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Articles on Disability & Rehabilitation
Sunday, 31 January 2016
Blog Editorial
Disability studies be it as academicians, researchers and practitioners or even as student we need to continuously be learners
WE THE PEOPLE INDIA’ looks forwards to provide a platform to bring together people from all walks of life and to gain from the experts in the related field.
Through this platform you'll be enlightened about the different aspects of disability including contextualizing Disability policies legislation and Acts related to special education .Sustainability, input –process outcome context framework for inclusive education, multi sensory approach multi discipline teams adaptations ,differential and effective instruction for regular classrooms ,historical perspective definitions and classification ,incidences and prevalence screening ,identifications and diagnosis ,characteristics ,associated disorder , causes and prevention intervention and educational programmes and strategies ,assertive technology and devices and other issues and concerns
Wednesday, 9 April 2014
INTERNATIONAL SCENARIO ON THE DEVELOPMENT OF LAWS IN THE FIELD OF DISABILITY REHABILITATION
By Mrs .Pragya Verma
1. Americans with
Disability Act (ADA )
(1990)
Extended civil rights similar to those of
the Civil Rights Act of 1964 to the people with disabilities Act, “Prohibits
discrimination on the basis of disability in: private sector employment,
service rendered by state and local governments, places of public
accommodations, transportation and telecommunications relay system”.
Integration is the fundamental to the purpose of the ADA . Regulations state that ‘a public entity
may not deny a qualified individual with a disability – the opportunity to pa rticipa te
in services, programmes or activities that are not sepa rate
or different, despite the existence of permissibly sepa rate
or different programmes or activities”.
2 The standard rules
on the equalization of opportunities for persons with disability (1993)
The declaration clearly stated that general education authorities are responsible for the education of persons with disabilities in integrated settings. Education of persons with disabilities should form an integralpa rt of national education
planning, curriculum development and school organization.
The declaration clearly stated that general education authorities are responsible for the education of persons with disabilities in integrated settings. Education of persons with disabilities should form an integral
Article -26 (Introduction) states that “the persons with
disabilities should receive the support of employment and social services”.
3 The Salamanca Statement and Framework for action
on Special Needs Education (1994)
The Salamanca
statement states,
· Every
child has a fundamental right to education and must be given the opportunity to
achieve and maintain acceptable level of learning.
· Every
child has unique characteristics, interests, abilities and learning needs.
· Education
systems should be designed and educational programmes implemented to take into
account the wide diversity of these characteristics and needs.
· Those
with special educational needs must have access to regular schools which should
accommodate them within child center pedagogy capa ble
of meeting these needs.
· Regular
schools with this inclusive orientation are most effective means of combating
discriminatory attitudes, creating welcoming communities, building an inclusive
society and achieving education for all; moreover they provide an effective
education to the majority of the children and improve the efficiency and
ultimately the cost effectiveness of the entire education system.
· Educational
policies at all levels should stipulate that children with special needs should
attend their neighborhood school that is the school that would be attended if
the child did not have the disability.
· The
Salamanca Framework for action further points through its Article – 6 that “
Experience in many countries demonstrates that the integration of the children
and youth with special needs is best achieve with in inclusive schools that serve
all the children with in a community. It is within this context that those with
special educational needs can achieve the fullest educational progress and
social integration.
4 United
Nation Convention on the Rights of Persons with Disabilities (2008)
Article 3 - General principles
The principles of the present Convention shall be:
a. Respect for inherent dignity, individual
autonomy including the freedom to make one’s own choices, and independence of
persons;
b.Non-discrimination;
c. Full and effective pa rticipa tion and inclusion in society;
d.Respect for difference and acceptance of
persons with disabilities as pa rt of
human diversity and humanity;
e. Equality of opportunity;
f. Accessibility;
g. Equality between men and women;
h. Respect for the evolving capa cities of children with special needs and respect
for the right of children with special needs to preserve their identities.
Article 5 - Equality and
non-discrimination
1. States Parties recognize that all persons are
equal before and under the law and are entitled without any discrimination to
the equal protection and equal benefit of the law.
2. States Parties shall prohibit all discrimination on the basis of disability and guarantee to persons with disabilities equal and effective legal protection against discrimination on all grounds.
2. States Parties shall prohibit all discrimination on the basis of disability and guarantee to persons with disabilities equal and effective legal protection against discrimination on all grounds.
3. In order to promote equality and eliminate
discrimination, States Parties shall take all appropriate steps to ensure that
reasonable accommodation is provided.
4. Specific measures which are necessary to
accelerate or achieve de facto equality of persons with disabilities shall not
be considered discrimination under the terms of the present Convention.
Article 6 - Women with disabilities
1. States Parties recognize that women and girls
with disabilities are subject to multiple discrimination, and in this regard
shall take measures to ensure the full and equal enjoyment by them of all human
rights and fundamental freedoms.
2. States Parties shall take all appropriate measures to ensure the full development, advancement and empowerment of women, for the purpose of guaranteeing them the exercise and enjoyment of the human rights and fundamental freedoms set out in the present Convention.
2. States Parties shall take all appropriate measures to ensure the full development, advancement and empowerment of women, for the purpose of guaranteeing them the exercise and enjoyment of the human rights and fundamental freedoms set out in the present Convention.
Article 7 - Children with special needs
1. States Parties shall take all necessary measures
to ensure the full enjoyment by children with special needs of all human rights
and fundamental freedoms on an equal basis with other children.
2. In all actions concerning children with special
needs, the best interests of the child shall be a primary consideration.
3. States Parties shall ensure that children with
special needs have the right to express their views freely on all matters
affecting them, their views being given due weight in accordance with their age
and maturity, on an equal basis with other children, and to be provided with
disability and age-appropriate assistance to realize that right.
Article 9 – Accessibility
1. To enable persons with disabilities to
live independently and pa rticipa te fully in all aspects of life, States Parties
shall take appropriate measures to ensure to persons with disabilities access,
on an equal basis with others, to the physical environment, to transportation,
to information and communications, including information and communications
technologies and systems, and to other facilities and services open or provided
to the public, both in urban and in rural areas. These measures, which shall
include the identification and elimination of obstacles and barriers to
accessibility, shall apply to, inter alia:
a. Buildings, roads, transportation and other
indoor and outdoor facilities, including schools, housing, medical facilities
and workplaces;
b. Information, communications and other
services, including electronic services and emergency services.
2. States Parties shall also take appropriate measures to:
a. Develop, promulgate and monitor the
implementation of minimum standards and guidelines for the accessibility of
facilities and services open or provided to the public;
b. Ensure that private entities that offer
facilities and services which are open or provided to the public take into
account all aspects of accessibility for persons with disabilities;
c. Provide training for stakeholders on
accessibility issues facing persons with disabilities;
d. Provide in buildings and other facilities
open to the public signage in Braille and in easy to read and understand forms;
e. Provide forms of live assistance and
intermediaries, including guides, readers and professional sign language
interpreters, to facilitate accessibility to buildings and other facilities
open to the public;
f.
Promote
other appropriate forms of assistance and support to persons with disabilities
to ensure their access to information;
g. Promote access for persons with
disabilities to new information and communications technologies and systems,
including the Internet;
h. Promote the design, development,
production and distribution of accessible information and communications
technologies and systems at an early stage, so that these technologies and
systems become accessible at minimum cost.
Article 12 - Equal recognition before the
law
1. States Parties reaffirm that persons with
disabilities have the right to recognition everywhere as persons before the
law.
2. States Parties shall recognize that persons
with disabilities enjoy legal capa city
on an equal basis with others in all aspects of life.
3. States Parties shall take appropriate measures
to provide access by persons with disabilities to the support they may require
in exercising their legal capa city.
4. States Parties shall ensure that all measures that relate to the exercise of legal capa city provide for
appropriate and effective safeguards to prevent abuse in accordance with
international human rights law. Such safeguards shall ensure that measures
relating to the exercise of legal capa city
respect the rights, will and preferences of the person, are free of conflict of
interest and undue influence, are proportional and tailored to the person’s
circumstances, apply for the shortest time possible and are subject to regular
review by a competent, independent and impa rtial
authority or judicial body. The safeguards shall be proportional to the degree
to which such measures affect the person’s rights and interests.
4. States Parties shall ensure that all measures that relate to the exercise of legal ca
5. Subject to the provisions of this article,
States Parties shall take all appropriate and effective measures to ensure the
equal right of persons with disabilities to own or inherit property, to control
their own financial affairs and to have equal access to bank loans, mortgages
and other forms of financial credit, and shall ensure that persons with
disabilities are not arbitrarily deprived of their property.
Article 13 - Access to justice
1. States Parties shall ensure effective access to
justice for persons with disabilities on an equal basis with others, including
through the provision of procedural and age-appropriate accommodations, in
order to facilitate their effective role as direct and indirect pa rticipa nts,
including as witnesses, in all legal proceedings, including at investigative
and other preliminary stages.
2. In order to help to ensure effective access to
justice for persons with disabilities, States Parties shall promote appropriate
training for those working in the field of administration of justice, including
police and prison staff.
Article 19 - Living independently and
being included in the community
States Parties to this Convention recognize the
equal right of all persons with disabilities to live in the community, with
choices equal to others, and shall take effective and appropriate measures to
facilitate full enjoyment by persons with disabilities of this right and their
full inclusion and pa rticipa tion in the community, including by ensuring that:
a. Persons with disabilities have the
opportunity to choose their place of residence and where and with whom they
live on an equal basis with others and are not obliged to live in a pa rticular living arrangement;
b. Persons with disabilities have access to a
range of in-home, residential and other community support services, including
personal assistance necessary to support living and inclusion in the community,
and to prevent isolation or segregation from the community;
c. Community services and facilities for the
general population are available on an equal basis to persons with disabilities
and are responsive to their needs.
Article 24 - Education
1. States Parties recognize the right of persons
with disabilities to education. With a view to realizing this right without
discrimination and on the basis of equal opportunity, States Parties shall
ensure an inclusive education system at all levels and life long learning
directed to:
a. The full development of human potential
and sense of dignity and self-worth, and the strengthening of respect for human
rights, fundamental freedoms and human diversity;
b. The development by persons with
disabilities of their personality, talents and creativity, as well as their
mental and physical abilities, to their fullest potential;
c. Enabling persons with disabilities to pa rticipa te
effectively in a free society.
2. In realizing this right, States Parties shall
ensure that:
a. Persons with disabilities are not excluded
from the general education system on the basis of disability, and that children
with special needs are not excluded from free and compulsory primary education,
or from secondary education, on the basis of disability;
b. Persons with disabilities can access an
inclusive, quality and free primary education and secondary education on an
equal basis with others in the communities in which they live;
c. Reasonable accommodation of the
individual’s requirements is provided;
d. Persons with disabilities receive the
support required, within the general education system, to facilitate their
effective education;
e. Effective individualized support measures
are provided in environments that maximize academic and social development,
consistent with the goal of full inclusion.
3. States Parties shall enable persons with
disabilities to learn life and social development skills to facilitate their
full and equal pa rticipa tion in education and as members of the community.
To this end, States Parties shall take appropriate measures, including:
a. Facilitating the learning of Braille,
alternative script, augmentative and alternative modes, means and formats of
communication and orientation and mobility skills, and facilitating peer
support and mentoring;
b. Facilitating the learning of sign language
and the promotion of the linguistic identity of the deaf community;
c. Ensuring that the education of persons,
and in pa rticular children, who are
blind, deaf or deafblind, is delivered in the most appropriate languages and
modes and means of communication for the individual, and in environments which
maximize academic and social development.
4. In order to help ensure the realization of this
right, States Parties shall take appropriate measures to employ teachers,
including teachers with disabilities, who are qualified in sign language and/or
Braille, and to train professionals and staff who work at all levels of
education. Such training shall incorporate disability awareness and the use of
appropriate augmentative and alternative modes, means and formats of
communication, educational techniques and materials to support persons with
disabilities.
5. States Parties shall ensure that persons with
disabilities are able to access general tertiary education, vocational
training, adult education and lifelong learning without discrimination and on
an equal basis with others. To this end, States Parties shall ensure that
reasonable accommodation is provided to persons with disabilities.
Article 26 - Habilitation and
rehabilitation
1. States Parties shall take effective and
appropriate measures, including through peer support, to enable persons with
disabilities to attain and maintain maximum independence, full physical,
mental, social and vocational ability, and full inclusion and pa rticipa tion
in all aspects of life. To that end, States Parties shall organize, strengthen
and extend comprehensive habilitation and rehabilitation services and
programmes, pa rticularly in the
areas of health, employment, education and social services, in such a way that
these services and programmes:
a. Begin at the earliest possible stage, and
are based on the multidisciplinary assessment of individual needs and
strengths;
b. Support pa rticipa tion and inclusion in the community and all
aspects of society, are voluntary, and are available to persons with
disabilities as close as possible to their own communities, including in rural
areas.
2. States Parties shall promote the development of
initial and continuing training for professionals and staff working in
habilitation and rehabilitation services.
3. States Parties shall promote the availability, knowledge and use of assistive devices and technologies, designed for persons with disabilities, as they relate to habilitation and rehabilitation.
3. States Parties shall promote the availability, knowledge and use of assistive devices and technologies, designed for persons with disabilities, as they relate to habilitation and rehabilitation.
Article 27 - Work and employment
1. States Parties recognize the right of persons
with disabilities to work, on an equal basis with others; this includes the
right to the opportunity to gain a living by work freely chosen or accepted in
a labour market and work environment that is open, inclusive and accessible to
persons with disabilities. States Parties shall safeguard and promote the
realization of the right to work, including for those who acquire a disability
during the course of employment, by taking appropriate steps, including through
legislation, to, inter alia:
a. Prohibit discrimination on the basis of
disability with regard to all matters concerning all forms of employment,
including conditions of recruitment, hiring and employment, continuance of
employment, career advancement and safe and healthy working conditions;
b.Protect the rights of persons with
disabilities, on an equal basis with others, to just and favourable conditions
of work, including equal opportunities and equal remuneration for work of equal
value, safe and healthy working conditions, including protection from
harassment, and the redress of grievances;
c. Ensure that persons with disabilities are
able to exercise their labour and trade union rights on an equal basis with
others;
d.Enable persons with disabilities to have
effective access to general technical and vocational guidance programmes,
placement services and vocational and continuing training;
e. Promote employment opportunities and
career advancement for persons with disabilities in the labour market, as well
as assistance in finding, obtaining, maintaining and returning to employment;
f. Promote opportunities for self-employment,
entrepreneurship, the development of cooperatives and starting one’s own
business;
g. Employ persons with disabilities in the
public sector;
h. Promote the employment of persons with
disabilities in the private sector through appropriate policies and measures,
which may include affirmative action programmes, incentives and other measures;
i. Ensure that reasonable accommodation is
provided to persons with disabilities in the workplace;
j. Promote the acquisition by persons with
disabilities of work experience in the open labour market;
k.Promote vocational and professional
rehabilitation, job retention and return-to-work programmes for persons with
disabilities.
2. States Parties shall ensure that persons with
disabilities are not held in slavery or in servitude, and are protected, on an
equal basis with others, from forced or compulsory labour.
********
Monday, 24 February 2014
The tem Specific Learning Disability (SLD): Tracing the Historical Evolution and confusion
Dr. Renu
Malaviya,
Associate Prof,
Deptt. Of Education,Lady Irwin College (University
of Delhi)
The evolution of definitions of LD
can be traced to the turn of the last century and is closely linked concepts of
organically based behavioural disorders.
The concept of LD arose from observations of children who were
hyperactive and impulsive; it was often presumed that the cause of these
unexpected behaviour disorders was constitutional in origin. Thus, these
children were described with terms such as organic driveness syndrome, minimal
brain injury, (Doris, 1993; Rutter,
1982; Satz & Fletcher, 1980)
Way
back in the 18th and the 19th century, children with
learning disabilities were often diagnosed and considered to have “minimal
brain dysfunction”. Further testing would indicate that the children tended to
show some neurological difficulties. Yet these neurological difficulties seem
to vary from child to child and in unpredictable ways. The experts of that era
realized that there appeared to be no predictable structure to these
neurological difficulties. Attempts at correlations with reference to the size
of the brain, pattern of blood flow to the brain, nerve impulse to the brain
and so on were studied. Yet no consistent structures were indentified.
Sometimes the diagnosis would indicate, perceptual deficits’. Yet attempts to
improve on the eye-hand coordination or on the visual scanning skills would not
work. All this did leave the scientific world a little perplexed.
Terms
such as “ minimum brain dysfunction”, “ stephosymbolia” ( reversal of letters),
hyperactive
and impulsive, organic driveness syndrome
and so on were extensively being used for these children. (Doris, 1993; Rutter, 1982; Satz
& Fletcher, 1980)
In
1963 Samual Kirk at Chicago coined the term “learning disability”. (1962, cited
in Streissguth, Bookstein, Sampson, & Barr, 1993, p.144). He urged the
scientific community to throw away the other previously used terminologies. The
term learning disability had its advantages:
·
It was a term which parents and
teachers could understand
·
It moved the concepts out of the
realm of only neurology and medicine towards the field of education.
·
Now the focus could be more towards
the issues related to information and language processing.
·
The educators begin to work upon
finding special education techniques.
According to Samuel Kirk, (1962):
‘A
learning disability refers to a retardation, disorder, or delayed development
in one or more of the processes of speech, language, reading, spelling,
writing, or arithmetic resulting from a possible cerebral dysfunction and/or
emotional or behavioral disturbance and not from mental retardation, sensory
deprivation, or cultural or instruction factors.’
[Kirk, S.
A. (1962). Educating exceptional children. Boston: Houghton Mifflin. (p. 261).]
As the term gained rapid acceptance, it facilitated
another important move. The
establishment of the term LD ( Learning Disability) as a special
education category, enabled children with LD to be included in being provided
special services related to education
and beyond. As of earlier they were
excluded from the special services as their learning characteristics did not
correspond to existing categories. This
in itself was a major step in the perspectives related to this disability.
In 1963, Samuel Kirk
addressed a gathering of anxious parents in Chicago, (Streissguth, Bookstein,
Sampson, & Barr, 1993) at which for the first time used publicly the term
learning disabilities to describe the children. He stated at the gathering
Dyslexics are a specific group of children,
adolescents and adults who have problems in learning. These problems are
generally in the area of reading, writing, spellings and mathematics. A
learning disability is found across all ages and in all socio-economic classes.
It is not a-typical of mental retardation as is mistaken by many people; in
fact the IQ scores of these children can be very high.
At the end of 1950’s
and early 1960’s the need to focus on, ‘Education for
all” started to emerge in Great Britain and the United States of America in the
1960s. At that time the difficulty that children were facing with learning in
the school system began to attract the attention of educationist and
psychologist seriously. As the momentum of getting each and every child into
school increased, the number of ‘intelligent’ and “able bodied” children, who
were unable to cope with learning in school especially with reading, writing
and mathematics also increased. These children were otherwise bright, fairly
articulate and had no sensory or visual handicap.
As
“Education for All” gained momentum in Great Britain, experience as well as effective school
teachers and principals observed that their were children who otherwise
appeared bright, were articulate and generally appeared to be learning, yet
when it came to examinations they would repeatedly not do well. They would not
be able to read well and it may be remembered that at that point of time getting
the children to read aloud in class was a major way of teaching . There are
documentations of school principals of that era who have indicated their
concern about these children who according to them were defiantly intelligent
but yet were failing repeatedly. Hence came in the term “dyslexia” (Dys means
difficulty and lexia means words). Gradually as each and every child was
now in the school system in Great Britain, there came in a realization that
there were another set of children who even if they were okay with the age
standard norm for reading, just could not write well. No amount of training
helped them become really better. The new term that came into existence was
dysgraphia (Dys means difficulty and graphia
indicating writing) and further as the
school system improved and more resources were pumped into the school system
another set of children were identified who came to be known as dyscalculia (Dys
means difficulty and calculia indicating arithmetic).
Now the
first term was dyslexia, and hence just as a petname/family name that many of us have, dyslexia in the mass
memory continued to used as the umbrella term for dyslexia, dysgraphia, dyscalculia,
aphasia and so on.
Now
around this time there was a lot of migration from Great Britain to the new
land called USA. The psychologist, educationist who migrated there for greener
pastors took with them the knowledge. They also took with the knowledge related
to the term MR (mental retardation). Therein the term MR was being reconsidered
as the terminology retardation was being now considered belittling. Therein the
term MR was being replaced with LD (learning disabilities).
Now as
the awareness increased in South Asia, it lead to certain amount of confusion. There was a
intermixing of the terminologies Mental Retardation (MR), Learning Disabilities
(LD) and Learning Difficulties (LD). Hence came in the confusion that a MR is
also LD or vice a versa. It needs a bit of minute observation as to why this
happened and continues to happen. The abbreviation LD stands for both learning disabilities
(LD) and learning difficulty (LD).
When we
say learning difficulty it implies that there is a difficulty in learning which
can be removed or which may not be possible to remove. For example if I am new
to learning a language say French, I will have learning difficulty (LD) and NOT
learning disability (LD). If my teacher does not know how to teach well than I
will face learning difficulty (LD) and NOT learning disability (LD).
So a
child with Mental retardation ( Intellectual disability) will have a learning
disability and so will a child with dyslexia have a learning disability.
Oh! Can
you now observe that type of confusion that the terminologies have created? Is
dyslexia only dyslexia or is dyslexia also dygraphia, dyscalculia , aphaisa and
others???? Hence as of now in South Asia the umbrella term used for
‘disability’ in reading, writing, arithmetic etc is Specific Learning
Disability (SLD).
The confusion has not ended as yet. I
can almost hear many of you saying SLD is NOT a disability and so even ASD is
NOT a disability. Well! Well ! I completely agree with you, these are the off
shoots of diversities in the brain structures. In my next article I will deal
with the brain diversities and whether it is learning difficulties (LD),
learning disabilities (LD) or Learning diversities (LD).
Before if
I sign off, I would also want to touch on the term “Slow Learner” . This it as
of now a sub-classification of Intellectual Disability or is it any one who is
learning slowing. If it is anyone who is learning slowing than could it be the
cause of faculty teaching, limitations of the child’s physical-socio-economic-
cultural environment??? If yes than who is the “slow”, the child or the teacher
or the parent?????
Slow learner
Learning disability
Learning difficulty
Learning deviance
Sp learning disability
MR
ASDD
Wednesday, 19 February 2014
Management of ADHD
Attention
Deficit Hyperactive Disorder (ADHD) is the most serious behavioural problems
not only among the children with special needs, but also among the normal
children. It requires timely and effective interventions. Most of the
professional especially clinical psychologists are less aware about different
modalities of effective treatment. This paper orients them about the different
modalities of treatment with details.
Comprehensive
Treatment for ADHD should always include a strong psychosocial component. Most
professionals believe that effective psychosocial treatment is the backbone of
good treatment for ADHD. Apart from pharmacotherapy, following psychosocial
modalities are found most effective in the treatment of ADHD.
(1) Behavioural
Intervention:
There are three parts of effective behavioural
interventions for ADHD children—
(i)
parent training,
(ii)
school interventions, and
(iii)
child-focused treatments.
Four points apply to all three parts:
(1) Always start
with goals that the child can achieve and improve in small steps (e.g., “baby
steps”);
(2)
Always be consistent—across different times of the day, different settings, and
different people;
(3)ADHD is a chronic problem for the
individual and treatments need to be implemented over the long duration—not
just for a few months; and
(4) Teaching and
learning new skills take time, and children’s improvement will be gradual with
behaviour modification.
(i)
Parent Training:
The first
session is often devoted to an overview of the diagnosis, causes, nature, and
prognosis of ADHD. Thereafter, in group or individual sessions, parents learn a
variety of techniques, some of which they may be already using at home but not
as consistently or correctly as needed. Parents go home and implement what they
learn in sessions during the week, and return to the parenting session the following
week to discuss progress, problem solve, and learn a new technique.
The topics covered in a typical series of parent training
sessions include the following topics in sequence.
1. Establishing house rules and structure
Ø Posted
chore lists
Ø Posted
morning and evening routines
Ø Posted
House Rules
Ø Review
until child has learned them
2. Learning to praise appropriate behaviours (praise
good behaviour at least five times as often as bad behaviour is criticized) and
ignore mild inappropriate behaviours.
3. Using appropriate commands
o
Obtain the child's attention: say the
child's name first
o
Use command not question language
(“Don’t you want to be good” is a bad command!)
o
Be specific, describing exactly what the
child is supposed to do (at the grocery checkout line “be good” is not a good
command! “Stand next to me and do not touch anything” is more specific!)
o
Be brief and appropriate to the child's
age
o
State consequences and always follow
through (praise compliance and provide consequences for noncompliance)
o
Have a firm but neutral (not angry) tone
of voice
4. Using when………..then contingencies
o
Give access to desired activities when the
child has completed a less desired activity (e.g., ride bike when finished
homework; watch TV when finished evening chores, going out with friends after
completed yard work)
o
For younger children, important to have
rewarding activity occur immediately
5. Planning ahead and working with children in
public places
o
Explain situation to child before activity
occurs
o
Establish ground rules, rewards, and
consequences
6. Time out from positive reinforcement
o
Assign short times away from preferred
activities when the child has violated expectations or rules
o
Give time off for appropriate behaviour
during time out and lengthen time for noncompliance with time out
o
Base times on children's ages—shorter
for younger children—e.g., one minute for each year of age
7. Daily Charts—Point/token systems with rewards and
consequences
o
Make charts with home rules/goals and
post prominently in house
o
Establish system for rewards for
following home rules and consequences for violations
o
Nickel jar for noncompliance or talking
back (e.g., put a nickel in for each compliance, remove two for noncompliance)
o
Home Daily Report Card (see target list
and creating a Daily Report Card for the home
8. School-home note system for rewarding behaviour
at school and tracking homework (see description below in School Interventions)
There are many other techniques that are part of a
good behavioural parenting program. Those listed above are included in almost
all of the good programs. Some families can learn these skills quickly in the
course of 8 or 10 meetings, while other families—often those with the most
severely impaired children—require more time and energy.
(ii) School Interventions
The following list includes typical classroom
behavioural management procedures. They are arranged in order from mildest and
least restrictive to more intensive and most restrictive procedures. Some of
these programs may be included in Individualized Educational Programs that may
apply to ADHD children
Typically an intervention is individualized and
consists of several components based on the child’s needs, the classroom
resources, and the teacher’s skills and preferences.
1. Classroom rules and structure
o
Typical classroom rules:
Ø Be
respectful of others
Ø Obey
adults
Ø Work
quietly
Ø Stay
in assigned seat/area
Ø Use
materials appropriately
Ø Raise
hand to speak or ask for help
Ø Stay
on task/complete assignments
o
Post rules and review before each class
until learned
o
Make rules objective and measurable
o
Number of rules depends on developmental
level
o
Establish a predictable environment
o
Enhance children’s organization
(folders/charts for work)
o Evaluate
rule-following and give feedback/consequences consistently
o
Tailor frequency of feedback to child’s
developmental level
2. Praise appropriate behaviours and ignore mild
inappropriate behaviours that are not reinforced by peer attention
o Use
at least five times as many praises as negative comments.
o Use
commands/reprimands to cue positive comments for children who are behaving
appropriately—that is, find children who can be praised each time a reprimand
or command is given to a child who is misbehaving.
3. Appropriate commands (clear, specific,
manageable) and private reprimands (at child’s desk as much as possible)—same characteristics
as for good commands for parents described above.
4. Accommodations and structure for individual child
(e.g., desk placement, task sheet)
o
Structure the classroom to maximize the
child’s success
o
Sit by teacher to facilitate monitoring
o
Pair with peer to help copy assignments
from board
o
Break assignments into small chunks
o
Give frequent and immediate feedback
o
Require corrections before new work
5. Increase academic performance
o
Focus on increasing completion and
accuracy on work
o
Provide task choices
o
Peer tutoring
o
Computer-assisted instruction
Such interventions have the advantage of being
proactive (i.e., could prevent problematic behaviour from occurring) and can be
implemented by individuals other than the classroom teachers (e.g., peers,
classroom aide). When disruptive behaviour is not the primary difficulty,
academic interventions sometimes lead to improvements in behaviour that are
equivalent to gains associated with more intensive classroom behavioural
strategies.
6. When…….then contingencies (e.g., recess time
contingent upon completing work, staying after school to complete work before
dismissal, assigning less desirable work prior to more desirable assignments,
require assignment completion in study hall before allowing free time) (same
guidelines as for parents described above)
7. Daily School-Home Report Card - Means of
identifying, monitoring, and changing classroom problems
o
Tool for parents and teacher to
communicate regularly
o
Individualized target behaviours
determined by teacher
o
Teachers evaluate targets at school and
send DRC home with the child
o
Parents provide home-based rewards; more
rewards for better performance and fewer for lesser performance
o
Continually monitor and make adjustments
to targets and criteria as behavior improves or new problems develop
o
Always used in the context of other
behavioral components (commands, praise, rules, academic programs)
o
Cost little and take minimal teacher
time
8. Behaviour chart/reward and consequence program
(point or token system) for the target child
o Establish
target behaviours and ensure child knows behaviours and goals (e.g., list on
index card taped to desk)
o Establish
rewards for meeting target behaviours
o Monitor
child and give feedback
o Reward
immediately for young children
o Use
points, tokens, stars that can later be exchanged for rewards
9. Class wide interventions and group contingencies
o
Establish goals for the class as well as
the individual
o
Establish rewards for appropriate
behaviour that anyone in class can earn (e.g., class lottery, jelly bean jar,
wacky bucks)
o
Establish reward system in which whole
class (or subset of class) earns rewards based on entire class functioning
(e.g., Good Behaviour Game) or ADHD child’s functioning (e.g., class earns
reward if ADHD child makes goals)
o
Encourages children to help one another
because everyone can be rewarded
o
Easier for teacher than individual
programs because improves whole class
o
Tailor frequency of rewards/consequences
to children’s developmental level
10. Time out (classroom, office); a program in which
a child is removed from the ongoing activity for a few minutes (less for
younger children and more for older) when he or she misbehaves (same guidelines
as for parents described above)
11. School-wide programs—e.g., discipline plans that
are school-wide can be structured to minimize the problems experienced by ADHD
children at the same time as they help manage the behaviour of all children in
a school.
(iii) Child Interventions
Nonspecific talk or play therapy in a therapist’s
office is not a form of treatment with scientific support for children with ADHD.
Instead, child-based treatments for ADHD with a scientific basis are those that
focus on peer relationships and that typically occur in group settings outside
of the therapist’s office. Very often, children with ADHD have serious disturbances
in peer relationships, and those problems are very strong predictors of
long-term outcomes. Children whose difficulties with peers are overcome will
have considerably better long-term outcomes than those whose peer relationships
remain problematic. Thus, intervention for peer relationships is a critical
component of treatment for children with ADHD and it is the focus of
child-based treatments.
There are five forms of intervention for peer
relationships, listed below.
1. Systematic teaching of social skills
o Cooperation
o Communication
o Being
positive and friendly
o Participation
o Helping/sharing
o Giving
compliments
o Coping
with teasing
2. Social problem solving
o Identifying
problem
o Brainstorming
solutions
o Choosing
best solution
o Planning
implementation
o Evaluating
outcome
3. Teaching other behavioural competencies that
other children consider important
o Sports
skills
o Rules
of sports
o Board
game rules
o Good
sportsmanship and good team membership
4. Decreasing undesirable and antisocial behaviours
o Target
bossy, intrusive, aggressive, and other disruptive behaviours that children
with ADHD exhibit with peers
o Establish
reward/consequence program to reduce these behaviours and to replace with
prosocial behaviours taught in social skills training
5. Developing a close friendship
o Develop
program to help child with ADHD develop a close friendship with another child
o Work
with family and teacher to facilitate the relationship
o May
serve an important role in improving long-term outcomes
(2) Working memory training
Many of the problems shown by children with ADHD
are linked with deficits in working
memory (or short-term memory). Training this memory may diminish some of
symptoms of ADHD. In a study by Klingberg et al., children with ADHD who
completed a computerized training program for working memory reported a
decrease in ADHD symptoms and performed better on working memory tests than the
control group. Some researchers attribute this to an improvement in working
memory generally, while others believe it is merely the natural effect of
practice.
(3) Timers
Timers have been found to be effective for
allowing people with ADHD to concentrate more effectively on the task at hand.
When a target is set, one method is to only turn the timer on whilst
working on the given task. A physical stopwatch or an online timer may be used.
(4) Neurofeedback
Neurofeedback
(NF) or EEG biofeedback is a treatment strategy used for children,
adolescents and adults with ADHD. The human brain emits electrical energy which
is measured with electrodes. Neurofeedback alerts the patient when beta waves
are present. This theory believes that those with ADHD can train themselves to
decrease ADHD symptoms.
No serious adverse side effects from neurofeedback
have been reported. Research into neurofeedback has been limited and
of low quality. While there is some indication on the effectiveness of
biofeedback it is not conclusive: several studies have yielded positive
results, however the best designed ones have either shown reduced effects or
non-existing ones.
(5) Aerobic fitness
Aerobic fitness may improve cognitive functioning
and neural organization related to executive control during pre-adolescent
development, though more studies are needed in this area. One study suggests
that athletic performance in boys with ADHD may increase peer acceptance when
accompanied by fewer negative behaviors.
(6) Massage Therapy
For children and adolescents with ADHD, pediatric
massage therapy has been found to improve mood and increase on-task behaviors,
while reducing anxiety and hyperactivity.
(7) Art Therapy
Art is thought by some to be an effective therapy
for some of the symptoms of ADHD.
(8) Media
Preliminary studies have supported the idea that
playing video games is a form of neurofeedback, which helps those with ADHD
self-regulate and improve learning. On the other hand ADHD may experience great
difficulty disengaging from the game, which may in turn negate any benefits
gained from these activities, and time management skills may be negatively
impacted as well.
(9) Nature:
Children who spend time outdoors in natural
settings, such as parks, seem to display fewer symptoms of ADHD, which has been
dubbed "Green Therapy".
(10)
Dietary supplements:
Omega-3
supplementation (seal, fish or krill oil) may reduce ADHD symptoms.
Magnesium
and vitamin B6 (pyridoxine) - In 2006, a study demonstrated that
children with autism/ADHD had significantly lower magnesium than controls, and
that the correction of this deficit was therapeutic. Mousain-Bosc et al.
showed that children with ADHD (n =46) had significantly lower red blood cell
magnesium levels than controls (n =30). Intervention with magnesium and vitamin
B6 reduced hyperactivity, /aggressiveness and improved school
attention.
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