Attention Deficit Hyperactive Disorder (ADHD) is a genetically inherited neurological disorder for which the diagnostic criteria specifically include impulsivity, attention deficits and hyperactivity. In addition to attention deficits, ADHD children often have specific learning disorders. The condition of ADHD may affect every area of a child’s functioning especially academic ability and behaviour, as well as social skills, co-ordination and health. A child without the over-activity does not attract attention and is more likely to be overlooked. Often people don’t realise that the child has difficulties which are not being addressed.
Medication (usually Ritalin, Concerta or Strattera) is the most common form of treatment. Professor Andre Venter, Paediatrician, stated that up to 80% of ADHD children respond to treatment with medication. Some parents reject its usage, preferring a more natural approach such as dietary and lifestyle interventions. Others combine medication and dietary intervention. Many parents don’t know which would be the better route for their children and end up anxious and guilt-ridden, worrying that they may not have made the right decision. This is a special plea to teachers to respect their choices – please don’t make a parent feel guilty because they have opted for medication; on the other hand please assist if the child is on a diet which avoids certain additives (eg artificial colourants). Don’t hand out jelly babies or other brightly coloured sweets as rewards. (Rather contact ADHASA and find out which sweets would be more suitable).
ADHD is closely associated with under-achievement at school and, for most, this is when the condition is first noticed or diagnosed.
HOW DOES ONE DEAL WITH AN ADD/ADHD CHILD IN THE CLASSROOM?
Read and learn about the condition and try to understand how it impacts upon the class, the teacher and the child himself. ADHD children are so often misunderstood and rejected that they will go out of their way to do the right thing for someone who supports and understands them. Parents also need to be educated about ADHD and, for optimum results, their co-operation and support are necessary.
The following areas regularly cause tremendous difficulty for the child and educators:
- ORGANISATION SKILLS: ADHD children usually have very poor organisation skills which may affect:
- Their ability to dress themselves, especially in the early school years.
- Bringing the right books and equipment to school.
- Desk organisation
- Academic performance, particularly maths and comprehension.
Initially teacher may have to help the child with his basic organisation e.g. tidy desk, help choose correct books, write down homework etc. Parents are asked to help by checking homework and sending the books and equipment to school.
- TACTILE DEFENSIVENESS, although not a recognised symptom of ADHD, is a condition which affects many children. It could also precipitate seemingly aggressive behaviour which mimics that of hyperactivity: Gentle or casual touch, usually pleasant and comforting to others, is registered as irritating or even painful. These are the children who shrink back when teacher puts her hand on their head or shoulder – who are obviously unhappy when somebody lightly touches their arm. They may also be super-sensitive to clothing because it irritates or feels scratchy and are often refuse to wear jerseys in winter preferring the cold to the unpleasant sensation of the garment. If the touch is unexpected, especially when it comes from behind, it may be interpreted as an attack which demands retaliation. These are the children who regularly fight on the playground or when standing in line. To the uninformed spectator the child seems unnecessarily aggressive but he is, in fact, reacting to others jostling against him (which he interprets as an attack). Avoid having the child stand in the middle of the line … put him at the back or give him a job which entails him standing next to rather than in the line. In the same way, seating position in the classroom is most important. Sensory Integration Therapy is effective, especially for young children. (In my experience these children respond to supplementation of Essential Fatty Acids as well as the co-nutrients needed to metabolise them)
- POSITION IN THE CLASSROOM can strongly influence the child’s performance. Ideally he needs to be near his teacher so that she can keep an eye on him and assist or prompt where necessary. Some children function best when their desk touches the teacher’s table – as long as the child does not interpret this as a punishment. However, this may be a disaster if the table is in the middle in front of the room because the tactile defensive child then has no way of telling who is going to throw the next paper ball or dart at him. He spends so much time worrying about such events that he is even less able to concentrate; and so should be against the wall but not next to a window.
These children may cope best at the back of the classroom where there is no threatened danger from behind. Some ADHD children like to box their desk in between a cupboard and the wall as this protects them from being distracted by those around them.
- DISTRACTIBILITY provides tremendous challenge to these children. They have great difficulty concentrating and maintaining focus – unless they are totally absorbed by the subject matter. The slightest distraction, such as a fly buzzing by, is enough to claim his attention and leave him completely oblivious of anything that is happening in the classroom.
Décor in the classroom is also important. If the child is next to a brightly decorated wall, this could totally distract him. (Teacher’s brightly coloured, floral patterned dress could do the same.) However, avoid making his corner too dull otherwise the ADHD child would then have to manufacture his own stimulation. Extreme distractibility becomes even more obvious when the very active child has been sitting in the classroom for a while and needs to dispel some of his excess energy. Rather than demanding that the child control himself (a nearly impossible task), send him on an errand and when he returns he will find it much easier to settle down. Avoid keeping these children in during break as a punishment. They need the opportunity to run around so that they can get rid of all that pent-up energy and are able to settle down after the break.
- THEY DO NOT PAY ATTENTION TO TEACHER OR FOLLOW INSTRUCTIONS
Immediately after the teacher has given the most detailed instructions, her ADHD child pupil puts up his hand and asks what he is supposed to be doing!!! He hasn’t registered a single word.
Hearing tests are often indicated for ADHD children. Research in the UK conducted by the Hyperactive Children’s Support Group showed that 50-60% of ADHD children who took part in the project had already had ear infections, and a child with recurrent ear infections is more likely to develop hearing problems. However, this is not necessarily the reason for the child not knowing what the teacher has said. Even if the ADHD child has perfect hearing, there might still be difficulty with him registering the message. This is especially noticeable when he is given a string of instructions e.g. “Take out your Maths books, turn to page 43 and do the first five sums.” He might have heard the first instruction but then is lost. (This also affects the ADHD child’s ability to remember a story – they remember the first few facts and then they know nothing about the rest.) The teacher could develop a few strategies to help the child: together they could work out a secret code. For example, when the child folds his arms it is a signal that he needs help and the teacher can then meander in his direction without the rest of the class realizing that he doesn’t know what to do. In the same way they could decide upon a code that the teacher could use (eg play with her left earring or reposition his pencil on his desk) to alert the child that he needs to settle down. It might even be necessary for the teacher to write his homework in his homework diary. This is an extra hassle but takes much less time than it would to punish the child for not doing his homework on the next day. Another solution could be to use the “buddy system” – seat him next to a quiet, capable, non ADHD child who could check that the child with ADHD has recorded homework etc and knows what to do. As long as the “buddy” is not affected or overwhelmed by the ADHD child, he could be a tremendous help.
- ESSENTIAL FATTY ACID (EFA) DEFICIENCY
This is linked to dietary intervention which has always been surrounded by controversy. In general the medical profession regards ADHD to be a neurological condition that requires treatment with medication. However, research has shown that supplementation with essential fatty acids (EFA) is important component in helping children with ADHD function at far higher levels. Correcting EFA deficiencies has helped children with concentration, behaviour, mood and all round performance. A healthy eating lifestyle and multivitamin and mineral supplementation have helped even more. Artificial colourants, synthetic flavourants and synthetic antioxidant preservatives should also be avoided. Research in the UK showed that up to 70% of children with ADHD improved with dietary intervention. ADHASA, the Attention Deficit and Hyperactivity Support Group of Southern Africa, has lists of products which are unlikely to affect a child with ADD/ADHD.
Contact them on 011-888-7655 weekday mornings.
- FINALLY …
Poor organisation skills, an EFA deficiency, tactile defensiveness, distractibility and other difficulties are bound to affect and aggravate a child’s behaviour. However, these children need to know the boundaries for their behaviour and abide by the rules, (which is very difficult for them). Compassionate discipline is the most effective.
Avoid tackling an ADHD child head on because this will only serve to bring out the aggression and make the child more determined to stand his ground. Try to understand the world as he sees and experiences it. Read books on behaviour modification but always make sure that the author has keen insight into ADHD. Probably the most important thing that a teacher can do for a child with ADHD is to help him overcome the difficulties he faces and to build his self image. A child with a good self image, and who believes in himself will be a much easier person to teach. A concerned teacher who can instill a feeling of confidence in a child with ADHD is providing a gift that could last a lifetime.