Understanding and Responding to Behavioural Issues of Students with ADHD, Sensory Integration Dysfunction and ODD Prepared by Ellen Young, Krista Heisinger Frost, and Michelle Hancock

What is Neurologically-Based Behaviour (NBB)?(Paula Cook, 2011)About 10 % of students cant reliably control what they say or do.The overarching name for the behavioural condition they exhibit is NBBNBB is behaviour that results from cerebral processes occurring in an abnormal manner that results in information not being processed correctly in the brain. The resulting behaviour is challenging, unpredictable, inconsistent and unresponsive to ordinary discipline.

3 Indicators of NBB1. Behaviour difficulties - atypical, inconsistent, compulsive or immune to normal behaviour management2. Language Difficulties problems understanding, processing, and expressing information verbally3. Academic Difficulties memory, fine and gross motor skills, comprehension, language and math skills deficits

Common Diagnoses within NBB:Brain injuriesAttention-Deficit Hyperactivity Disorder Oppositional Defiant DisorderBipolar Disorder

Anxiety Disorders Fetal Alcohol Spectrum DisorderSensory Integration DysfunctionAutism Spectrum DisorderLearning Disabilities

Attention Deficit Hyperactivity Disorder (AD/HD)Common neurobiological condition affecting 5-8 % of school age children (Barkley, 1998)Symptoms persist into adulthood in approximately 60% of cases (4% of adults) (Kessler et al., 2006)Characterized by developmentally inappropriate levels of inattention, and/or impulsivity and/or hyperactivityChronic, incurable condition

Possible Causes of AD/HDThe current model of the cause of AD/HD is rooted in the biological paradigm that emphasizes neurobiological, neuroanatomical and genetic mechanisms.Research clearly indicates genetic factor; likely multiple interacting genes (Tannock, 1998; Swanson and Castellanos, 2002)Other causal factors: low birth weight, prenatal maternal smoking, prenatal problems may also contribute (Connor, 2002)

Neurology of AD/HD(Barkley, 2005)

Structural differences in the brain and neurotransmitter: Dopamine and norepinephrine dysregulation (Barkley, 2005)Smaller, less active, less developed brain regions (cerebellum, prefrontal cortex, basal ganglia)Bad parenting is not a cause!http://www.youtube.com/watch?v=u82nzTzL7To&feature=related

Proper Steps in Diagnosis No single testClinical assessment of the individuals academic, social and emotional functioning and developmental level in order to determine if DSM-IV diagnostic criteria are metHistory : interviews with parents, teachers, childUse rating scales and checklists (Conners Parent and Teacher rating scale, Barkleys Home and School Situation Questionnaire); Continuous Performance Tests (TOVA)Physical exam (to rule out other medical problems or to determine the presence or absence of co-existing conditions)

DSM IVThe American Psychiatric Association's Diagnostic and Statistical Manual-IV, Text Revision (DSM-IV) is used by mental health professionals (school and clinical psychologists, clinical social workers, doctors) to help diagnose ADHD. This diagnostic standard helps ensure that people are appropriately diagnosed and treated for ADHD.

The DSM-IV characterizes the following 3 subtypes of AD/HD:(http://www.nichq.org/toolkits_publications/complete_adhd/01ADHD%20Introduction.pdf) Inattentive only (AD/HD-I) (formerly known as attention-deficit disorder [ADD])Children with this form of AD/HD are not overly active. Because they do not disrupt the classroom or other activities, their symptoms may not be noticed. Among girls with ADHD, this form is most common. Approximately 30% to 40% of children with AD/HD have this subtype. Hyperactive/Impulsive (AD/HD-HI)Children with this type of AD/HD show hyperactive and impulsive behavior but can pay attention. This subtype accounts for a small percentage, approximately 10%, of children with ADHD. Combined Inattentive/Hyperactive/Impulsive (AD/HD-C)Children with this type of AD/HD show all 3 symptoms. This is the most common type of AD/HD. The majority of children with AD/HD have this subtype, approximately 50% to 60%.

MimicsAnxiety, depression, mental retardation, sleep apnea, hypo/hyperthyroidism, Central Auditory Processing Dysfunction, severe sensory impairment, and learning disabilities may cause similar symptoms may actually be the primary diagnosis or may co-exist with AD/HD

Co-Existing Conditions(Baren, 2002)

Comorbidity% among teens with ADHD% in general teen populationLearning disability20-605-15Bipolar disorder6-103-4Major depression9-323-5Anxiety disorder10-403-10Conduct disorder20-56UnknownODD20-672-16

Popular MisconceptionsAD/HD is environmentally causedAD/HD is over diagnosedMost kids outgrow symptoms (about 1/3 do)AD/HD means inability to pay attentionAD/HD kids need to put in more effortKids notice benefits of medicationConsequences change behaviourStimulant medication leads to alcohol and substance abuseADHD affects males more than females

Importance of Early Identification and InterventionPotential areas of impairment: academic achievementrelationships: family and friendslow self-esteemaccidental injuriesSmoking and substance abuseMotor vehicle accidentsLegal difficulties-delinquencyOccupational/vocational

ADHD and Juvenile Criminal Justice System (Robert Eme, American School of Professional Psychology, 2008)2, 300,000 adults and 100,000 juveniles are incarcerated in the United StatesAt least 25% and up to 50% have ADHDThis holds true for incarcerated females; may even be more likely than males to have ADHD

Multi-modal Treatment: Medical, Educational and Behavioural InterventionsParent and child education about diagnosis and treatmentBehaviour modification management techniquesMedication Psychotherapy/Counseling (family; individual: self-esteem and coping skills)Coaching (develop better habits, social skills training)School programming (IEP, AEP, BIP)Physical Exercise Complementary and alternative medicine (CAM) for AD/HD such as elimination of: sugar, food additives, preservatives; EEG biofeedback are not supported in the literature (Rojas and Chan, 2005)Severity and type of AD/HD should be considered

National Institute of Mental Health Study: Multimodal Treatment Study of Children with AD/HD (1999)Children who were treated with medication alone (which was carefully managed and individually tailored) and children who received both medication and behavioural treatment experienced the greatest improvements in their AD/HD symptoms (attention, hyperactivity, impulsivity)medication and behavioural treatment had added benefits for non-AD/HD symptom domains (parent-rated oppositional/aggressive symptoms, parent-child relations, teacher-rated social skills, internalizing symptoms, reading achievement)

Impact of Stimulant MedicationIncreased:AttentionConcentrationComplianceEffort on tasksAmount and accuracy of school workDecreased:Activity levelsImpulsivityNegative behavioursPhysical & verbal hostility

Medication Impact(Dr. Russel Barkley)Working memorySelf-talk, self-esteem and emotional controlVerbal fluencyMotor coordination, handwritingAcceptance by and interaction with peersAwareness of the game in sportDecreased punishment by others

Behaviour ModificationThe scientific literature, the National Institute of Mental Health and other professional organizations support stimulant medication and behaviourally oriented psychosocial treatments, also called behavior therapy or behavior modification, as effective treatments for AD/HD.

Behaviour modification teaches children specific techniques and skills:children with AD/HD face problems beyond the core symptoms of inattention, hyperactivity and impulsivityThese include poor academic performance and behavior at school, poor relationships with peers and family members, and failure to obey adult requests. to help improve their behaviorskills are reinforced by parents and teachers.

Behaviour modification is often put in terms of ABCs:

Antecedents: conditions or context in which problem behavior occurs

Behaviours: responses or actions that concern teacher or parent exhibited by the student

Consequences: events and behaviours that follow the occurrence of the problem behavior

Parents and teachers learn and establish programs in which:the environmental antecedents (A) and consequences (C) are modified to change the childs target behavour (B). Treatment response is monitored via observation and measurement, and the interventions are modified when they fail to be helpful or are no longer needed.

Daily school-home report-cardThis tool allows parents and teacher to communicate regularly, identifying, monitoring and changing classroom problems. It is inexpensive and minimal teacher time is required.Can use a report-card or simply a calendar with a smile or frown for each day

Teachers determine the individualized target behaviors

Teachers evaluate targets at school and send the report card home with the child.Parents provide home-based rewards; more rewards for better performance and fewer for lesser performance.Teachers continually monitor and make adjustments to targets and criteria as behavior improves or new problems develop.Use the report card with other behavioral components such as commands, praise, rules, and academic programs.

SubjectsScienceMathLASSGymClass participationCompletes assigned work in classFollows class rulesGets along with othersCompletes homeworkTeacher Initials

Behaviour InterventionsBe consistentUse positive reinforcementContractsToken programsResponse costRedirectionTime-out/thinking areas

Teach problem-solving skillsCommunication skillsSelf-advocacy skillsList-makingTeach Agenda/day-planner use

5 Effective Forms of Intervention for Peer RelationshipsSystematic teaching of social skillsTeaching social problem solving (eg: early years: rock/paper/scissors) Teaching other behavioral skills often considered important by children, such as sports skills and board game rules Decreasing undesirable and antisocial behaviorsHelp to develop a close friendship

Programs use methods that include:Coachinguse of examplesModeling, role-playing and practicefeedback, rewards and consequences, Social skills training groups are the most common intervention and the focus is on the systematic teaching of social skills.

90% of Children with ADHD have Academic Challenges

Written expressionMath (times tables and word problems)Spelling and ReadingOverall low academic achievement scoresDisorganized, incomplete homeworkDifficulty getting started (procrastination)Impaired sense of time (it will take me forever to do this!)

Middle School: ADHD Brick Wall (Dendy, 2008) Increased demands for executive functioning (management functions of the brain):OrganizationMemoryMore complex academic workWorking independentlyMore homeworkMore complex routines (change classes/teachers)

Greatest Areas of DifficultyDifficulty following multiple-step directionsGive written directions, ask child to repeat directions, chunk work into manageable units, use graphic organizersCompleting tasks in a timely manner Use a timer (cellphone or watch), help child develop a plan (timeline), offer incentive, allow more timeRecall of rote detailsuse mnemonics, color-coding, use image associationCopying and writingallow more time, give hand-outs or note frames, chunk work, laptop: type instead of hand-writing

Reframe Your ThinkingGifts of AH/HDStudents are:EnergeticCreativeRisk-takers (in a good way)PersuasiveVerbalBig picture thinkersGood long-term memoryFree thinkersMostly good looking

ReferencesBaren, M. (2002). ADHD in adolescents: Will you know it when you see it? Contemporary Pediatrics, 19(5), 124-143. Barkley, R. (1998). Attention Deficit Hyperactivity Disorders: A Handbook for Diagnosis and Treatment. New York: Guilford Press.Barkley, R. (2005). Attention Deficit Hyperactivity Disorders: A Handbook for Diagnosis and Treatment (3rd ed.). New York: Guilford Press.Connor, D.R. (2002). Preschool Attention deficit hyperactivity disorder: A review of prevelance, diagnosis, neurobiology, and stimulant treatment. Journal of Developmental Behaviour Pediatrics 23 (1Suppl):S1-S9.Dendy, C. Understanding the Impact of ADHD & Executive Functions on Learning and Behaviour. In: Proceedings of the ADDA 13th National Conference. Minneapolis, MN. pp. 166-83.Eme, R. (2008). ADHD & The Criminal Justice System. In: Proceedings of the ADDA 13th National Conference. Minneapolis, MN. pp. 89-91.Kessler, R.C., Adler, L., Barkley, R., Biederman, J. The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. Am Journal of Psychiatry (2006), 163:724-732.MTA Cooperative Group. (1999). A 14-Month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1073-1086)

ReferencesMTA Cooperative Group. (1999). Moderators and mediators of treatment responses for children with attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1088-1096)Rojas, N.L., and Chan, C. (2005). Old and new controversies in the alternative treatment of attention-deficit hyperactivity disorder. Mental Retardation and Developmental Disabilities Research Reviews, 11: 116-130.Swanson, J.M., and Castellanos, F.X. (2002). Biological Basis of ADHD-Neuroanatomy, Genetics, and Pathophysiology. In P.S. Jensen and J.R. Cooper (eds.) Attention deficit hyperactivity disorder: State of the science, best practices, pp. 7-1-7-20. Kingston, New Jersey.Tannock, R. (1998). Attention deficit hyperactivity disorder: Advances in cognitive, neurobiological, and genetic research. Journal of Child Psychology and Psychiatry, 39, 65-99.

Sensory Processing DisorderorSensory Integration Dysfunction

Dr. A. Jean Ayres 1920- 1989

Background InformationAlso known as Sensory Processing DisorderDr. A. Jean Ayres first developed the theory of Sensory Integration Dysfunction in the 1960sWrote two books Sensory Integration and Learning Disorders in 1972 and Sensory Integration and the Child in 1979Was an occupational therapist and developmental psychologistWorked at the Institute for Brain Research at the University of California at Los Angeles.

What is Sensory Processing Disorder?Sensory integrative/ processing disorders are a set of conditions caused by an insufficient ability of the central nervous system to take in, register, modulate, perceive, and/or combine sensory experiences (input) from the environment around us.The neural messages become disorganized as they travel up towards the higher brain centers. The messages may also become overly-amplified or diminished, and are hence unusable. Sensory inputs are the building blocks of learning and relating to our environment and the people in it.Video: What is SPD?

The Senses

The Five Basic Senses or Far Senses:SightSoundTasteSmellTouch -Respond to external stimuli from the environment. (Kranowitz,40,41)Body Centered Sensory Systems or Near Senses:Interoceptive- internal organs- e.g. heart rate, hungerTactile- info received through the skinVestibular- movement-pull of earths gravity/balanceProprioception- info from muscles and joints

Causes of SPD according to Dr. AyresHereditary predisposition for minimal brain dysfunctionEnvironmental toxins air contaminants, destructive virusesCombination of hereditary and environmental toxinsLack of oxygen at birth Children who lead deprived lives- little contact with people or thingsNeurological disordersInternal sensory deprivation(sensory stimulation is present in the environment but the stimulation doesnt nourish every part of the brain) (Ayres, 54-56)

The Symptoms or BehavioursExhibited Each childs symptoms are different and unique, making it difficult to diagnose sensory processing disorder.Hyperactivity and Distractibility - activity usually not purposeful, cannot shut out noises, lights, etc.Behaviour Problems- not happy with self, fussy, overly sensitive; negative self concept- negative reactions from othersSpeech Development- speech and articulation develops slowly

The Symptoms/ Behaviours ContdMuscle Tone and Coordination- if vestibular, proprioceptive, and tactile systems are not working well- poor motor coordination results.Learning at School- learning starts from the bottom of the brain and moves up if the senses are disorganized then learning and behaviour problems will resultTeen-age Problems- may have learned how to compensate for sensory processing disorder if not may drop out of school ---major lack of organization.These symptoms are end products of inefficient and irregular sensory processing in the brain. (Ayres, 56-59)

An Evaluation by an Occupational Therapist Considers: Perception and registration of sensorimotor information- what the child sees, hears, touches, tastes, and smellsHow movement and gravity are experiencedGathers information through clinical observations, sensory history, and standardized tests: - Can the child use sensorimotor experiences to learn, interact. explore, and demonstrate knowledge? - Does the child respond negatively or with extreme behaviours (flight, fright, fight responses) to unexpected or light touch, unstable surfaces, loud noises, visual distractions, or certain tastes, textures, and smells? - Can the child filter out irrelevant sensory input? (Williams, Shellenberger, 3)

The Brains Ability to Self RegulateMechanisms needed to self regulate:Modulation- neural switches can turn on or off depending on activity levelInhibition- reduce connections between sensory intake and behavioural outputHabituation brain tunes out familiar sensory messagesFacilitation connections between sensory intake and behavioural output(Kranowitz, 42-44)

The Alert Program for Self- RegulationUses the analogy of a car engine to introduce self-regulation to studentsThe program can be adapted to all agesIt entails three stages: 1.identifying engine speeds, 2.experimenting with changing engine speeds, and 3.regulating engine speeds; with each stage consisting of a number of steps or mile markers.Speeds are as follows: high (hyper, overexcited), low (sluggish, spacey) and just right (easy to learn and get along with others)There are activities that can be used for each step and each step should be modelled for the student to be able to thoroughly understand the engine levels and how to change themProgram is designed to give students the ability to self regulate their engines according to the activity they are doing.(Williams & Shellenberger)

Types of SPDSensory Modulation Dysfunction- the brain cannot regulate the amount of sensory information it allows to enter. (Hypersensitivity, hyperreactivity - registers sensations too intensely; and Hyposensitivity, hyporeactivity not getting enough sensory information. (Kranowitz, 57-58)Developmental Dyspraxia child is unable to mentally visualize new movements. (Vestibular, proprioception and tactile systems are impaired)

Types of SPD ContdPostural- Bilateral Integration Dysfunction- poor ability to use both sides of the body together; tendency not to cross the body midline; unusual fear /discomfort in certain positions (on tummy, moving backwards, going down stairs, riding on parents shoulders.Video: Therapy

Sensory Integrative Therapy The central idea of this therapy is to provide and control sensory input especially the input from the vestibular system, muscles and joints, and skin in such a way that the child spontaneously forms the adaptive responses that integrate those sensations. (Ayres, 140)Most effective if child directs his own actions while therapist directs the environment.Motor activity is valuable in that it provides the sensory input that helps to organize the learning process-just as the body movements of early animals led to the evolution of a brain that could think and read. (Ayres, 141)

The Balanced Sensory DietNeed sensory input and experiences to grow and learnA sensory diet is a planned and scheduled activity program designed and implemented by an occupational therapist to meet the childs needs.It includes a combination of alerting, organizing and calming techniques that lead directly to the near senses. (Sandra Nelson,7)http://home.comcast.net/~momtofive/SIDWEBPAGE2.htm

Five Important CaveatsCarol Kranowitz (1998) writes it is important to remember these five caveats:The child with sensory dysfunction does not necessarily exhibit every characteristic. Thus the child with vestibular dysfunction may have poor balance but good muscle tone.Sometimes the child will show characteristics of a dysfunction one day but not the next. For instance, the child with proprioceptive problems may trip over every bump in the pavement on Friday yet score every soccer goal on Saturday. Inconsistency is a hallmark of neurological dysfunction.

Caveats Contd3. The child may exhibit characteristics of a particular dysfunction yet not have that dysfunction. For example, the child who typically withdraws from being touched may seem to be hypersensitive to tactile stimulation but may, have an emotional problem.4. The child may be both hypersensitive and hyposensitive. For example, the child may be extremely sensitive to light touch, jerking away from a soft pat on the shoulder, while being rather indifferent to the deep pain of an inoculation.

Caveats Contd5. Everyone has some sensory integration problems now and then, because no one is well regulated all the time. All kinds of stimuli can temporarily disrupt normal functioning of the brain, either by overloading it with, or depriving it of, sensory stimulation. (Kranowitz, 61)

Is SPD a Real Diagnosis?Yes, it is a real diagnosis even though- not enough significant scientific research through controlled studies to quantify, prove, or predict the symptoms and life course of this disorder.Research by the SPD Foundation indicates that 1 in every 20 children experiences symptoms of Sensory Processing Disorder that are significant enough to affect their ability to participate fully in every day life.

(http://www.sensorycritters.com/SI_Information.html.)

The Diagnostic and Statistical Manual -5th Edition (DSM-V)With extensive research and advocacy from the Sensory Processing Disorder Foundation, the American Psychiatric Association which publishes the Diagnostic and Statistical Manual -5th Edition (DSM-V) continues to consider the addition of Sensory Processing Disorder to the DSM-V. The new DSM-V will be published in 2013.http://summit-education.com/dsm-v/spd-and-the-dsm-v-doreit-s-bialer/

ReferencesAyres, Jean A. (1979). Sensory integration and the child. Los Angeles, CA: Western Psychological Services.Kranowitz, Carol S. (1998). The out-of-sync child: Recognizing and coping with sensory integration dysfunction. New York, NY: The Berkley Publishing Group.Kranowitz, Carol S. (2003). The out of-sync child has fun: activities for kids with sensory integration. New York, NY: The Berkley Publishing GroupMucklow, Nancy. (2009). The sensory team handbook. Kingston, ON: Michael Grass House.Nelson, Sandra. Sensory integration dysfunction: The misunderstood, misdiagnosed and unseen disability. http://home.comcast.net/~momfive/SIDWEBPAGE2.htm11/03/2011

References

Prainito Pediatric Therapy. What is sensory integration? http://prainitopediatrictherapy.com/prainitopediatrictherapysensoryintegration.aspx 13/02/2011Sensory processing disorder...Is SPD a real diagnosis?http://www.sensorycritters.com?SI_Information.html 11/03/2011Sensory processing disorder checklist: Signs and symptoms of dysfunction.http://www.sensory-processing-disorder.com/sensory-processing-disorder-checklist.html 11/02/2011 Sensory processing disorder checklist. http://www.spdfoundation.net/library/checklist.html 11/03/2011Williams, M. and Shellenberger, S. (1994). How does your engine run? A leaders guide to the alert program for self-regulation. Albuquerque, NM: Therapy Works Inc.

Oppositional-Defiant Disorder (ODD)

DSM-IV Characteristics of ODDOppositional Defiant Disorder A. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:(1) often loses temper(2) often argues with adults(3) often actively defies or refuses to comply with adults' requests or rules(4) often deliberately annoys people(5) often blames others for his or her mistakes or misbehavior(6) is often touchy or easily annoyed by others(7) is often angry and resentful(8) is often spiteful or vindictive

DSM-IV Characteristics, ctdNote: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.C. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder.D. Criteria are not met for Conduct Disorder, and, if the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Risk Factorsmother smoked during pregnancypoor socioeconomic environmentparents display maladaptive behaviour (includes general family instability, alcoholism, drug addiction, criminality)childhood abuse (including childhood sexual abuse) or exposure to violence between parentscognitive ability (IQ)association with peers who engage in deviant behaviour during early adolescenceGenetic link possible but not proven

Case Study: KendraOpenly defiant, rude meets criteria (and diagnosis is in place)Peers exclude her (group work, classroom seating, frequently bounces from one social group to the other)Parents divorced lives with MomMother does not return phone calls or emails from the teacherReferral to Divisional Psychologist was only first requested in Grade 9

Case Study, ctdMissed 24+ classes in first semester; Mom called the school to excuse all absencesGot into a fight at school (smashed a girls cell phone, so the girl smashed Kendras face into the floor) signs of CD are already appearingWhat is wrong with the system that a child would be so far-gone by the time they reach high school?

What Causes ODD? Possible pathway to ODD: starts during infancySome infants have a difficult temperament (about 15%) think reciprocity infant or not, it is difficult for many parents/caregivers to show constant love for a baby who is seldom happyIf primary caregiver (usually Mom) is rejecting/cold and inconsistent with the child, a disorganized pattern of attachment develops (child mistrusts primary caregiver)

Pathway to ODD, ctdThough children can develop late attachment (age 4-6), almost ALL children who have experienced very poor caregiving in the first years of life will develop adjustment problems. So then, by the time the child arrives at school, a great deal of damage has already been doneIf ODD is left untreated, it often progresses into Conduct Disorder and possibly Antisocial Personality Disorder huge risk factors for criminality in adulthood.

CaveatThere is no known cause for ODD. Research indicates that such a pathway as the one just described seems to be more common, but it is not the only pathway to ODD. ODD without diagnosis of another disorder is more likely to be attributable to a pathway such as the one described.

Treatment OptionsResearch is unanimous treatment is MUCH more effective when the parents are supportive of the childs treatment, and are willing to change themselvesOften, ODD is encouraged unwittingly by the parents For instance, the child is throwing a tantrum parents give in to the request just to get him to stop child has learned to throw tantrums to get his way

Types of TreatmentODD appears to be acquired through environmental factors this is likely the reason why most research favours therapeutic techniques to treat ODD rather than medication. HOWEVER ODD is often comorbid with other disorders (usually AD/HD, but sometimes autism and depressive or anxiety disorders) so these underlying conditions must be treated before ODD can be attended to.

What Happened with Kendra?She does not have an EA for any of her classes (Level 1 funding only)Past teachers have described coping techniques such as ignoring in order to deal with Kendra through the years. She has been on the wait-list for the Divisional Psychologist since Nov. 2010Her academic skills are below-levelShe indicated to one teacher that she hopes to drop out of school as soon as she turns 16.

Working within a Flawed SystemThe public can be quick to condemn teachers and assign blame for students problems however, parents need to work with us rather than against us if we want to see real changeOur school system is not horrible but I believe our preschool care system is. I wondered why I keep hearing about Germany (lowest dropout rate) and Finland (best academic results) in the news and did some digging

Germany and Finland: a quick tangentAs it turns out, maternity leave in both of these countries is among the best in the world.Both countries have a paid leave (just under 1 year each) followed by an optional, additional unpaid leave for up to the time the child turns threeCanada has 15 weeks maternity followed by 37 weeks parental leaveThe USA has 0 weeks paid leave and a maximum legislated twelve weeks off work with no pay for mat leave

But I digress There are certainly patterns that emerge when comparing countries preschool care to school performance, but this is simply an observation an interesting thought for future study and public policy reforms

So What CAN We Do? What can be done with a student like Kendra, with a mother who refuses to work together with her childs teachers? The vice-principal suggested allowing Kendra to take breaks from the classroom she does this during every class now and leaves for 15 minutes+ at a time is this to her advantage?The Special Education teacher who completed one classroom visit with one of Kendras teachers suggested the teacher show the child as much love as possible

What Can Be Done, CtdThe literature suggests the following strategies for teachers: Seating: place student in a location where distracting stimuli are least presentUse daily schedules to eliminate the childs opportunity for idle timeGive instructions clearly and simply, standing in front of the blank overhead screen to eliminate background distractionsStructure every moment of the day

More StrategiesManage the daily antecedentsKnow what they are usually:Being told noBeing told to stop doing somethingHearing a sharp directive to begin doing somethingSeeing any facial expression/gesture that conveys disapprovalHaving idle time Individual children also have their own antecedents get to understand what these are and avoid them if possible

Strategies, CtdAntecedents to enhance: allowing choice and foreshadowing activities. Continue to try to involve the parents, BUT DO SO IN A NONJUDGMENTAL WAY. If you convey any judgment toward the parent, this will only serve to drive them away even if the child developed ODD as a direct result of their personal qualities as a parent:They certainly didnt do it on purpose!They feel frustrated themselves at being unsure how to help their child

Some Idealistic RealismGovernmental reforms are not the easiest or most likely resolution to the disjuncture between the quality of childcare prior to age 5 and entry into the public school system. Resource Teachers/Guidance Counsellors/School Administration could consider contacting daycares near the school to host a 1-hour evening session to talk about positive parenting strategies this is part of being a leader.

Other IdeasSchools need to do more to encourage parents to come in to meet the teachers why not a Fun Fair, a barbecue, etc. The relationship with parents is absolutely crucial to the success of students with severe behaviour disordersTeachers we cannot diagnose, we cannot suggest conditions we can report symptoms. So why not keep a selection of brochures available in the classroom then at parent-teacher night, parents may feel more inclined to grab some reading material than to feel as though theyre being judged on the quality of their parenting

LastlyMore needs to be done during teacher training programs to prepare new teachers for these realities. Teachers who dont immediately return to school for a PBDE are missing out on a lot of important information!References see hard copy of final assignment

Diagnostic Criteria for ADHD5 symptom-related criteria for diagnosisUse modified version of DSM-IV for general public found on Center for Disease Control and Prevention website(http://www.cdc.gov/ncbddd/adhd/diagnosis.html)

A. Either 1 (Inattention) or 2 (Hyperactivity-impulsivity):

(1) Inattention:six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

(1) Inattention:(a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities(b) often has difficulty sustaining attention in tasks or play activities(c) often does not seem to listen when spoken to directly(d) often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)(e) often has difficulty organizing tasks and activities

(1) Inattention continued(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)(g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)(h) is often easily distracted by extraneous stimuli(i) is often forgetful in daily activities

(2) Hyperactivity-impulsivity:

six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive inconsistent with developmental level:

:

Hyperactivity

(a) often fidgets with hands or feet or squirms in seat(b) often leaves seat in classroom or in other situations in which remaining seated is expected(c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)(d) often has difficulty playing or engaging in leisure activities quietly(e) is often "on the go" or often acts as if "driven by a motor"(f) often talks excessively

Impulsivity(g) often blurts out answers before questions have been completed(h) often has difficulty awaiting turn(i) often interrupts or intrudes on others (e.g., butts into conversations or games)

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.

C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).

D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of:a Pervasive Developmental DisorderSchizophrenia, or other Psychotic Disorderare not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

***Dr. Cook redesigned her classroom routines with this feature of NBB in mind.