IN THE TEACHING-LEARNING PROCESS, OBJECTIVES AND CONTENTS

• Russell Barkley states that schools and teachers can influence, modify and minimize the difficulties of the pupil with ADHD mainly by:

- Changing the environment and adjusting stimulus for the child with ADHD.

- Managing consequences of their behavior.

- Training them in some strategies and skills so their executive functioning, delay time, inhibition capacity, internal language and emotional self-regulation improves.

• CHANGE THE ENVIRONMENT AND ADJUST STIMULY TO THE PUPIL

 

1. Structure the environment:

• Orders:

. First make him stop what he is doing.

. Choose appropriately the moment and the situation.

. Give one and clear order in a positive way.

. Use a firm tone of voice and use proximity and physical contact.

. Make sure he is looking at us and guarantee he pays attention to the order.

. Do not give explanations, argue or reason about our order.

. Ask him to repeat the order to himself, loud voice if necessary.

. Repeat the order only twice and be systematic.

. Make him do the order if you need to tell him a third time, guiding and giving physical accompaniment: make him see he is able to do it, and avoid bad consequences and punishment.

• Norms:
  . Reach consensus about which, how many and the consequences for not following them.
  . Use visual reminders.
  . Use external verbal reminders from the adult and make him repeat it as self-instruction.
  . Meet the agreed consequences both when they follow the given norm and when they do not.
  . Do a problem solving process to analyze it.
  . Use a mistake-correction strategy while the pupil is working, not only at the end of the process.

• Habits:
  . They are more immature than their peers and often have not acquired previous basic habits.
  . They need: more practice and reminding; they need us to be more present and even accompany them to achieve it; therefore they should do it more often with our direct supervision.

2. Externalize (outsource) and internalize information:

• Externalize: turning the information that we get into something physical, tangible.

. Use visual reminders (pictures, post-it, notes).

. Make time «visible» (watches, timers, chronometers, sand watches…songs and music).

• Internalize: being a model for them and working to get the rest of the class to be a model for them as well using strategies such as:

. Self-instructions as self-guides.

. Inhibiting the immediate response and reflecting on it before doing anything.

. Self-control and self-regulation when facing emotionally difficult situations.

 

• MANAGING CONSECUENCES FOR THE PUPIL

“If we do not foresee and we do not adapt the environment to the child with ADHD difficulties beforehand, we will be facing inappropriate behavior and failure»

• Behavior modification techniques (managing consequences): reinforcement, extinction, time out, punishment… ARE NOT EFFECTIVE with pupils with ADHD.

• The most efficient techniques are the ones that can be applied:

*More often *More immediately *More persistently

* More intensely * More contingently * More tangibly

 

“Quite often their problem is to do with NOT USING WHAT THEY DO KNOW» so…

• If they do not know how to do it, ¿why punish them?

• If they do know and it is an attention or an impulsivity problem that prevents them from doing it, ¿why punish them?

• It is so much more effective to act in a positive way and when facing failure not relying on the punishment but in the THINKING PROCESS.

• Be happy with the pupil, connect with him, trust him, support him, realize how much he is suffering and feel the hard time he is having, be on his side, be a team to face difficulties, be with him and be linked, connected with him.

• When you have to face inappropriate behavior of a pupil with ADHD you will need to be coherent, there needs to be consequences and we will have to set limits, but
  * Punishment SHOULD NOT go “in crescendo” just because it does not work.
  * Punishment IS NOT USEFUL when there is no reflecting about it.

• We need to make sure that:
  - the pupil has been listened to.
  - we empathize with their difficulty to control their emotions (anger/wrath)
  - we help him to generate alternatives for the future.
  - We accompany them so that our presence helps them change.
  - we revise with them the way they put on changes.
  - we give them positive feedback for trying to change
  - and we are there to start again when they do not succeed

 

STRATEGIES TO HELP THE PUPIL MANAGE HIS BEHAVIOUR

1. Response inhibition:

• Programme «Stop and Think»: Train the pupil to stop whatever he is doing when shown a visual Stop sign and then follow this instructions:

. I stop

. I observe: ¿what has happened? ¿how do I know it? ¿how can I solve it?

. I decide: ¿ what alternatives can I think of? ¿What consequences follow each of these alternatives? ¿which one do I think is the best?

. I take it to action

. I evaluate the results

2. Training on self-instructions

• The pupil with ADHD needs to acquire an internal language to regulate his behavior.

3. Cognitive Modeling

• Each situation can be an opportunity to offer a model of an adult that:

• The teacher can be a very efficient model that «solves problems talking to himself loud voice, following self-instructions».

4. Visualizing past and future

• The teacher asks the pupil to visualize a past situation similar to the one he has to solve now.

• The teacher helps him to pay attention to the relevant stimulus: i.e. the tone of voice, the face expression, the body posture of the person that is giving him an order to be done «right now» and what consequences there will be if he ignores that face expression, tone of voice, gesture; finally, the teacher helps him visualize what will happen on the contrary if he does what he is ask to and how he is asked to do.

• This same strategy can be used to visualize the future: what would happen if…?

5. Reinforced self-evaluation

• Pupils with ADHD tend to over value their work :
  “they have always done everything they had to do, they have done it properly and they have not had any problems o difficulties.»

• But when there is a heavy emotional load (fear, anxiety, angst) they tend to undervalue themselves, they have a very negative view of themselves, see themselves as unable and think nothing they do is going to turn out ok.

6. Cognitive Monitoring

• It is strategy to develop the capacity to stay in the task, to concentrate.

• We need to use an acoustic device (i.e. timer) with the frequency that we establish beeps/sounds that the pupil will identify as the moment to assess what he is doing at this moment:
  Am I concentrated on the task?
  What am I thinking of?

• At the beginning of the training, time is adjusted to the pupil´s difficulties. If he has big difficulties, the timer will sound often, every 4-5 minutes; as he progresses the beep sounds less often.

• As this procedure is used the pupil starts to automatically check his performance, without the use of any oral sound/mark.

• It could also be used with the whole class as «moment for self-evaluation» since every pupil can benefit from it.

7. Problem Solving.

• Cognitive process by which we learn to take decisions to solve school or personal/social difficulties effectively, following a series of steps.

• It is appropriate to use it at tutorial sessions in the classroom, but specially as close to the conflict situation as possible – in situ- starting with simple situations with low emotional load.

• The teacher guides the pupil to reflect on the answer to these questions:
  1. Problem definition:
  . Type: what is the problem? What happened?
  . Causes: why did it happen?
  . Personal implication: what part did I take in this problem? What did I do?
  . Emotional regulation: how did I feel? How do I feel now?
  . Consequences: what are the consequences of what I did?
  . Self-evaluation: how did I do it? what do I think about myself?.
  2. Aims:
  . Which is my objective/aim?
  3. Generating different alternatives:
  . How can I solve it? - we can use a brainstorming technique
  . What other solutions could I think of…? What other solutions can I think of?
  4. Evaluating different alternatives: to help him choose the best alternative, analyzing the pros and cons.
  . Would i achieve my aim if i do this? (objective)
  . Which is the best option? Which is the most effective?...
  5. Decision making:
  . Which one are we going to choose? (after having analyzed all the options)
  6. Executing.
  7. Continuous assessment: monitor if the pupil is following the established plan.
  . How am I doing?
  . Am I really applying the strategy I chose?
  8. Final assessment:
  . Which is the result? How do I feel? And others?...

 

EMOTIONAL SELF REGULATION

• If a child with ADHD seems to FEEL everything AMPLIFIED. Both positive and negative emotions.

• Often children with ADHD show a spiral of intense and negative emotions:
  - Fear of failure: at exams, not to be invited to birthday parties or social events, to do it wrong «again», to get a bad note on the school diary…
  - Shame: when they don´t know the right answer in the class, when they something silly without thinking, when they get a row in front of the class…l
  - Anger: for not being understood, for accumulating negative situations, for getting a sanction they think is unfair…
  - Sadness: for feeling incompetent, a failure… «no matter what I do I ALWAYS get it wrong»

• We all know that someone SAD, UNGRY, ASHAMED, ANXIOUS OR SCARED “thinks worse”

• When talking about a child with ADHD this situation gets more severe because of the executive dysfunctions that make it very difficult for them to self-regulate and express their emotions.

• What we know is that to work on EMOTIONAL REGULATIO teachers need to focus on helping them, supporting them, teaching them, training them, preparing them for:
  
  - Controlling inappropriate behavior.
  - Learn to calm himself and regulate the physiological alert.
  - Focus his attention again.
  
  

• We need to invest the whatever time needed to help the child to calm down NOT ONLY to face anger and bad mood explosions, but also to face anxiety or fear, shame or sadness; and pay them the necessary attention cause these emotions have very important consequences on the child and his environment.

• If we act focusing on our own body and limbic system, through full attention to this emotional state and its sensations, our brain will let us go «though a motorway» (where many more neuronal connections will take place) and will allow our cortical brain, once we are calmer, to follow instructions.

 

EMOTIONS AND BEHAVIOUR

• Create spaces and time to work explicitly on both aspects and guarantee that the child «feels sensed».

• Directed to the whole group and not only to the child with ADHD.

• Use individual records once we establish specific aims.

• Establish a daily communication system with the family.

• Offer «reward activities» in the classroom for the whole group: i.e. «play time», «we set up a restaurant or any other role-play activity»…

1. Specific training with the pupil with ADHD in individual or small group sessions:

• Breathing and Relaxation.

• Yoga, meditation, mindfulness (full attention).

• Working on emotions: identify them, relate them to body sensations, learn to express them, talk about them explicitly.

• Prepare an effective answer for negative emotions: inhibit the immediate response and work on appropriate ways of expressing negative but legitimate emotions understanding there is no such thing as «bad emotions» but «bad way of expressing them».

• Send messages to our body using self-instructions: “be calm», «breath deeply», «the worst is over», etc.

• Visualize being in control, being calm, being successful.

• Safe place: imagine yourself in a safe place where you can feel calm (needs previous training).

2. Introduce relaxation/mindfulness/yoga in your daily routine in the classroom:

• Use any of the multiple programmes edited in the market that will give you an specific guide to enable you to introduce relaxation in the classroom.

• Coordinate with specialist Physical Education, Art or Music teachers if you find that those subjects are more appropriate for this task.

• KEY IDEAS:
  
  * Try to use calm-relaxing music as a background sound and gentle light in the room.

* Use a relaxed tone of voice, speak at a slow pace, emphasizing the lines that you want to outstand.

* It is normal at the beginning that children laugh at this activity since they are not used to it; let it happen and explain to them that this exercise/activity Works better and it is more enjoyable if you keep quiet and concentrated and that´s why we are going to try and keep calm.

* Do not force any child to closet the eyes if they don´t want to do it. Explain to them that closing the eyes helps to concentrate and invite them to try, but make sure they know it is not obligatory to do so.

* Encourage them to take a proper position from the beginning lying on their backs, with arms and legs out stretched, to avoid muscular tension. Or sitting down with arms lying gently on their lap, hands open in a confortable position.

* If we persist in this exercise children will get used to the routine, will start feeling physically and psychologically safe, and will start asking to do it more often since they will start feeling the benefit of it.

3. Work on meditation in the emotions corner of your class:
   “Children need to feel safe. When they learn to meditate, they learn that safety can also be inside themselves. If we teach them how to meditate, the world would be a different place» Maureen Garth, 2012.

 

ANGER REACTIONS:

• The first thing we need to assume is that we have to “calm ourselves down and wait till they calm down as well”. Try to be in a quiet place, away from other people.

• Try to put yourself in his position (be empathetic).

• Do not be intrusive or over invasive. Do not give them a huge row. Do not loose control.

• Listen attentively to him/her.

• Do not enter in a debate or conversation about it; it is not the right moment. We can not do everything at the same time.

• Postpone intervention to reflect and dialogue until he is calm enough for it.

• Do not punish, criticize or give a row in public.

• Talk to the family to inform them about these reactions and suggest the necessity to take the child to clinical psychological attention and support them in this process.