Attention difficulties, poor

Transcription

Attention
difficulties,
poor
impulse
control,
overactivity
or
ADHD
(attention deficit/hyperactivity disorder)
Teaching and managing children and school students
LOGO
Cataloguing-in-publication data
618.92
ATT
Attention difficulties, poor impulse control, overactivity or ADHD
(attention deficit/hyperactivity disorder). – [Adelaide] : Dept. of
Education, Training and Employment, 1999.
28 p. : ill.
1. Attention deficit disorders – Care and treatment.
2. Learning disabilities.
3. Hyperactive children.
DDC21: 618.928589
ISBN:
0 7308 5792 1
SCIS order no.: 962336
South Australian government and non-government centres and schools are
permitted to copy this document to use in supporting children/students.
Health professionals are permitted to copy relevant sections for use in
collaboration with centres, schools and families.
The centre, school or health professional shall not sell, hire or otherwise derive
revenue from copies of the material, nor distribute copies of the material for any
other purpose.
© 1999 Department of Education, Training and Employment, 1999
Acknowledgments
This resource could not have been produced without the generous assistance of
a wide range of professionals in health, care and education and many families
living with children with attention difficulties, poor impulse control, overactivity or
ADHD.
Cover illustration by P & D Design
Layout and word processing by Julia Rowe
ISBN 0 7308 5792 1
Foreword
Attention difficulties, poor impulse control, overactivity or ADHD (attention deficit/hyperactivity disorder): teaching and
managing children and school students has been written to help careworkers and educators improve the participation
and success of children and students in centre and school communities. It is relevant to parents and health
professionals.
This document is the result of extensive collaboration between Department of Education, Training and Employment
personnel; paediatricians; child psychiatrists; general practitioners; psychologists; parent representatives and families.
As a result, it reflects and supports both departmental policy and practice, particularly in the areas of behaviour and
health care management, and the recommendations of the 1997 National Health and Medical Research Council report
Attention deficit hyperactivity disorder.
Attention difficulties, poor impulse control, overactivity or ADHD (attention deficit/hyperactivity disorder): teaching and
managing children and school students details practical teaching and management strategies and emphasises the
importance of a strong partnership between home, centre and school, and health professionals. It is recommended to
centre and school communities to enhance teaching, learning and care for all South Australian children and students.
Geoff Spring
CHIEF EXECUTIVE
Experts agree that people working together using a combination of
educational, family, behavioural, psychosocial and medical
interventions offer the best outcomes for these students. Early
intervention is preferable to delay.
The diagnosis of ADHD in toddlers and pre/schoolers is complicated
by normal developmental changes and environmental factors.
Behaviour management and parent guidance is essential, and
medication should be used with caution.
National Health and Medical Research Council 1997
Attention Deficit Hyperactivity Disorder (ADHD)
Contents
Chapter
Page
1
ADHD within a spectrum of behaviour ....................................................................................................... 7
2
Assessment and diagnosis ............................................................................................................................. 8
3
2.1
Professional assessment and diagnosis
2.2
Specific issues relating to the assessment of young children
2.3
ADHD and other difficulties
2.4
Role of teachers and care workers
Teaching and behaviour management strategies............................................................................... 10
3.1
Early childhood
3.2
School
4
Medication ......................................................................................................................................................... 14
5
Roles and responsibilities ............................................................................................................................ 15
6
Sample documentation ................................................................................................................................. 17
Sample letter from a doctor or psychologist to a principal/director
Learning behaviour questionnaire
General health information
Medication plan
7
Resources and support services: South Australia .............................................................................. 23
Parent information pamphlets .................................................................................................................... 24
ADHD within a spectrum of behaviour
In the course of their development, some
children/students have difficulty concentrating and
paying attention. They are easily distracted and don't
seem to plan their actions, and so have a disorganised,
chaotic personal style. They do not seem to consider
the consequences of their actions and will repeatedly
break the rules or upset others. They can be fidgety
and always on the go. They may crave stimulation and
have difficulty understanding social cues.
All these behaviours may be quite age appropriate,
especially for younger children, as part of a child’s
normal behavioural development. Teachers provide
activities to help such children develop more productive
learning and behavioural patterns.
In some children, these behaviours may be persistent,
excessive and may seriously interfere with learning.
They may pose significant management challenges for
parents and teachers. Frustration experienced by the
child, peers, teachers and parents can also create
complexity. At such times teachers and parents may
seek advice and assistance from a range of support
services within early childhood and schooling services,
child and mental health services, doctors, or
psychologists.
Sometimes professional assessment will lead to a
diagnosis of attention deficit disorder or attention
deficit/hyperactivity disorder (ADHD). There is
considerable professional debate about whether ADHD
refers to specific conditions or to extremes of normal
distributions of behaviours.
1
The most recent diagnostic manual1 describes ADHD
as a persistent pattern of inattention and/or
hyperactivity-impulsivity that is more frequent and
severe than is typically observed in individuals at a
comparable level of development.
ADHD occurs much more frequently in boys, especially
in the hyperactive-impulsive form.
Three subtypes of ADHD have been identified:
• predominant features of hyperactivity and
impulsivity
• predominant features of difficulties with attention
• a mixture of both of these.
For ADHD to be diagnosed:
• there must have been some symptoms present
before the age of seven, although diagnosis will
frequently not be made until the demands of
preschooling and schooling reveal difficulties
• symptoms must have lasted for over six months
• there must be problems present in at least two
settings eg at home and at school
• these problems must be severe enough to impair
the child/student's functioning in social, academic or
occupational settings
• the symptoms are not better accounted for by
another mental/behavioural disorder.
1
American Psychiatric Association. 1994
Attention difficulties, poor impulse control, overactivity or ADHD (attention deficit/hyperactivity disorder): teaching and managing children and school students
7
Assessment and diagnosis
2
2.1
Professional
diagnosis
assessment
and
The identification of this disorder is a matter for doctors
and psychologists.
In making a diagnosis these
professionals would normally consider reports from the
child/student’s teachers, parents and other people who
know him/her well to assess whether the behaviours
occur across a variety of settings, or are dependent on
changing features of the child/student’s environment.
Impact on the child/student’s functioning needs to be
carefully assessed. Professionals must also consider a
number of possible explanations of the behaviours in
order to rule out other explanations and diagnoses,
such as:
• difficulties with vision or hearing
• difficulties understanding or using language
• neurological problems, for example head injury,
epilepsy, brain tumours, high blood lead levels or
allergies
• psychological or emotional factors, for example
depression, anxiety, mood disorders, trauma or
stress
• difficulties within the family, for example ongoing
conflict within relationships or parental discipline
styles
• intellectual difficulties or disability
• developmental delay
• advanced development.
Teachers may be asked to complete behaviour
questionnaires or rating scales. They may be asked for
comment or behavioural observations related to
behaviour management strategies and outcomes, and
learning strengths and weaknesses. Assistance by all
centre and school staff in providing behavioural
observations will ensure the best possible decisions are
made about the nature of the child/student's needs and
any subsequent management plan.
2.2
Specific issues relating to
assessment of young children
the
The diagnosis of ADHD in toddlers and preschoolers is
complicated by normal developmental changes and
environmental factors. Behaviour management and
parent guidance is essential, and medication should be
used with caution 2.
There is considerable professional debate about
whether ADHD refers to a specific disorder or to
extremes of the normal range of behaviours. The
determination of whether a young child's behaviour is
excessive or severe compared to other children is
complex. High activity levels, short attention spans and
difficulty controlling their impulses are behaviours that
often characterise young children and may represent
developmentally appropriate behaviours. Surveys of
parent opinion of children under four years old
demonstrate that over 50% of parents report their
children to be 'hyperactive'.
The common, current rating scales and questionnaires
that are used to assess and diagnose ADHD have been
designed for older children (over seven years old). The
behaviours described in these measures (eg inability to
remain seated for a period of time) are not necessarily
appropriate for younger children.
These measures are also based on comparisons with
older children: age appropriate comparisons are not
available for the younger age population. It is not valid
to draw conclusions on the basis of comparing the
behaviour of a four-year old child with that of an eight
year-old child.
Some professionals use questionnaires with preschool
children to assess hyperactivity and attention problems.
These do not give a diagnosis but can be used to
advise clinical interventions.
Young children display a wider variation of behaviours
in different settings, further complicating the reliability
and validity of assessment.
Any assessment of a young child should include the
review of the strategies addressing the learning, skills
and behaviour of that child.
Whilst diagnosis of ADHD in preschool-aged children
could be considered, great care should be given before
attaching such a diagnosis to a young child. If that
diagnosis is considered, a second expert opinion is
often sought as confirmation.
There is no medical or other test that absolutely
confirms or rules out a diagnosis of this condition.
Diagnosis and assessment of ADHD are complex and
require analysis by doctors and psychologists who have
the information and training on which to make such a
judgement.
2
8
National Health and Medical Research Council. 1997.
ADHD and other difficulties
2.3
The co-existence of other difficulties/conditions which
may also require diagnosis, treatment and intervention
can add to the complexity of managing some
children/students with ADHD.
Research on ADHD indicates the possible coexistence
of conditions and disorders such as:
• learning difficulties
• language difficulties
• poor, short-term memory
• underachievement at centre/school
• immature motor coordination
• low self-esteem, emotional immaturity
• mood and anxiety disorders
• Tourettes syndrome: 'multiple motor tics/spasms
and one or more vocal tics/utterances occurring
many times a day'
Role of teachers and care
workers
2.4
As with any other medical or psychological condition,
centre and school-based staff members cannot
diagnose ADHD. Nor should they anticipate a diagnosis
(for example by telling parents that they suspect ADHD
or advising them to go to their doctor for medication). If
staff members are concerned about a child/student's
behaviour they should share their observations with the
child’s parent(s) as soon as possible. They may discuss
referral to departmental guidance, behaviour or early
childhood services or to a private practitioner for
appropriate assessment and advice. It is not the role of
teachers to question a doctor’s or psychologist’s
diagnosis. They may however, seek, through the
parent, further clarification about the student’s
management plan and offer to document behavioural
observations to advise review of this plan.
and for school aged children:
• oppositional defiant disorder: negative, provocative,
compulsive behaviour (eight years and older)
• conduct disorder: deliberate breaking of rules with
lack of consideration of others, lack of 'moral
conscience' (ten years and older)
• obsessive-compulsive
disorder:
recurrent
obsessions or compulsions that are severe enough
to be time consuming or cause marked distress or
significant impairment (five years and older).
Many individual, family, centre/school and other
environmental factors can contribute to a child or
student acting in a particular way. What constitutes
difficult or inexplicable behaviour may be a short term
or long term response to changes in the individual’s
circumstances. If ongoing concern remains, further
assessment, by doctors (including psychiatrists and
paediatricians) and psychologists, is recommended.
9
3
3.1
Teaching and behaviour management strategies
Early childhood
Q What are some good ways to adapt teaching and
behaviour management strategies in the centre
environment?
A
There are many successful strategies. Most
involve positive behaviour management strategies and
good teaching practice.
Effective management of children who exhibit attention
difficulties, poor impulse control or overactivity begins
with a thorough observation of the centre, the program,
the teaching style, the child's behaviours and the
interactions between these factors.
In line with effective
approaches, consider:
behaviour
management
Environmental adaptation
This includes the physical environment, the program or
curriculum, teaching and interaction styles and the
overall 'culture' of the setting.
Positive programming and teaching
This refers to adapting the curriculum to meet the
child's needs and may involve the teaching of specific
skills.
Corrective strategies
These are specific behavioural strategies used to
increase or decrease specific behaviours.
Collaboration with parents
This is necessary to ensure
generalisation of approach.
consistency
and
Environmental adaptation
Adaptations can be made to:
• ensure all areas are safe, visible and well monitored
• establish both 'active' areas and 'quiet' areas
• organise busy traffic areas well away from areas
requiring focus and concentration
• identify 'hot spots' and re-organise them
• identify 'distracters' (noise, visual material) and
modify them.
Positive programming and teaching
Programs can be adapted to:
• provide warning before a change in activities and
close supervision during transition times
• provide limited choices during free activity
• use activity cards to follow through until the task is
completed
• break tasks down into smaller steps
• allow extra time to complete tasks
• take the child's attention span/activity level into
account when organising daily activities (eg mat
time)
10
• use smaller groups when possible
• utilise the child's strengths and interests when
planning activities
routines and create a predictable
environment
be consistent
use visual signs to cue teaching and provide
reminders for the child
teach and practise centre routines, with patient
repetition, as needed.
• establish
•
•
•
The teaching and interaction style supports the student
when it:
• is positive and enthusiastic
• models positive thinking about learning and the
process of learning
• builds a positive relationship with the child, aiming
towards building the child's self confidence and self
esteem
• shows a genuine interest in the child's strengths
• acknowledges small steps of progress or small
changes for that individual
• encourages effort as well as outcome
• frequently provides encouraging feedback.
Children can be taught explicitly to:
• request help
• request a break
• say 'stop'
• say what they need rather than gesture or wait.
Teaching listening skills is fundamental to building
success. This can be enhanced when the teacher:
• models good listening
• consistently establishes eye contact and the child's
attention when speaking to him/her
• uses language the child understands
• asks the child to repeat back instructions
• programs listening games
• provides specific feedback - ‘great listening!'.
Teaching self control is most important. This will be
enhanced when teachers:
• use the 'stop, think, do' process
• teach body awareness
• discuss the consequences of actions
• introduce the idea of ‘your choice' in relation to
behaviour.
Teaching coping skills will provide a foundation for
effective functioning. This includes explicitly teaching:
• anger management
• relaxation strategies
• assertive behaviour.
Teaching social skills may be especially important.
Ideas to help include:
• teach the language which facilitates positive social
interaction
• teach specific skills such as using people's names,
taking turns, sharing, saying sorry
• teach conflict resolution in a way which is
developmentally appropriate.
Corrective strategies
This group of children may need rewards and reinforcement to a much greater degree than others.
Ways to achieve this include:
• increase the use of verbal reinforcers (eg praise,
encouragement, feedback)
• increase the use of non-verbal reinforcers (eg
smiles, glances, nods)
• negotiate cues you will use specifically with the child
(eg touching your ear as a cue for the child to listen)
• use tokens, star charts, work and behaviour
contracts
• allow the child to earn activity time
• negotiate rewards, making sure they are important
to the child and 'earnable' within a short time
• renegotiate rewards regularly so their novelty does
not wear off.
When rewards are delayed offer more frequent
feedback. Give reminders of the goal and express
confidence that the goal can be achieved.
With all these actions it will be necessary for staff to
work in a consistent, planned way as much as possible.
Opportunities to learn and practise skills in a variety of
ways over a period of time will be needed. Time-out or
other deterrents are best used in a planned and specific
way.
Children with attention difficulties, who have difficulty
controlling impulses or who are very overactive can be
extremely challenging. An important message for staff
is manage your own stress level. Look after yourself!
Ways to do this include:
• monitor your own stress
• accept the limits of the situation
• define for yourself small goals/targets and think in
'small steps of progress’
• involve other centre staff, or support staff in problem
solving or when working through the heat of a
particularly stressful incident/day.
Early childhood psychologists are able to provide more
information about these strategies.
Parents are generally the first and most significant
carers and educators of their children.
Effective
support for these children requires an on-going
partnership between parents and centre staff.
11
3.2
School
Q What are some good ways to adapt school
teaching and classroom management strategies ?
A
There are many successful approaches. Most are
good teaching practices recommended for use with all
students
Build positive relationships
Children with attention difficulties or poor impulse
control, or who are overactive will be supported by
teaching and classroom management strategies which
build positive relationships. Ways to achieve this
include:
• get to know the students’ interests
• have informal conversations
• use the students’ interests within a reward system
• have fun.
Foster emotional resilience
Teachers are in a position to communicate optimism
and hope and help put difficulties into perspective.
Ways to do this include:
• be reassuring
• model a positive approach to ‘mistakes’
• use humour
• use encouraging language, talking in a positive way
about the future
• emphasise ‘progress’, identifying measures of
progress and involving the student in the process
• discuss emotions within the curriculum, identifying
alternative, acceptable ways of dealing with anger,
frustration, happiness and sadness
• allow time to ‘cool off’ when angry.
Establish classroom routines
These students need a predictable environment. Ways
to achieve this include:
•
•
•
visually display and review rules
refer to an overview for the day/lesson
be consistent when managing behaviour.
These students are greatly supported by consistent and
predictable teacher expectations and behaviour
management strategies. It is helpful when the teacher:
• stays calm
• is
non-confrontational
while
maintaining
expectations
• gives reminder cues
• has curriculum activities ready for difficult times of
the day
• closely monitors transition times.
12
Develop a plan for the unexpected
It is helpful to be prepared for unexpected changes to
routine and interruptions. Useful strategies include:
• give feedback about the student’s level of
excitement and asking for calmer behaviour
• use peer support
• use a distraction such as an errand or classroom
task
• have a teacher-buddy classroom.
Use rewards and reinforcements
This group of students may need reinforcers to a much
greater degree than other students. Ways to achieve
this include:
• increase the use of verbal reinforcers, praise,
encouragement and feedback
• increase the use of non-verbal reinforcers, such as
glances and smiles
• negotiate and use cues, for example touching the
ear means ‘listen’
• use tokens, star charts, work contracts
• provide a system of (individual, small group or
whole class) reward, through ‘earned’ time
• negotiate rewards, ensuring they are ‘earnable’ in
the short-term, and use them for a limited-time
before renegotiating new rewards.
When rewards are delayed, offer more frequent
feedback. Give reminders of the goal and express
confidence that the goal can be achieved.
Help develop planning skills
When tasks require sustained attention planning and
organisation, this group needs assistance. The teacher
can:
• prepare the student for ‘special effort’ sustained
attention
• break the task into smaller steps
• use story plans or project plans
• display relevant cognitive question prompts for
example What do I have to do? What’s the first step
... then ... last? Am I following my plan? Is my
answer sensible, realistic? Am I happy with this
work?
• use cue cards and other signals to help the student
sustain attention/follow their plan
• adopt general approaches such as ‘stop-think-do’
• provide a checklist to help the student manage the
task (brainstorm with whole class before beginning
the activity; the student might need to be trained to
use the checklist)
• use a buddy/teacher to check the homework diary
• use a tape-recorder to tape assignments/homework.
Help develop memory
Teach group skills and social skills explicitly
Difficulties with short-term memory are common in this
group. Ways to help minimise the effects of poor shortterm memory include:
• recap the last lesson, that is refer to important
points and create links to the new lesson
• visually display class rules and current themes and
tasks
• have procedure sheets, for example for consistent
formatting of work
• ask the student to repeat or summarise instructions
• encourage the student to develop their own
strategies, such as writing things down or taperecording reminders and instructions.
Parents of children with ADHD frequently express
concern about their child lacking social skills and being
socially rejected. Some ways to enhance social skills
are to:
• use explicit social skills teaching programs
• sit near the student in group activities
• prepare the student for group activity by rehearsing
a relevant focus, for example ‘listening’ or ‘watching
body language’
• give the student a specific task in the group
• frequently check for feedback asking the student to
evaluate their own performance and progress with
social skills
• create lots of opportunities for the development of
social skills within a structured setting, for example
paired learning, groupwork using explicit roles such
as facilitator or observer, organising a buddy-forthe-day or person of the week.
Manage time-on-task
Students will benefit from explicit strategies to increase
their time-on-ask. Strategies include:
• seat the student between quieter students
• get the student to nominate a peer ‘study-buddy’ as
a good influence
• use egg-timers or clocks
• have the student monitor their own performance, for
example colour in the smiley face or circle the rating
which describes effort and time on task in the
previous lesson
• negotiate an on-task reminder cue
• for students who work quickly and impulsively
introduce a visual record of checking work, for
example writing ‘ch’ on the bottom of the page to
indicate checking has been done.
Be aware of the student’s need to move
Students who are overactive will benefit from extra
opportunities to move around. Ways to accommodate
this include:
• introduce and legitimise a ‘seat-break’, for example
to run an errand, or stand up to work
• allow a few minutes to stretch between lessons
• supervise transition times closely.
Manage your own stress level
Look after yourself! You can:
• monitor your own stress
• manage emotional involvement
• accept the limits of the situation
• give yourself small goals/targets; think in small
steps
• involve colleagues.
Support available
School psychologists are able to provide more
information about these strategies and to explore either
concerns you may have about the student.
Parents are generally the first and most significant
carers and educators of their children.
Effective
support for these children requires an on-going
partnership between parents and centre staff.
13
4
Medication
Doctors may prescribe medication for children
diagnosed with ADHD. When correctly prescribed use
of such drugs as Methylphenidate (brand name Ritalin)
and Dexamphetamine (brand name Dexamphetamine)
have been found to be both effective and safe in the
short term3. These drugs, in the prescribed dosages,
have effects on most people rather than having specific
effects only on those diagnosed as having ADHD. This
means that response to medication is not a diagnostic
test.
For preschool age children caution must be exercised
in using medication as there is limited research on the
effects of medication in this age group. The research
does indicate that children of this age do not respond
as well to medication as older children. The side
effects of medication are more pronounced in young
children3.
Research into the use of medication with students
diagnosed with ADHD/ADD suggests that 70-80% of
students show significant improvements in their ability
to sustain attention, to concentrate, to control
impulsivity and to function socially and academically.
There are well documented side effects of stimulant
medication. These include appetite loss, irritability,
sleep disturbance and mood or tic problems. The
doctor is responsible for monitoring any such sideeffects.
Drug therapy should be combined with educational,
family and behavioural strategies. This requires liaison
and effective communication between doctors,
educators, parents and others involved, such as
psychologists or family therapists.
Multiple drug regimes, in which a child is prescribed a
combination of more than one drug, are not
recommended by most paediatricians and particularly
not for preschool aged children.
If asked to supervise multiple drug regimes, staff can,
through the parent, seek clear confirmation from the
treating doctor that this is required during the school
day.
3
14
National Health and Medical Research Council. 1997.
The role of centre and school staff in
medication management
Support offered by school staff to children or students
who are prescribed medication is determined by duty of
care and occupational health safety and welfare
obligations, and the requirement to ensure there is no
discrimination in provision of departmental services to
students with health care needs.
In practice this means that school staff should:
• actively seek to obtain up-to-date, relevant
health care information
This will include a plan for medication details which,
for medical reasons, cannot be taken outside school
hours. Parents should provide a medication plan,
completed by the doctor or pharmacist, before
asking teachers to accept responsibility for
supervising student medication.
• store medication
Any medication accepted by the school to be stored
for a student must be in the original dispensing
container. Schools should ideally accept medication
on a daily basis and certainly no more than a week's
supply at a time. Parents can ask the pharmacist for
a second fully labelled container for medication kept
at home.
• record medication as supervised by school
staff
Schools do not generally administer medication.
They can supervise a child taking medication and
must record this in a daily medication log, detailing
the student's name, medication, dose, method of
taking medication and the time it was taken.
• negotiate ways for students to remember to
take their medication
Staff cannot guarantee they can remind children to
take their medication, but they can help establish
reminder systems, particularly for children with
ADHD who often have difficulty remembering tasks.
Students could wear alarmed wrist watches or
medication can be scheduled at the same time as
something else, for example the lunch break.
• adhere to review dates
Long term medication should be regularly reviewed
by the doctor: medication plans for ADHD should be
reviewed at least every 6 months.
Roles and responsibilities
Effective management depends on a partnership
between the student, parents, teachers and others
involved, with each fulfilling clear and agreed actions
and responsibilities. The following checklist can be
used as a guide and should be adapted to each
situation.
Role of principals and directors
• inform parents as soon as possible of concerns
•
•
•
•
•
•
•
•
•
regarding the management of the child/student’s
health care, learning and behaviour management
needs
ensure that procedures are developed and used to
resolve issues
arrange for, or recommend, the involvement of
resource persons, support groups or other people or
agencies who may be able to help in formulating
support plans
manage development of an individual child/student's
support plan which sets out agreed roles and
responsibilities, monitors and reviews plans, and
ensures planning for transition from one setting to
another
require written advice from professionals treating all
children/students diagnosed with ADHD, and ensure
this is incorporated onto the child/student’s medical
records
ensure
that
management
needs including
medication arrangements (if medication is
prescribed to be taken within school hours) are
based on written medical advice and are in
accordance with school policy
communicate student management and support
needs to relevant staff in a confidential manner, and
implement support plans in an appropriate manner
ensure efficient and confidential processes for
storage of and staff access to medical record cards
and child/ student support plans
ensure that record cards and child/student support
plans are updated regularly
ensure that staff have access to information and
training opportunities in order to fulfil their agreed
roles as documented in the child/student’s support
plan.
Role of teaching and support staff
• keep the principal/director informed
• encourage and provide opportunities for the
•
•
•
child/student to take responsibility for his/her
behaviour in a manner that reflects age, stage of
development and capability
become familiar with the medical record cards and
individual support plans of children/students in your
care, respecting the confidential nature of the
information contained in these records
support the management of children/students
diagnosed with ADHD as documented on medical
record cards and in the individual's support plan
inform parents as soon as possible of concerns
regarding management of the child/student’s health
care, learning and behaviour management needs
5
• work with other professionals, such as school
•
•
•
psychologists and behaviour support staff, in
consultation with parents, if concerns continue
ensure learning strategies include children/students
diagnosed with ADHD: this will involve strategies
important for all children/students and those
requiring explicit planning and perseverance for
children/students diagnosed with ADHD
help to plan and implement a student's support plan,
if one is needed
document and report on the child's/students’
behaviour and learning, including reporting
observations of individual behaviour and learning,
using checklists and other instruments. It does not
involve making assessments of the effects of
medication, or making or presuming a diagnosis.
Role of parents/caregivers/guardians
• continue to take primary responsibility for their
child's well being and educational program
• encourage and provide opportunities for the child to
•
•
•
•
•
•
•
•
take responsibility for her/his behaviour in a manner
that reflects her/his age, stage of development, and
capability
approach the centre/school if in need of information
or support, or if difficulties arise
be prepared to discuss how concerns can be
resolved, or whether other people or resources are
needed
help write their child's support plan and undertake
home-based management strategies which support
and generalise the plan
involve other professionals such as support services
within DETE, doctors and/or psychologists, if
concerns remain
inform the centre/school if their child has been
diagnosed with ADHD
complete, with the doctor, the medical record and
the medication schedule
liaise with the doctor and centre/school to ensure
that details of managing medication (if necessary)
are negotiated and carried out, and they involve
minimal supervision or interruption to the
centre/school day
deliver any prescribed medication required with the
doctor’s written instructions, in a single-dose fully
labelled container (or weekly dose if that has been
negotiated).
Role of students
• take increasing responsibility, whenever safe and
•
possible, and in a manner reflecting their age, stage
of development and capability, for their health care,
behaviour and learning
fulfil responsibilities as agreed through the student
support plan process.
15
Role of doctors or specialists in relation to
centres and schools
• consult with parents/caregivers/guardians on the
•
•
•
•
16
most effective way to provide additional information
to the centre or school about the child’s individual
management needs
liaise, if appropriate, with centres or schools to
assist in or advise on the implementation of
intervention programs
If medication is prescribed and must be taken during
centre/school hours:
provide a medication plan for the school day
recognise that centre/school staff cannot force a
student to take medication
try to make arrangements (eg timing) that will fit
in with the centre/school and the child/student's
program.
provide general information about ADHD and
guidelines for helping the child/student if requested
support and contribute, if appropriate, to reviews of
interventions and programs devised to assist
diagnosed/assessed children or students.
Sample documentation
FORM 1
sample letter from a doctor or psychologist to a principal/director
FORM 2
Learning behaviour questionnaire
FORM 3
General health information
FORM 4
Medication Plan
6
17
FORM 1
Sample letter from a doctor or psychologist seeking cooperation in completing a request for information.
This letter implies that some form of behaviour observation sheet is attached.
Doctor/psychologist’s name: ........................................................................................................................
Address: ...........................................................................................................................................................
Phone:.......................................................................... Fax: .........................................................................
Dear Principal/Director
I write regarding one of my patients/clients:
Name: ...............................................................................................Date of birth: ...........................................................
requesting information concerning his/her behaviour at centre/school. This letter is written in accord with agreed
Department of Education, Training and Employment procedures for obtaining advice from a centre/school concerning a
child’s behaviour and learning when the information is needed to assist in an assessment/diagnostic process or to be
used in a treatment/intervention plan.
To assist with this process, please complete the enclosed questionnaires:
(a) Name of rating scale or questionnaire
(b) Learning/Behaviour Questionnaire for behaviours causing the greatest concern at centre/school.
Please ring me on ............................................................................................. if you would like to discuss this request.
What are the best times for me to contact you? ...................................................................................................................
..............................................................................................................................................................................................
Permission to release information:
Parent’s or guardian' s authorisation
.................................................................................................... give permission to the staff of ......................................
(name of parent / guardian)
........................................................................................................................ centre/school to release information to:
(name of preschool / school)
Dr/Mr/Ms/Miss/Mrs -------------------------------------------------------------------------------------------------------------------------------------(name of doctor / psychologist)
concerning my child -----------------------------------------------------------------------------------------------------------------------------------(name of child)
for the purpose of assisting in the assessment and management of my child.
(Signed)
18
_______________________________
_____________________
Name of parent / guardian
Date
FORM 2
LEARNING BEHAVIOUR
questionnaire
Child/student's name: ........................................................................................................................................
Date of birth: .......................................................................................................................................................
1.
What are the child/student’s interests and personal strengths?
2.
What behaviours are causing the greatest concern in your setting?
3.
Do you have concerns in relation to the child/student’s learning? If so, please outline.
4.
When were these difficulties first reported? And by whom?
5.
Please describe how often, for how long, and at what level of intensity the concerning behaviours have
been occurring.
19
FORM 2
6.
Please describe how the child/student's difficulties impact on his/her functioning in your setting.
7.
Do these behaviours occur in all situations with all staff? If not, please specify any discrepancies.
8.
Have any interventions been implemented? If yes, please specify and indicate how they worked.
9.
Who has provided support or advice in developing these interventions?
10.
Are there any factors that seem to affect/be related to the behaviours or learning difficulties?
Please attach any additional comments
Thank you for your time and support
Dr/Mr/Ms/Miss/Mrs ................................................................................................................................................................
Date ......................................................................................................................................................................................
20
Centre or School
FORM 3
GENERAL HEALTH INFORMATION
Confidential
To be completed by the treating health professional (general practitioner, psychiatrist, psychologist, nurse) for any children/students who
need additional care/supervision related to their mental health and well-being.
This information is confidential and will be available only to supervising staff and emergency medical personnel.
Child/Student Name ................................................................................. Date of Birth .........................................
Family name
First name
Medic Alert Number (if relevant) ...................................................................... Review Date ..........................................
Description of the condition
It is not necessary to provide a full medical history. Centre/school staff need know only information relevant to the care, education and
welfare of the child/student while in their care.
Management issues for the centre/school
Please include only information that centre/school staff will need to care for and teach the child/student, for example:
impact on capacity to attend and participate in daily classroom activities
limitations on physical activity
need for rest/privacy
need for additional emotional support
behaviour management plan
considerations necessary for camps, excursions
Please provide details.
Additional information/requests attached to this record
Medication plan (if supervision of medication is recommended at the centre/school)
Yes
No
Behaviour/learning questionnaire for completion by staff
Yes
No
Observation/behaviour log for completion by staff
Yes
No
General information about this child/student’s condition
Yes
No
Other (please specify) ...................................................................................................................................................
Yes
No
...............................................................................................................................................................................................................................
Authorisation and release
Health professional ............................................................................................................... Signature.......................................................
Printed name
Address...........................................................................................................................................................................................................
Phone ....................................................................................................................Date.................................................................................
Should you need to contact me, with the child/student and parent’s consent, I can be reached at ..............................................................
............................................................. . Preferred times...............................................................................................................................
I have read and understand this information and any attachments indicated above.
I approve the release of this information to centre or school staff and emergency medical personnel.
I understand it is my responsibility to ensure this information is up-dated each year and more often if necessary.
Parent/Guardian or Adult Student ..............................................................................................................................................................
Family name
First name
Signature ........................................................................................ Date .......................................................................................................
21
Centre or School
FORM 4
MEDICATION PLAN
Confidential
To be completed by the DOCTOR and the PARENT/GUARDIAN.
This information is confidential and will be available only to supervising staff and emergency medical personnel.
Child/Student name .................................................................................. Date of birth ..........................................
Family name
Medic Alert number
(if relevant)
First name
..................................................................... Review date ..........................................
To the doctor
Please:
complete all sections of this form
schedule medication outside care/school hours wherever possible.
be specific: As needed is not sufficient direction for teaching staff
nominate the simplest method. For example: Oral or ‘puffer’ medication is much easier to arrange than a nebuliser.
Please note:
staff accept only medication which is in the original, fully labelled pharmacy container
staff do not monitor the effects of medication as they have no training to do this
staff are instructed to seek emergency medical assistance if concerned about a child/student’s behaviour following
medication.
NAME OF MEDICATION
How much is to be taken at the following times
(Cross X squares where no medication is needed)
Before
school/session
care
Recess/
morning break
time
Lunch time
After
school/session
care
Authorisation and release
Medical practitioner .............................................................................................................. Signature.......................................................
Printed name
Address...........................................................................................................................................................................................................
Phone ....................................................................................................................Date.................................................................................
I have read and understand this information and any attachments indicated above.
I approve the release of this information to centre or school staff and emergency medical personnel.
I understand it is my responsibility to ensure this information is up-dated each year and more often if necessary.
Parent/Guardian or Adult student ..............................................................................................................................................................
Family name
First name
Signature ...............................................................................................................Date.................................................................................
22
Resources and support services:
South Australia
7
The most effective management support for the child or
student uses a combination of educational, family,
behavioural, psychosocial and medical interventions,
including:
• modification of curriculum content and delivery with
explicit teaching of new skills
• behaviour management (behaviour modification,
cognitive behaviour therapy)
• family support
• for some older children, medication.
Support services and resources within the South
Australian Department of Education, Training and
Employment for preschool-aged children:
• Early Childhood Support Services (ECSS)
This is a multidisciplinary team of psychologists,
special educators, speech pathologists and social
workers who have specialised skills in working with
young children. They may be involved in the
identification and assessment process and assist
staff in developing and implementing management
plans involving a range of strategies best suited to
the needs of the child, centre and family.
• Training and development
These programs, provided by the ECSS team,
include both information sessions and skills based
courses.
• Early Childhood Resource Centre
This centre contains a wide range of books, videos,
and articles.
Support services/resources within the department for
school-aged students include:
• Guidance officers
Guidance officers are registered psychologists and
teachers. They may be involved in helping the
classroom teacher to clarify issues related to the
student’s learning and ways to adapt the curriculum
to meet the student’s needs.
Assessment of
cognitive and social-emotional functioning may also
be completed. The guidance officer may have a
role in facilitating discussion between the teacher
and parent to further explore the student’s
educational needs and how these can be met in an
integrated way. Such discussions may involve
senior staff, school counsellors or others.
• Behaviour support teams
Behaviour support teams comprise trained,
experienced teachers working with students with
behavioural difficulties. They can help teachers,
students and parents focus on behavioural
strategies to manage difficult behaviour.
• Speech pathologists
Speech pathologists can assess a child’s speech
and language needs and provide programming
advice.
These services can be contacted at departmental
district offices, usually through a referral from the
school principal, or centre director or teacher. Prereferral discussion is often appropriate.
Resource centres and support personnel can provide
advice about the many relevant resources/programs in
areas such as collaborative learning, development of
social skills, anger management, conflict resolution,
peer mediation, developing self-esteem, coping with
change, relaxation and inner mental training, optimistic
thinking. There are also materials about ways to
monitor time-on-task, improve memory, cognitive
strategies to help self-talk/planning, and develop
thinking skills, for example, the Internet/Web Page
access Newsgroup or Listserv, or the Departmental
web page – www.nexus.edu.au
Services outside the department include:
• Child and Adolescent Mental Health Services
• Child and Youth Health, which also has a 24 hr
Parent Helpline
• general practitioners, who can refer to specialists
such as paediatricians and child psychiatrists
• private psychologists
• therapists including speech therapists, family
therapists, occupational therapists.
The parent information, which follows, can
reproduced by centres and schools for distribution.
be
23
Support at your centre
Where can you get support?
Difficulties with listening, acting before thinking or
being overactive can interfere with your child’s
learning and affect interactions with other children.
Please discuss with centre staff any concerns you
have and ways to help you address these
concerns.
The following agencies can provide support:
Staff can, with your permission, request support
from early childhood support services which
include psychologists, speech pathologists, social
workers and special educators who have
specialised skills in working with young children.
Good communication with the centre is essential.
Please approach the centre if difficulties arise
and discuss how they can be resolved.
• local community centres (various supports)
• Child and
(CAMHS)
Eastern
Western
Northern
Southern
Adolescent Mental Health Services
(Paradise) ....... Ph: 8207 8999
(Pt Adelaide) ... Ph: 8341 1222
(Elizabeth) ....... Ph: 8252 0133
(Marion)........... Ph: 8292 7744
(Noarlunga) ..... Ph: 8362 1234
(Flinders) ......... Ph: 8204 5412
Mt Gambier ....................... Ph: 8724 2446
Murray Bridge ................... Ph: 8535 6780
Berri
........................ Ph: 8582 4290
• Child and Youth
assessment).
Phone: 8303 1500
Health
ATTENTION
DIFFICULTIES,
POOR IMPULSE
CONTROL
OR OVERACTIVE
BEHAVIOURS
in
(developmental
preschool-aged children
• Parent Help Line (advice).
Phone: 1300 364 100
• Women’s & Children’s Hospital.
Phone: 8204 7000.
You can also get information from:
• Attention Disorders
Phone: 8221 5166
Association
of
SA.
• Students and Youth with Attention Deficit
Disorder, PO Box 6058 Halifax Street 5000.
Phone: 041 227 3310
Parents, children and professionals
working together
• books and videos at your local library
• newsgroups or listserv on the Internet
• private psychologists or doctors listed in the
yellow pages.
24
What are we talking about?
Recommended interventions
Professional help
If your child has difficulty listening, is easily
distracted, acts before thinking or is always on the
go, remember:
An approach uses the benefits of behaviour
management strategies and teaches new skills,
rather than medication, is considered to be best
practice for preschool-aged children.
A doctor or psychologist will consider other factors
that could be causing the behaviour such as
neurological, developmental, emotional, family or
physical (eg earache, headache) issues. He/she
will want to take a family history and ask you to
describe how your child behaves in a range of
settings.
• many children show these tendencies to some
degree as they’re growing up and learning to
control themselves
• most children eventually respond to positive
teaching and parenting practices that shape
behaviour and help the child take increasing
responsibility.
If your child’s behaviour continues to concern you
and doesn’t respond to your management you
might like to:
• talk with staff about how your child behaves at
the centre
• talk to a psychologist or your family doctor
about your child.
Effective communication between parents and all
the professionals involved is also crucial.
Interventions for use with young children include:
• modification of centre programs
Centre staff might be asked to comment on how
your child behaves at the centre.
• behaviour strategies
• teaching new skills (eg social skills, listening)
• specialised therapies (occupational, speech).
Each child, however, is unique and complex,
and will need individual assessment and an
individual intervention plan.
The issue of medication
Medication is not generally recommended for
preschool-aged children.
If your child is prescribed medication, the preschool
will need written advice on the proposed
management.
Other conditions
Other conditions can make the management of a
child with attentional or behavioural difficulties
more complex. These other conditions can include:
• learning difficulties
• language difficulties or poor short-term memory
• immature motor coordination
• low self-esteem, emotional immaturity
• mood/anxiety disorders
• behavioural difficulties.
Further assessment and intervention by a
paediatrician, psychiatrist or psychologist could be
required if your child has other difficulties.
25
Support at your school
Where can you get support?
Difficulties with attention, impulse control or
overactivity can interfere with your child’s learning
and affect interactions with other students. Please
discuss with school staff any concerns you have
and ways to help you address these concerns.
The following agencies can provide support:
local community centres (various supports)
Child and Adolescent Mental Health Services
(CAMHS)
Eastern (Paradise) ....... Ph: 8207 8999
Western (Pt Adelaide) ... Ph: 8341 1222
Northern (Elizabeth) ....... Ph: 8252 0133
Southern (Marion)........... Ph: 8292 7744
(Noarlunga) ..... Ph: 8362 1234
(Flinders) ......... Ph: 8204 5412
Mt Gambier ....................... Ph: 8724 2446
Murray Bridge ................... Ph: 8535 6780
Berri
........................ Ph: 8582 4290
The school can, with your permission, request
support from district support services which include
guidance officers (educational psychologists),
speech pathologists and behaviour support teams.
If your child is diagnosed as having ADHD the
school will need written advice on any proposed
interventions.
If your child needs to take medication during school
time please provide the doctor’s written instructions
to the school and deliver the medication in a single
dose, fully labelled container.
Good communication with the school is essential.
Please approach the school if difficulties arise and
discuss how they can be resolved.
Remember, home support is vital.
Child and Youth
assessment).
Phone: 8303 1500
Health
(developmental
Parent Help Line (advice).
Phone: 1300 364 100
Women’s & Children’s Hospital.
Phone: 8204 7000.
You can also get information from:
Attention Disorders Association
ph 8221 5166
in
of
SA,
Students and Youth with Attention Deficit
Disorder, PO Box 6058 Halifax Street 5000,
Ph: 041 227 3310
books and videos at your local library
newsgroups or listserv on the Internet
private psychologists or doctors listed in the
yellow pages.
26
ATTENTION
DIFFICULTIES,
POOR IMPULSE
CONTROL
OR OVERACTIVE
BEHAVIOURS
or
ATTENTION DEFICIT/
HYPERACTIVITY
DISORDER (ADHD)
school-aged children
Parents, students and professionals
working together
What are we talking about?
Recommended interventions
Professional help
If your child can’t concentrate or listen, is easily
distracted, disorganised, acts before thinking and is
always active, remember:
many children show these tendencies to some
degree as they’re growing up
most children eventually respond to positive
teaching and parenting practices that shape
behaviour and help the child take increasing
responsibility.
The best outcomes are when people work together
using a combination of educational, family,
psychosocial and medical interventions.
In assessing the situation, a specialist will consider
other factors that could be causing the behaviour.
These may be neurological, developmental,
emotional, family or physical (eg earache,
headache) issues. He/she will want to take a family
history and ask you to describe how your child
behaves in a range of settings.
If your child’s behaviour continues to concern you
and doesn’t respond to your management you
might like to:
talk with the classroom teacher about how your
child behaves that way at school
talk to a psychologist or your family doctor
about your child.
Successful interventions are:
modification of school programs
family counselling
behaviour modification
cognitive–behaviour therapy
other therapies (occupational, speech)
medication
teaching new skills (social skills, listening).
Each child, however, is unique and complex,
and will need individual assessment and an
individual intervention plan.
School staff might be asked to comment on how
your child behaves at school.
Other conditions
Other conditions can make the management of a
child with ADHD more complex. Difficulties that can
accompany attention difficulties, poor impulse
control or overactive behaviours include:
learning difficulties
language difficulties or poor short-term memory
immature motor coordination
low self-esteem, emotional immaturity
mood/anxiety disorders
behavioural difficulties.
Further assessment and intervention by a
paediatrician, psychiatrist or psychologist at some
stage of your child’s schooling could be required if
your child has other difficulties.
27

Attention difficulties, poor

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