Another Answer (Tailored for all of you!) to a Reader's Question: What is the Best School Environment for Children with ADHD?

I know that it may seem hard to believe, but children with ADHD need stimulation so that they can achieve hyperfocus. In fact, oftentimes, if a child with ADHD does not find stimulation, he stimulates himself, for example, by tapping a pencil on his desk, by spinning his chair, etc. Therefore, some children with ADHD might respond to the school environment that you describe as distracting to your son, as one that instead, is stimulating.

However, if your child finds his current school environment too distracting, he may need a more structured environment, where every component of that context is consistent and constant. Due to the tenuous economic situation in which our schools find themselves, it may be difficult to find a public school with smaller classes, unfortunately. If cost is not an issue, then I would suggest a private school, which will most typically have smaller classes. I would suggest one with a person who is an expert in academic support, however.

 If private school is not an option, then perhaps find a town which would be characterized by a smaller population than the one in which your child’s school is currently located. If the population is not as large, then it is likely that the classes would be smaller.

Even more important, however than the number of students in a class, is the organization, structure, consistency, and predictability of the teaching, the classroom subjects, the classroom materials as well as the activities in which the children are involved.

An example of that consistency, are rules for the children’s behavior that have been written in a positive tone and are based on a collaborative effort of the teacher and the students. These rules must be followed by everyone consistently.

In addition to classroom rules, the teacher’s lessons should be designed according to the developmentally appropriate needs of each child, as well as to each child’s individual learning styles, learning strengths and needs.

 In order to help the child with ADHD to focus optimally, the teacher should have the child’s desk as close to her desk as possible, without stigmatizing the child. Additionally, the child with ADHD should not be seated next to a child who has similar behavioral issues.

So what am I really saying? The appearance of the school as well as the number of the students in each class, is not nearly as important as whether or not the child’s needs are being met by a teacher who is extremely organized, consistent and patient in terms of the symptoms that a child with ADHD exhibits. Therefore, when you look for a new school for your child, I would look to see if the teachers who are working with your child are warm, organized, consistent, patient, and knowledgeable of how important it is to teach children with ADHD inclusive of emotional intelligence. Our children need to talk about how they feel and desperately need someone to listen to them.

Comments?

Be Careful Concerning the Social Skills that you Model for your Children!

The other day, I was driving in New York City. There was some traffic and I was trying to turn into a street from an avenue. I had to wait for the cars ahead of me to drive, so I was inching forward one foot at a time. Additionally, as I was trying to turn into the street, I had to stop and wait for the pedestrians to cross before I completed my turn. I had waited seemingly a long time before completing my turn, when I saw a mother crossing the street with her son.


I sat at that intersection and was not planning to move until they finished crossing the street. As I sat there waiting, the mother shouted out “Patience, grandma!” I was stunned. First of all, I do not look like the stereotype of a grandma. I have long red hair and I do not look anything like a grandma (not that there is anything wrong with that!) in any way. Second, I was sitting there patiently for an interminable time, with no intention of driving until they had finished crossing the street. Third and perhaps the most important point, is that the mother made a very inappropriate and disrespectful comment in front of her child!

How are children supposed to treat other people with respect if their parent is disrespectful? So…please be careful what social skills you model as a parent when you are trying to teach positive social skills to your children!

The Answer to a Question that was Posed in my Question Forum: What is the Best/Most Successful Environment for Children with ADHD?

Even though I answered one of my reader's questions in the comments section, I felt that the topic was such an important one, that I would write my answer here, as well.

 Here is my comment:

The best/most successful environment for children with ADHD is one that is structured in terms of being consistent, but not restrictive. Every component of the child with ADHD’s environment should be organized in a structured and constant way, so that the child with ADHD knows what to expect at all times.



For example, his room should be organized with a specific place for each toy or book, which is color coded. You will need to work with him until he knows the relationship of a specific color to the place where it may be found. You can color code the books separately according to their titles. Even if your child is too young to read as of yet, you are bringing literacy into his life in the natural setting of his room.


The importance of organizing his room is so that he will become accountable for his personal items. By becoming responsible, he will feel ownership of his personal items and therefore, build positive self-esteem.


Why use color-coding? Children with ADHD need stimulation. By incorporating a colorful cue as to where the material should be placed when they are finished with it, will help him to remember where it goes. By doing so, he will precisely know where to return the material to its place after accessing it.


The child with ADHD's activities within his environment should be structured and consistent as well. For example, he should do his homework the same time every day. In terms of not being restrictive, this is what I mean: The place where he chooses to do his homework, as well as where he will do his homework, may be varied and determined by him within his activity level. He may choose to do his homework at the kitchen table, walking around or lying down on his stomach.


Children with ADHD work best within their activity level as chosen by them. I would encourage him to do his homework by himself. That being said, you can scaffold or support him by asking him questions about his homework from time to time, which will give you an idea as whether or not he is doing it.


Caveat: I would NOT ask him if he has finished his homework, which might cause him to become angry and noncompliant. I would, however, ask him something about the subject that he is studying. For example, if he is studying certain Constitutional amendments, you might say, “I can never remember what the 14th Amendment says. Could you remind me?”


I would also color code his homework folders, and then teach him which color represents a specific subject. By doing so, the likelihood of him remembering to put each subject’s homework in his schoolbag is higher. He should place the completed subject in the prescribed folder immediately upon finishing it. The more organized the child with ADHD’s environment, the higher likelihood that he will feel comfortable in knowing what to expect in terms of his responsibilities. In that way, he will become more accountable in terms of his personal items.

The Importance of Play as a Vehicle to Teach Social Skills to Young Children with ADHD

When I was teaching my graduate students last night, one of my students who is a student teacher in a kindergarten class asked me “How can I teach social skills in our kindergarten class when there is no playtime?” It appears, arguably, that kindergarten is the new college, where only academics are taught with no time for play included into the schedule. Those kindergarten children do not even have recess!



Play is a powerful learning context that helps a child to become engaged in social interaction with their peers with no predetermined outcome. Additionally, play helps to build a child’s creativity because those outcomes are due to trial and error.


Kindergarten and preschool is a time that is typically rich in terms of opportunities to teach social skills to children with ADHD. However, if young children with ADHD do not have the opportunity to play with their peers in school, how will they learn the positive social skills that they need to experience positive social experiences? The answer is that if those children do not have the opportunity to play during school, it will very difficult for them to learn those positive social skills.


Children with ADHD arguably need assistance and support from their teachers in order to learn social skills. Therefore, if the opportunities for social interaction are not part of their school day, the child with ADHD’s teachers will not be able to teach them the necessary social skills.


I often suggest to teachers that even though they are teaching academics, there are ALWAYS opportunities to embed the teaching of social skills into their academic subjects. I know that in active preschool and kindergarten classrooms where the children are involved in collaborative projects, there have to be ample opportunities for teaching positive social skills. Additionally, lunchtime is a perfect time to teach positive social skills, in terms of learning good manners, listening to others without interrupting, being respectful, among other social skills.


If you are an early childhood teacher who has children in your classroom who either have a diagnosis of ADHD or those whom you suspect have ADHD, please teach social skills intentionally through any opportunities that you can design. Remember: Children with ADHD with social skills problems become adults with ADHD who have social skills problems.

Today is a Question Forum

Hi Everyone:

Today is a day that I have dedicated as a question forum day. I will take any questions that you write to me, and will answer them quickly.  Are the following some of the topics about which you would like to ask?

• ADHD: What is is?
• A child with ADHD
• An adult with ADHD (perhaps you?)
• Social skills problems: What are they?
• A child who has social skills problems
• An adult who has social skills problems
• Other disorders besides ADHD that are accompanied by problems with social skills

Ask away!!!!!

Is your Child with ADHD Immature? How does that Immaturity Affect his Daily Existence?

As we are completing yet another year of school, have you asked yourself why your child or a student with ADHD in your class appears immature, as compared to the typical children in your home or classroom? Is there a delay in brain development in children with ADHD that causes them to be developmentally delayed approximately three years? Does knowing and understanding about that developmental delay help teachers and parents to manage children with ADHD in a more positive way?

I have previously discussed the definitive research that was completed by Shaw et al. (2007), concerning whether or not there was a delay in brain development in children with ADHD. Here is a quote from Dr. Shaw:

“The current study, really ever since ADHD was first described, there's been a debate about whether it represents a delay in brain development or whether it's due to a complete deviation away from normal brain development. To address this question we looked at the cortex and we measured the thickness of the cortex across thousands of points in the brain in about 450 kids, some with ADHD some without. And we looked at how the cortex developed. What we found is that in all children the cortex starts off quite thin it then gets thicker. It reaches its peak thickness and then starts thinner throughout adolescence. And the big difference we find in the current study was between the ADHD kids and the kids who didn't have ADHD was in the age at which they reached this milestone of peak cortical thickness throughout the brain. So for healthy kids they sort of peak around age 7 or 8, whereas the ADHD kids there delayed and they reach their peak at about age 10.”

“So while there was delay the sequence or the order in which the different parts of the brain matured was very similar in both the kids with ADHD and those who didn't have it. So if ADHD was a complete deviation away from normal brain development you'd expect the sequence to be completely disrupted and it wasn't. So we think this is pretty strong evidence that ADHD is more of a delay in brain development” (Retrieved April 6, 2011 from http://www.nih.gov/news/radio/nov2007/11302007adhd.htm).

So now that we know, according to the results of Shaw et al.’s (2007) definitive research, that children with ADHD mature approximately three years later than typical children, how does that affect our expectations for the child with ADHD? How does this information affect the parent’s daily interactions with their child? How does it affect the child’s teacher’s expectations for the child with ADHD?

Despite the results of this definitive research, teachers and parents, respectively, (rightfully so) have certain expectations and standards to which the children in their class and at home must adhere. The best that we can hope for is that both you and your child’s teacher have some understanding of the child with ADHD’s immaturity, which will help all of the adults in his life to manage these children in a more positive way.

That being said, we must encourage our children with ADHD to realize those expectations. Oftentimes children with ADHD do not think about others’ expectations for them. If they do not realize those expectations, how can they satisfy those expectations? The answer is if they do not realize the expectations that are set for everyone, they cannot meet them.

It is vital to do the following for our children with ADHD, so that they learn about the expectations that others set for them: (This list is for teachers and parents) (If the child with ADHD does not read, find some pictures that will cue them regarding their responsibilities.)

• Do not assume that if other children understand the expectations that are set for them, that children with ADHD are aware of those expectations

• Explain about expectations in general, as well as how they apply to individuals

• Talk to the child with ADHD either in one long conversation, or depending on his attention span, in a few short conversations about the following:

o grooming standards at home and at school

o housekeeping responsibilities at home, especially concerning his own possessions and his room

o an explanation of classroom responsibilities

o an explanation of behavioral expectations toward the teacher as well as toward his peers

o age-appropriate social skills (I would NOT use the word age-appropriate with the child, but as long as you are aware of what that phrase means, you can explain it to the child in a positive way)

o the change in the expectations for him for the next school year

It will be interesting to hear if by explaining the child’s expectations to him, he will become more flexible and responsive as related to how you and his teacher can help him to become accountable, as well as to begin to meet the daily expectations that others delineate for him.

Seeing Behavior Challenges as Lagging Skills: An Update on Collaborative Problem Solving

by Mark Katz, PhD

WHY ARE CHALLENGING CHILDREN SO CHALLENGING? Ross Greene, PhD, says the answer is simple: “They lack the skills not to be challenging.” Experts in the field of child neuropsychology, including some leading ADHD researchers, have been saying much the same thing.

To effectively control our behavior, regulate our emotions, communicate our needs, think flexibly and get along socially, we call upon a number of different skills. Children delayed in these skills often struggle behaviorally, socially, and emotionally. To help them, says Greene, we need to start by seeing challenging behaviors through “a new set of lenses.” His innovative Collaborative Problem Solving (CPS) model does just that.

The CPS approach, first highlighted in this column in October 2006, has helped countless parents, teachers, school administrators, and healthcare professionals learn to see a host of challenging behaviors through a new set of lenses. This is a necessary first step, says Greene, in successfully implementing CPS’s many other unique and innovative components.

Once lagging skills are successfully identified, CPS practitioners turn their sights to how they impact a child’s ability to meet everyday demands. For it is when everyday demands outweigh existing skills that challenging behaviors are set in motion, ranging from benign to extreme. Some children whine, some explode in fits of rage. Greene chooses not to describe behavioral reactions in diagnostic terms. Instead, they’re merely somewhere on what he call the “spectrum of looking bad,” a continuum of behaviors all human beings exhibit when they are not able to look good.

Wherever they lie on the spectrum, challenging behaviors relate directly to unsolved problems, like completing homework, completing assignments at school, or handling disappointment when you lose at a game. For some children, Greene observes, as few as two or three unsolved problems can account for seventy to eighty percent of their challenging episodes. He developed a one-page assessment and intervention guide, known as the ALSUP, or Assessment of Lagging Skills and Unsolved Problems (see sidebar) to help identify lagging skills and unsolved problems.

Three common approaches to handling challenging behaviors

Adults have three options for resolving unsolved problems with children: Plan A, Plan B, and Plan C. Plan A involves solving problems unilaterally, usually through imposition of adult will, often with adult-imposed consequences attached (“You’ll do it my way and that’s it”; “I’ll count to three – 1, 2, 3”). For children with lagging skills, Plan A can actually precipitate challenging behavior by further aggravating problems rather than resolving them. Indeed, it often results in an adult-child power struggle. Plan B involves solving problems collaboratively and is where CPS practitioners spend the bulk of their time with children. Plan C requires dropping an unsolved problem for now, because we’re working on a much higher priority issue at the moment.

Solving problems collaboratively, or Plan B, involves three steps (or ingredients): 1) Empathy, 2) Define the Problem, and 3) Invitation. The goal of the Empathy step is information gathering, but in a very nonjudgmental or neutral way; solutions come later. Adults first have to be very good listeners, so they can understand a child’s concern in the clearest and most accurate way possible. If we’re doing the Empathy step well, a child should feel heard. Next comes the Define the Problem step, when the adult’s concern is entered into consideration. Time is taken to ensure that it’s clarified, heard, and understood. Up to this point there has been no talk of solutions, just two concerns about an unsolved problem yet to be resolved. It’s in the third step, the Invitation, that solutions are discussed in a brainstorming process designed to address the two concerns.

A solution is not reached in CPS until both the adult and the child agree that the solution is acceptable. Among its many other innovative features, CPS not only focuses on a child’s concerns, but on the adults’ concerns as well. Whether it’s a parent, teacher, or staff member in a residential treatment center, the process requires that the adult and the child arrive at a mutually agreed-upon solution to an unsolved problem. “It takes two to tango,” says Greene. Many treatment strategies focus on a child’s problem, separate from the impact it might be having on the important adults in the child’s life. CPS places the focus on a relationship. And when mutually satisfactory solutions are reached, a relationship can grow even stronger than it already is.

Another distinguishing feature of CPS is that it works directly on important and predictable unsolved problems. It makes the process clear, focused, and meaningful, both to the child and to the adult. Another benefit is that children receive a lot of practice in learning how to listen, how to understand the perspective of others, and to see how their behavior impacts those to whom they feel connected. Adults get a lot of practice in these skills as well. And when adults and children continually engage in Plan B resolutions of unsolved problems, children’s lagging skills grow stronger. Rather than focusing directly on improving lagging skills in hopes of resolving unsolved problems, CPS practitioners work on successfully resolving unsolved problems collaboratively, which in turn serves indirectly to improve lagging skills.

“How do we know when CPS is working?” Several ways, according to Greene. A child begins to engage in Plan B openly and starts to talk about meaningful information related to personal concerns. Trust is increasing and the relationship feels like it’s growing stronger. Unsolved problems are being resolved, and their number is decreasing. Slowly but surely, lagging skills are also being trained. And the adult engaged in the CPS process is more optimistic about better days down the road.

Lives in the Balance

Greene founded Lives in the Balance, a nonprofit organization that provides free web-based resources to parents, teachers, clinicians, and others to help them understand children prone to behavioral challenges through this new set of lenses. Visitors to the site can learn about CPS in impressive detail through articles, training handouts, streaming videos of an actual full-day training on CPS conducted by Greene, and streaming videos of CPS in action in real-life vignettes.

They can also access a Listening Library that contains recorded archives from the three weekly web-based radio programs Greene conducts. One focuses primarily on applying CPS at home, a second on its application at school, and a third for implementing the model in restrictive therapeutic facilities. Dates and times of upcoming radio broadcasts are also listed for those wishing to call in live. Among its many other features, the website also provides an advocacy component, where individuals wishing to communicate with adults whom they feel could benefit from learning about CPS can, for a fee, send those adults an anonymous package of materials explaining the CPS process. Visit livesinthebalance.org to learn more about CPS.

CPS and Response to Intervention

Rather than waiting for struggling children to fail before determining whether they qualify for special education services, Response to Intervention (RtI) is designed to identify the earliest signs of an academic or behavioral problem and to provide evidence-based interventions that can strengthen skills and resolve behavioral challenges before they grow more serious. Unique to this paradigm is its ongoing (formative) assessment process known as progress monitoring, which provides a continuous picture of a child’s “response to intervention.”

If interventions are successful they can either be continued or faded out. If unsuccessful, more intensive interventions can be implemented, and again monitored closely to determine their effectiveness. This represents a significant departure from how children have traditionally qualified for additional help for learning, behavior, social, or emotional difficulties. No longer do children have to fail repeatedly before help is forthcoming.

For those addressing challenging behaviors within an RtI paradigm, Greene believes that CPS can be a very helpful tool for children who show early warning signs of more serious problems. In school, challenging behaviors are not often viewed as a function of lagging skills. But by seeing the behaviors through “new lenses” as a function of lagging skills, we incorporate experiences in the struggling child’s life that can help him or her improve lagging skills. “Our explanation guides our intervention,” says Greene. CPS may have an important role to play in preventing and reducing challenging behaviors among school-age children, but successfully implementing it in schools may require that we treat challenging behaviors more like we treat learning disabilities, more as a function of specific skill deficits needing to be strengthened.

In addition to previously conducted studies, several large-scale independent studies of the effectiveness of CPS are currently underway. These include a five-year NIMH-funded study at the Virginia Tech Child Study Center and a large-scale study involving twelve public schools in Maine (funded by the Maine Juvenile Justice Advisory Group).

________________________________________

A clinical and consulting psychologist, Mark Katz is the director of Learning Development Services, an educational, psychological, and neuropsychological center located in San Diego. He is a contributing editor to Attention magazine and a member of its editorial advisory board, a former member of CHADD’s professional advisory board, and a recipient of the CHADD Hall of Fame Award.

This article originally appeared in the April 2011 issue of Attention magazine. Copyright © 2011 by Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD). All rights reserved.









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