self-esteem.

To encourage a good sense of self, this child must be helped to recognize personal strengths and to develop them.  Using many of the behavior management will help.  The child's self-esteem will improve when s/he feels competent.  These are not children who can't, or won't.  They can, and do.  It's just that "can" and "do" come harder for them.

Does My Child Need Special Education?

Approximately one half of the children with ADD are able to learn satisfactorily and perform to their ability levels within a regular education classroom when the disorder is recognized, understood, and when curriculum adjustments to the regular program of instruction are made.

The other half of the  children with ADD will require special education services, most of which can be provided within the regular education classroom or the resource room.  Such services might include teaching of organization techniques, behavior modification programs, daily or weekly report cards, training in self-monitoring, self-evaluation, and self-instruction methods, and the coordination of efforts among the different teachers working with the child.

Some child - approximately 15% -- will need a more intensive program,  perticularly those children who have other disabilities in addition to ADD.  A series of steps is typically necessary in order for a child to be placed into a special education program.  First, the child is referred to the local school district's evaluation team.  An evaluation is then made to determine what effect the child's disability is having on his/her ability to perform educationally.  Once a child is determined to be eligible for special education and related services, the parents collaborate with the school in developing an Individual Educational Program (IEP).  The IEP is designed to address the child's specific problems and unique learning needs.  Strategies to improve social and behavioral problems are also addressed in the IEP.

What Are My Child's Legal Rights For Special Education?

Numerous sources are available to provide information about your child's right to receive special education and related services.  For an in-depth explanation of the laws governing the rights of chiuldren, contact the National Information Center for Children and Youth With Disabilities (NICHCY).  Request a copy of NICHCY's NEWS DIGEST entitiles The Education of Children and Youth with Special Needs:  What Do the Laws Say?  (Volume I, Number 1, 1991).
 

Where Can I Find A Parent Support Group?

There are numerous ADD parent support groups located throughout the country.  For information about a group in your location, contact:

            CH.A.D.D. (Children with Attention Deficit Disorders)
            499 NW 70th Avenue
            Suite 308
            Plantation, Florida    33317

You can also call CH.A.D.D. at (305) 587-3700

If there is no parent support group in you area, the CH.A.D.D. staff can give you guidance in how to start a group in your area.
 
 

References:

Barkley, R.  (1990)  Attention Deficit Hyperactivity Disorder, a handbook for diagnosis and
    treatment.  New York:  Guilford Press
American Psychiatric Association  (1987)  Diagnostic and statistical manual of mental
    disorders (3rd Edition-revised).  Washington DC.: Author.
Fowler, MC.  (1990)  Maybe you know my kid:  A parent's guide to identifying, understanding,
    and helping your child with ADHD.  New York: Birch Lane Press.
Zametkin, A., Mordahl, T.E., Gross, M., KingA.C., Semple, W.E., Rumsey, J., Hamburger, S., &
    Cohen, R.M. (1990).  Cerebral glucose metabolism in adults with hyperactivity of childhood
    onset.  New England Journal of Medicine, 323(2), 1361-1366.








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