Attention-deficit hyperactivity disorder (ADHD) affects millions of children around the world.
Children with this condition have a poorer ability to focus attention, are overly active and sometimes impulsive in their behaviour.
There are 3 subtypes of ADHD
1. Mostly inattentive
Where the child is mostly unable to pay attention.
2. Mostly hyperactive / impulsive
Where the child is overly active and does things without any forethought.
3. Combined
Where both the above-mentioned symptoms present themselves.
Implementing strategies to support students with ADHD
Children with ADHD often do poorly in school, suffer from a low self-image and may not be able to form healthy or stable relationships with others due to their impetuous nature.
To help these students, there must be coordinated effort in the home, school and medical environments. All stakeholders (parents, caregivers, teachers, counsellors, doctors, and therapists) must work together as a team to support strategies implemented across these three areas.
In the home environment
Parents and caregivers must understand that their child cannot help his own behaviour.
They should manage their expectations of their child’s progress and be realistic about what their child can achieve based on the support they can provide.
1. Building structure within home life
Like other children, those with ADHD need structure to function well. One example is a fixed daily schedule detailing morning, afternoon, and evening routines.
Daily schedules can be presented on a large chart on the wall in the bedroom or in the living room, serving as a constant visual reminder of what to do next. For every item accomplished, a sticker reward can be given. Once 10-20 stickers are collected, they can be exchanged for a larger prize.
Source: Amazon
Bear in mind that it will take some time to reinforce the rules at home. All caregivers must be consistent in behaviour to elicit the appropriate response from the child, else the child will likely be more confused and develop self-doubt.
2. A suitable home environment for hyperactive children
For hyperactive or overactive children, the home should have as little furniture as possible to minimise opportunities for injury.
The child should not be left alone by himself at all. Window grilles need to be locked and sharp edges or corners should be covered to prevent accidents. Kitchen appliances and tools should be kept hidden away.
To burn off abundant energy, the child can be taken down to the park to run, cycle and play for at least an hour a day or more, if the weather permits and under adult supervision.
3. For children prone to distraction
Organisation
Desks for homework should be placed against a wall, away from windows or the door.
All stationery and books should be organised to be within easy reach. Parents can help organise their child’s subject worksheets in files that are colour-coded or numbered. Caregivers can teach the child to file his papers neatly and teach him to pack his schoolbag as well.
Please note that since planning and organisation are a subset of the executive function skills, it will take some time for the child to learn and inculcate them as part of his positive habits.
Improving attention span
For children with short attention spans, toys like Lego and puzzles will probably hold little interest.
Although it is tempting to put the child in front of the TV or computer to get some respite from caregiving, it is important to limit TV viewing or screen time. There is scientific evidence that fast-moving images can further overstimulate the brain, so much so that listening in a classroom setting can become a tiresome and boring task.
It is perfectly fine that the child suffers a little boredom every day. The child will probably whine and complain, and the caregiver might be extremely tempted to resort to turning on the TV or a video to keep the child occupied. Most parents will cave in - I did, all the time.
Even so, it might be better in the long run if the child can learn to find his own constructive activities, or if the parent can provide them.
An indication that the child’s attention span has improved is if the duration of time the child is engaged by these activities increases over the weeks and months. Every bit of progress counts!
In school
It is important that the school teacher is aware of the student’s condition so that the teacher can be sensitive to the student’s needs.
The teacher should be able to regulate their own emotions and reactions too, as handling an ADHD child in a classroom of 30-40 other students is extremely demanding.
1. Classroom management
As with the home, it is important to minimise as much distraction as possible.
Place the ADHD child away from doors and windows. If this is not possible, seat him in front of the teacher.
Clear instructions must be given, and if possible, written on the board to provide a visual stimulus. A timer can be used to indicate how much time should be spent on a task. Some flexibility can be given if students need more time.
Active students can also be given roles like passing out papers and books to allow them some time out of their seat; students with ADHD may find it hard to sit still for an extended amount of time.
2. Involving other students
A buddy or two could be assigned to the student with ADHD to help remind him of tasks and provide a little peer encouragement.
This must be done sensitively. Take care to make sure the student with ADHD does not feel inferior or inadequate. It is possible that the buddy is unwilling to help due to personality differences.
Regardless, all these are good teaching moments to inculcate empathy and positive values in the classroom, but they will take time.
3. Teaching strategies
Group work
A long-standing challenge of teaching is the size of the class. It is virtually impossible to teach a class of 30-40 students effectively. In the last 20-25 years, the solution to this was to break up the whole class in smaller groups of 5-8 students.
While group work should not replace explicit teaching completely, students with ADHD might benefit if it was carried out weekly or fortnightly. The interaction between the students, division and ownership of work, accountability, and even positive peer-influence can also elicit good behaviour.
No doubt teething problems may arise at first, but once teachers and students gain confidence in their own abilities and see that more meaningful interaction is possible, group work can provide the variety in the classroom activities needed to make learning more vibrant.
Online lessons
For online lessons, a good tool to use is the ‘breakout room’.
Primary school children may find it difficult to concentrate on long lectures that are more than 30 minutes long. This is even harder for ADHD students.
Teachers can plan shorter 20-minute sessions and rotate among the preassigned ‘breakout rooms’ to check on the students’ understanding and if they need additional help.
The smaller groups will also facilitate communication and make the experience less intimidating for all the students, not just those with ADHD.
4. Good communication with parents
There must be open and frequent communication between parents and teachers so that feedback can be acted upon in a timely manner.
It may even be necessary for the student with ADHD to be given fewer assignments than the rest of the class in the beginning. This is so the student with ADHD does not feel overwhelmed.
Medical Support
I once had a student come into the tuition centre for a trial lesson.
He could only focus for 10 minutes. Within half an hour he walked through all three rooms of the centre and nearly locked himself in one of the rooms. I quickly called the mother to come fetch him and told her I would not be able to teach him unless he could calm down.
Although I am not in favour of medicating the student with ADHD, when the student’s behaviour is so unpredictable that it has potential to be self-injurious, medical support will probably be in the student’s best interest.
Alternative Strategies
If the student’s behaviour is disruptive and prevents him from functioning in the mainstream school environment, the parents might consider home-schooling him until the PSLE.
Students with ADHD may suffer from lower self esteem and anxiety. It is not uncommon for these students to be the brunt of bullying. The abrupt behaviour and inability to be attentive may also cause friction with classmates and teachers.
While this is quite a drastic step, it could be a healthy option for the student if parents have the means and resources. Taking the student out of mainstream school and enrolling him in regular enrichment and tuition classes with smaller enrolments may be beneficial instead.
Keep going!
Children with ADHD are challenging to handle and raise as their behaviour can be unpredictable. In some cases the behaviour can even be extreme. Family rules and social norms will most likely be difficult to enforce or encourage.
Parents and caregivers must change their perceptions and understand that the child cannot help himself or his behaviour.
With encouragement, empathy and support, the child must also learn to change his behaviour. This will greatly influence his capacity to learn in a communal setting, be it a classroom, enrichment class or home-school environment.
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