1. Prepared by Ellen Young, Krista Heisinger Frost, and Michelle Hancock
Understanding and Responding to Behavioural Issues of Students with ADHD, Sensory Integration Dysfunction and ODD
Prepared by Ellen Young, Krista Heisinger Frost, and Michelle Hancock

2. What is Neurologically-Based Behaviour (NBB)? (Paula Cook, 2011)
About 10 % of students can’t reliably control what they say or do.
The overarching name for the behavioural condition they exhibit is NBB
NBB is behaviour that results from cerebral processes occurring in an abnormal manner that results in information not being processed correctly in the brain. The resulting behaviour is challenging, unpredictable, inconsistent and unresponsive to ordinary discipline.

3. 3 Indicators of NBB
1. Behaviour difficulties - atypical, inconsistent, compulsive or immune to normal behaviour management 2. Language Difficulties – problems understanding, processing, and expressing information verbally 3. Academic Difficulties – memory, fine and gross motor skills, comprehension, language and math skills deficits

4. Common Diagnoses within NBB:
Brain injuries
Attention-Deficit Hyperactivity Disorder
Oppositional Defiant Disorder
Bipolar Disorder
Anxiety Disorders
Fetal Alcohol Spectrum Disorder
Sensory Integration Dysfunction
Autism Spectrum Disorder
Learning Disabilities

5. Attention Deficit Hyperactivity Disorder (AD/HD)
Common neurobiological condition affecting 5-8 % of school age children (Barkley, 1998)
Symptoms persist into adulthood in approximately 60% of cases (4% of adults) (Kessler et al., 2006)
Characterized by developmentally inappropriate levels of inattention, and/or impulsivity and/or hyperactivity
Chronic, incurable condition

6. Possible Causes of AD/HD
The current model of the cause of AD/HD is rooted in the biological paradigm that emphasizes neurobiological, neuroanatomical and genetic mechanisms.
Research clearly indicates genetic factor; likely multiple interacting genes (Tannock, 1998; Swanson and Castellanos, 2002)
Other causal factors: low birth weight, prenatal maternal smoking, prenatal problems may also contribute (Connor, 2002)

7. Neurology of AD/HD (Barkley, 2005)
Structural differences in the brain and neurotransmitter: Dopamine and norepinephrine dysregulation (Barkley, 2005)
Smaller, less active, less developed brain regions (cerebellum, prefrontal cortex, basal ganglia)
Bad parenting is not a cause!

8. Proper Steps in Diagnosis – No single test
Clinical assessment of the individual’s academic, social and emotional functioning and developmental level in order to determine if DSM-IV diagnostic criteria are met
History : interviews with parents, teachers, child
Use rating scales and checklists (Conner’s Parent and Teacher rating scale, Barkley’s Home and School Situation Questionnaire); Continuous Performance Tests (TOVA)
Physical exam (to rule out other medical problems or to determine the presence or absence of co-existing conditions)

9. DSM IV
The American Psychiatric Association's Diagnostic and Statistical Manual-IV, Text Revision (DSM-IV) is used by mental health professionals (school and clinical psychologists, clinical social workers, doctors) to help diagnose ADHD. This diagnostic standard helps ensure that people are appropriately diagnosed and treated for ADHD.

10. The DSM-IV characterizes the following 3 subtypes of AD/HD: (
• Inattentive only (AD/HD-I) (formerly known as attention-deficit disorder [ADD])—Children with this form of AD/HD are not overly active. Because they do not disrupt the classroom or other activities, their symptoms may not be noticed. Among girls with ADHD, this form is most common. Approximately 30% to 40% of children with AD/HD have this subtype.
• Hyperactive/Impulsive (AD/HD-HI)—Children with this type of AD/HD show hyperactive and impulsive behavior but can pay attention. This subtype accounts for a small percentage, approximately 10%, of children with ADHD.
• Combined Inattentive/Hyperactive/Impulsive (AD/HD-C)—Children with this type of AD/HD show all 3 symptoms. This is the most common type of AD/HD. The majority of children with AD/HD have this subtype, approximately 50% to 60%.

11. Mimics
Anxiety, depression, mental retardation, sleep apnea, hypo/hyperthyroidism, Central Auditory Processing Dysfunction, severe sensory impairment, and learning disabilities may cause similar symptoms may actually be the primary diagnosis or may co-exist with AD/HD

12. Co-Existing Conditions (Baren, 2002)
Comorbidity
% among teens with ADHD
% in general teen population
Learning disability
20-60
5-15
Bipolar disorder
6-10
3-4
Major depression
9-32
3-5
Anxiety disorder
10-40
3-10
Conduct disorder
20-56
Unknown
ODD
20-67
2-16

13. Popular Misconceptions
AD/HD is environmentally caused
AD/HD is over diagnosed
Most kids outgrow symptoms (about 1/3 do)
AD/HD means inability to pay attention
AD/HD kids need to put in more effort
Kids notice benefits of medication
Consequences change behaviour
Stimulant medication leads to alcohol and substance abuse
ADHD affects males more than females

14. Importance of Early Identification and Intervention
Potential areas of impairment:
academic achievement
relationships: family and friends
low self-esteem
accidental injuries
Smoking and substance abuse
Motor vehicle accidents
Legal difficulties-delinquency
Occupational/vocational

15. ADHD and Juvenile Criminal Justice System (Robert Eme, American School of Professional Psychology, 2008)
2, 300,000 adults and 100,000 juveniles are incarcerated in the United States
At least 25% and up to 50% have ADHD
This holds true for incarcerated females; may even be more likely than males to have ADHD

16. Multi-modal Treatment: Medical, Educational and Behavioural Interventions
Parent and child education about diagnosis and treatment
Behaviour modification management techniques
Medication
Psychotherapy/Counseling (family; individual: self-esteem and coping skills)
Coaching (develop better habits, social skills training)
School programming (IEP, AEP, BIP)
Physical Exercise
Complementary and alternative medicine (CAM) for AD/HD such as elimination of: sugar, food additives, preservatives; EEG biofeedback are not supported in the literature (Rojas and Chan, 2005)
Severity and type of AD/HD should be considered

17. National Institute of Mental Health Study: Multimodal Treatment Study of Children with AD/HD (1999)
Children who were treated with medication alone (which was carefully managed and individually tailored) and children who received both medication and behavioural treatment experienced the greatest improvements in their AD/HD symptoms (attention, hyperactivity, impulsivity)
medication and behavioural treatment had added benefits for non-AD/HD symptom domains (parent-rated oppositional/aggressive symptoms, parent-child relations, teacher-rated social skills, internalizing symptoms, reading achievement)

18. Impact of Stimulant Medication
Increased:
Decreased:
Attention
Concentration
Compliance
Effort on tasks
Amount and accuracy of school work
Activity levels
Impulsivity
Negative behaviours
Physical & verbal hostility

19. Medication Impact (Dr. Russel Barkley)
Working memory
Self-talk, self-esteem and emotional control
Verbal fluency
Motor coordination, handwriting
Acceptance by and interaction with peers
Awareness of the game in sport
Decreased punishment by others

20. Behaviour Modification
The scientific literature, the National Institute of Mental Health and other professional organizations support stimulant medication and behaviourally oriented psychosocial treatments, also called behavior therapy or behavior modification, as effective treatments for AD/HD.

21. Behaviour modification teaches children specific techniques and skills:
children with AD/HD face problems beyond the core symptoms of inattention, hyperactivity and impulsivity
These include poor academic performance and behavior at school, poor relationships with peers and family members, and failure to obey adult requests.
to help improve their behavior
skills are reinforced by parents and teachers.

22. Behaviour modification is often put in terms of ABCs:
Antecedents: conditions or context in which problem behavior occurs
Behaviours: responses or actions that concern teacher or parent exhibited by the student
Consequences: events and behaviours that follow the occurrence of the problem behavior

23. Parents and teachers learn and establish programs in which:
the environmental antecedents (A) and consequences (C) are modified to change the child’s target behavour (B).
Treatment response is monitored via observation and measurement, and the interventions are modified when they fail to be helpful or are no longer needed.

24. Daily school-home report-card
This tool allows parents and teacher to communicate regularly, identifying, monitoring and changing classroom problems.
It is inexpensive and minimal teacher time is required.
Can use a report-card or simply a calendar with a smile or frown for each day

25. Teachers determine the individualized target behaviors
Teachers evaluate targets at school and send the report card home with the child.
Parents provide home-based rewards; more rewards for better performance and fewer for lesser performance.
Teachers continually monitor and make adjustments to targets and criteria as behavior improves or new problems develop.
Use the report card with other behavioral components such as commands, praise, rules, and academic programs.

26. Subjects
Science
Math LA SS
Gym
Class participation
Completes assigned work in class
Follows class rules
Gets along with others
Completes homework
Teacher Initials

27. Behaviour Interventions
Be consistent
Use positive reinforcement
Contracts
Token programs
Response cost
Redirection
Time-out/thinking areas
Teach problem-solving skills
Communication skills
Self-advocacy skills
List-making
Teach Agenda/day-planner use

28. 5 Effective Forms of Intervention for Peer Relationships
Systematic teaching of social skills
Teaching social problem solving (eg: early years: rock/paper/scissors)
Teaching other behavioral skills often considered important by children, such as sports skills and board game rules
Decreasing undesirable and antisocial behaviors
Help to develop a close friendship

29. Programs use methods that include:
Coaching
use of examples
Modeling, role-playing and practice
feedback, rewards and consequences,
Social skills training groups are the most common intervention and the focus is on the systematic teaching of social skills.

30. 90% of Children with ADHD have Academic Challenges
Written expression
Math (times tables and word problems)
Spelling and Reading
Overall low academic achievement scores
Disorganized, incomplete homework
Difficulty getting started (procrastination)
Impaired sense of time (it will take me forever to do this!)

31. Middle School: ADHD Brick Wall (Dendy, 2008)
Increased demands for executive functioning (management functions of the brain):
Organization
Memory
More complex academic work
Working independently
More homework
More complex routines (change classes/teachers)

32. Greatest Areas of Difficulty
Difficulty following multiple-step directions
Give written directions, ask child to repeat directions, chunk work into manageable units, use graphic organizers
Completing tasks in a timely manner
Use a timer (cellphone or watch), help child develop a plan (timeline), offer incentive, allow more time
Recall of rote details
use mnemonics, color-coding, use image association
Copying and writing
allow more time, give hand-outs or note frames, chunk work, laptop: type instead of hand-writing

33. Reframe Your Thinking Gifts of AH/HD
Students are:
Energetic
Creative
Risk-takers (in a good way)
Persuasive
Verbal
Big picture thinkers
Good long-term memory
Free thinkers
Mostly good looking

34. References
Baren, M. (2002). ADHD in adolescents: Will you know it when you see it? Contemporary Pediatrics, 19(5),
Barkley, R. (1998). Attention Deficit Hyperactivity Disorders: A Handbook for Diagnosis and Treatment. New York: Guilford Press.
Barkley, R. (2005). Attention Deficit Hyperactivity Disorders: A Handbook for Diagnosis and Treatment (3rd ed.). New York: Guilford Press.
Connor, D.R. (2002). Preschool Attention deficit hyperactivity disorder: A review of prevelance, diagnosis, neurobiology, and stimulant treatment. Journal of Developmental Behaviour Pediatrics 23 (1Suppl):S1-S9.
Dendy, C. Understanding the Impact of ADHD & Executive Functions on Learning and Behaviour. In: Proceedings of the ADDA 13th National Conference. Minneapolis, MN. pp
Eme, R. (2008). ADHD & The Criminal Justice System. In: Proceedings of the ADDA 13th National Conference. Minneapolis, MN. pp
Kessler, R.C., Adler, L., Barkley, R., Biederman, J. The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. Am Journal of Psychiatry (2006), 163:
MTA Cooperative Group. (1999). A 14-Month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, )

35. References
MTA Cooperative Group. (1999). Moderators and mediators of treatment responses for children with attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, )
Rojas, N.L., and Chan, C. (2005). Old and new controversies in the alternative treatment of attention-deficit hyperactivity disorder. Mental Retardation and Developmental Disabilities Research Reviews, 11:
Swanson, J.M., and Castellanos, F.X. (2002). Biological Basis of ADHD-Neuroanatomy, Genetics, and Pathophysiology. In P.S. Jensen and J.R. Cooper (eds.) Attention deficit hyperactivity disorder: State of the science, best practices, pp Kingston, New Jersey.
Tannock, R. (1998). Attention deficit hyperactivity disorder: Advances in cognitive, neurobiological, and genetic research. Journal of Child Psychology and Psychiatry, 39,

36. Sensory Processing Disorder or Sensory Integration Dysfunction36

37. Dr. A. Jean Ayres

38. Background Information
Also known as Sensory Processing Disorder
Dr. A. Jean Ayres first developed the theory of Sensory Integration Dysfunction in the 1960’s
Wrote two books –Sensory Integration and Learning Disorders in 1972 and Sensory Integration and the Child in 1979
Was an occupational therapist and developmental psychologist
Worked at the Institute for Brain Research at the University of California at Los Angeles.

39. What is Sensory Processing Disorder?
“Sensory integrative/ processing disorders are a set of conditions caused by an insufficient ability of the central nervous system to take in, register, modulate, perceive, and/or combine sensory experiences (input) from the environment around us.”
“The neural messages become disorganized as they travel up towards the higher brain centers. The messages may also become overly-amplified or diminished, and are hence unusable. Sensory inputs are the building blocks of learning and relating to our environment and the people in it.”
Video: What is SPD?

40. The Senses Body Centered Sensory Systems or “Near Senses”:
Interoceptive- internal organs- e.g. heart rate, hunger
Tactile- info received through the skin
Vestibular- movement-pull of earth’s gravity/balance
Proprioception- info from muscles and joints
The Five Basic Senses or “Far Senses”:
Sight
Sound
Taste
Smell
Touch
-Respond to external stimuli from the environment.
(Kranowitz,40,41)

41. Causes of SPD according to Dr. Ayres
Hereditary predisposition for minimal brain dysfunction
Environmental toxins – air contaminants, destructive viruses
Combination of hereditary and environmental toxins
Lack of oxygen at birth
Children who lead deprived lives- little contact with people or things
Neurological disorders
Internal sensory deprivation(sensory stimulation is present in the environment but the stimulation doesn’t nourish every part of the brain) (Ayres, 54-56)

42. The Symptoms or Behaviours Exhibited
Each child’s symptoms are different and unique, making it difficult to diagnose sensory processing disorder.
Hyperactivity and Distractibility - activity usually not purposeful, cannot “shut out” noises, lights, etc.
Behaviour Problems- not happy with self, fussy, overly sensitive; negative self concept- negative reactions from others
Speech Development- speech and articulation develops slowly
Dr. Cook redesigned her classroom routines with this feature of NBB in mind. 42

43. The Symptoms/ Behaviours Cont’d
Muscle Tone and Coordination- if vestibular, proprioceptive, and tactile systems are not working well- poor motor coordination results.
Learning at School- learning starts from the bottom of the brain and moves up– if the senses are disorganized then learning and behaviour problems will result
Teen-age Problems- may have learned how to compensate for sensory processing disorder– if not may drop out of school ---major lack of organization.
These symptoms are end products of inefficient and irregular sensory processing in the brain. (Ayres, 56-59)

44. An Evaluation by an Occupational Therapist Considers:
Perception and registration of sensorimotor information- what the child sees, hears, touches, tastes, and smells
How movement and gravity are experienced
Gathers information through clinical observations, sensory history, and standardized tests:
- “Can the child use sensorimotor experiences to learn, interact. explore, and demonstrate knowledge?
- Does the child respond negatively or with extreme behaviours (flight, fright, fight responses) to unexpected or light touch, unstable surfaces, loud noises, visual distractions, or certain tastes, textures, and smells?
- Can the child filter out irrelevant sensory input?”
(Williams, Shellenberger, 3)

45. The Brain’s Ability to Self Regulate
Mechanisms needed to self regulate:
Modulation- neural switches can turn on or off depending on activity level
Inhibition- reduce connections between sensory intake and behavioural output
Habituation – brain tunes out familiar sensory messages
Facilitation – connections between sensory intake and behavioural output
(Kranowitz, 42-44)

46. The Alert Program for Self- Regulation
Uses the analogy of a car engine to introduce self-regulation to students
The program can be adapted to all ages
It entails three stages: 1.identifying engine speeds, 2.experimenting with changing engine speeds, and 3.regulating engine speeds; with each stage consisting of a number of steps or mile markers.
Speeds are as follows: high (hyper, overexcited), low (sluggish, spacey) and just right (easy to learn and get along with others)
There are activities that can be used for each step and each step should be modelled for the student to be able to thoroughly understand the engine levels and how to change them
Program is designed to give students the ability to self regulate their engines according to the activity they are doing.
(Williams & Shellenberger)

47. Types of SPD
Sensory Modulation Dysfunction- the brain cannot regulate the amount of sensory information it allows to enter. (Hypersensitivity, hyperreactivity - registers sensations too intensely; and Hyposensitivity, hyporeactivity – not getting enough sensory information. (Kranowitz, 57-58)
Developmental Dyspraxia – child is unable to mentally visualize new movements. (Vestibular, proprioception and tactile systems are impaired)

48. Types of SPD Cont’d
Postural- Bilateral Integration Dysfunction- poor ability to use both sides of the body together; tendency not to cross the body midline; unusual fear /discomfort in certain positions (on tummy, moving backwards, going down stairs, riding on parents’ shoulders.
Video: Therapy

49. Sensory Integrative Therapy
“The central idea of this therapy is to provide and control sensory input especially the input from the vestibular system, muscles and joints, and skin in such a way that the child spontaneously forms the adaptive responses that integrate those sensations.” (Ayres, 140)
Most effective if child directs his own actions while therapist directs the environment.
“Motor activity is valuable in that it provides the sensory input that helps to organize the learning process-just as the body movements of early animals led to the evolution of a brain that could think and read.” (Ayres, 141)

50. The Balanced Sensory Diet
Need sensory input and experiences to grow and learn
A sensory diet is a planned and scheduled activity program designed and implemented by an occupational therapist to meet the child’s needs.
It includes a “combination of alerting, organizing and calming techniques that lead directly to the “near” senses. (Sandra Nelson,7)

51. Five Important Caveats
Carol Kranowitz (1998) writes it is important to remember these five caveats:
“The child with sensory dysfunction does not necessarily exhibit every characteristic. Thus the child with vestibular dysfunction may have poor balance but good muscle tone.”
“Sometimes the child will show characteristics of a dysfunction one day but not the next. For instance, the child with proprioceptive problems may trip over every bump in the pavement on Friday yet score every soccer goal on Saturday. Inconsistency is a hallmark of neurological dysfunction.”

52. Caveats Cont’d
3. “The child may exhibit characteristics of a particular dysfunction yet not have that dysfunction. For example, the child who typically withdraws from being touched may seem to be hypersensitive to tactile stimulation but may, have an emotional problem.” 4. “The child may be both hypersensitive and hyposensitive. For example, the child may be extremely sensitive to light touch, jerking away from a soft pat on the shoulder, while being rather indifferent to the deep pain of an inoculation.”

53. Caveats Cont’d
5. “Everyone has some sensory integration problems now and then, because no one is well regulated all the time. All kinds of stimuli can temporarily disrupt normal functioning of the brain, either by overloading it with, or depriving it of, sensory stimulation.” (Kranowitz, 61)

54. Is SPD a Real Diagnosis? Yes, it is a real diagnosis even though-
not enough significant scientific research through controlled studies to quantify, prove, or predict the symptoms and life course of this disorder.
“Research by the SPD Foundation indicates that 1 in every 20 children experiences symptoms of Sensory Processing Disorder that are significant enough to affect their ability to participate fully in every day life.” (

55. The Diagnostic and Statistical Manual -5th Edition (DSM-V)
“With extensive research and advocacy from the Sensory Processing Disorder Foundation, the American Psychiatric Association which publishes the Diagnostic and Statistical Manual -5th Edition (DSM-V) continues to consider the addition of “Sensory Processing Disorder” to the DSM-V.”
The new DSM-V will be published in 2013.

56. References
Ayres, Jean A. (1979). Sensory integration and the child. Los Angeles, CA: Western Psychological Services. Kranowitz, Carol S. (1998). The out-of-sync child: Recognizing and coping with sensory integration dysfunction. New York, NY: The Berkley Publishing Group. Kranowitz, Carol S. (2003). The out –of-sync child has fun: activities for kids with sensory integration. New York, NY: The Berkley Publishing Group Mucklow, Nancy. (2009). The sensory team handbook. Kingston, ON: Michael Grass House. Nelson, Sandra. Sensory integration dysfunction: “The misunderstood, misdiagnosed and unseen disability. 11/03/2011

57. References
Prainito Pediatric Therapy. What is sensory integration? 13/02/2011 Sensory processing disorder...Is SPD a real diagnosis? 11/03/2011 Sensory processing disorder checklist: Signs and symptoms of dysfunction. 11/02/2011 Sensory processing disorder checklist. 11/03/2011 Williams, M. and Shellenberger, S. (1994). “How does your engine run?” A leader’s guide to the alert program for self-regulation. Albuquerque, NM: Therapy Works Inc.

58. Oppositional-Defiant Disorder (ODD)

59. DSM-IV Characteristics of ODD
Oppositional Defiant Disorder
A. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:
(1)  often loses temper
(2)  often argues with adults
(3)  often actively defies or refuses to comply with adults' requests or rules
(4)  often deliberately annoys people
(5)  often blames others for his or her mistakes or misbehavior
(6)  is often touchy or easily annoyed by others
(7)  is often angry and resentful
(8)  is often spiteful or vindictive

60. DSM-IV Characteristics, ct’d
Note: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.
B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
C. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder.
D. Criteria are not met for Conduct Disorder, and, if the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

61. Risk Factors mother smoked during pregnancy
poor socioeconomic environment
parents display maladaptive behaviour (includes general family instability, alcoholism, drug addiction, criminality)
childhood abuse (including childhood sexual abuse) or exposure to violence between parents
cognitive ability (IQ)
association with peers who engage in deviant behaviour during early adolescence
Genetic link possible but not proven

62. Case Study: Kendra
Openly defiant, rude – meets criteria (and diagnosis is in place)
Peers exclude her (group work, classroom seating, frequently bounces from one social group to the other)
Parents divorced – lives with Mom
Mother does not return phone calls or s from the teacher
Referral to Divisional Psychologist was only first requested in Grade 9

63. Case Study, ct’d
Missed 24+ classes in first semester; Mom called the school to “excuse” all absences
Got into a fight at school (smashed a girl’s cell phone, so the girl smashed Kendra’s face into the floor) – signs of CD are already appearing
What is wrong with the system that a child would be so far-gone by the time they reach high school?

64. What Causes ODD? Possible pathway to ODD: starts during infancy
Some infants have a difficult temperament (about 15%) – think reciprocity – infant or not, it is difficult for many parents/caregivers to show constant love for a baby who is seldom happy
If primary caregiver (usually Mom) is rejecting/cold and inconsistent with the child, a disorganized pattern of attachment develops (child mistrusts primary caregiver)

65. Pathway to ODD, ct’d
Though children can develop late attachment (age 4-6), almost ALL children who have experienced very poor caregiving in the first years of life will develop adjustment problems.
So then, by the time the child arrives at school, a great deal of damage has already been done
If ODD is left untreated, it often progresses into Conduct Disorder and possibly Antisocial Personality Disorder – huge risk factors for criminality in adulthood.

66. Caveat There is no known cause for ODD.
Research indicates that such a pathway as the one just described seems to be more common, but it is not the only pathway to ODD.
ODD without diagnosis of another disorder is more likely to be attributable to a pathway such as the one described.

67. Treatment Options
Research is unanimous – treatment is MUCH more effective when the parents are supportive of the child’s treatment, and are willing to change themselves
Often, ODD is encouraged unwittingly by the parents
For instance, the child is throwing a tantrum – parents give in to the request just to get him to stop – child has learned to throw tantrums to get his way

68. Types of Treatment
ODD appears to be acquired through environmental factors – this is likely the reason why most research favours therapeutic techniques to treat ODD rather than medication.
HOWEVER – ODD is often comorbid with other disorders (usually AD/HD, but sometimes autism and depressive or anxiety disorders) – so these underlying conditions must be treated before ODD can be attended to.

69. What Happened with Kendra?
She does not have an EA for any of her classes (Level 1 funding only)
Past teachers have described coping techniques such as ignoring in order to “deal” with Kendra through the years.
She has been on the “wait-list” for the Divisional Psychologist since Nov. 2010
Her academic skills are below-level
She indicated to one teacher that she hopes to drop out of school as soon as she turns 16.

70. Working within a Flawed System
The public can be quick to condemn teachers and assign blame for students’ problems – however, parents need to work with us rather than against us if we want to see real change
Our school system is not horrible – but I believe our preschool care system is.
I wondered why I keep hearing about Germany (lowest dropout rate) and Finland (best academic results) in the news and did some digging

71. Germany and Finland: a quick tangent
As it turns out, maternity leave in both of these countries is among the best in the world.
Both countries have a paid leave (just under 1 year each) followed by an optional, additional unpaid leave… for up to the time the child turns three
Canada has 15 weeks maternity followed by 37 weeks parental leave
The USA has 0 weeks paid leave and a maximum legislated twelve weeks off work with no pay for mat leave

72. But I digress…
There are certainly patterns that emerge when comparing countries’ preschool care to school performance, but this is simply an observation… an interesting thought for future study and public policy reforms

73. So What CAN We Do?
What can be done with a student like Kendra, with a mother who refuses to work together with her child’s teachers?
The vice-principal suggested allowing Kendra to take breaks from the classroom – she does this during every class now and leaves for 15 minutes+ at a time… is this to her advantage?
The Special Education teacher who completed one classroom visit with one of Kendra’s teachers suggested the teacher show the child as much love as possible

74. What Can Be Done, Ct’d
The literature suggests the following strategies for teachers:
Seating: place student in a location where distracting stimuli are least present
Use daily schedules to eliminate the child’s opportunity for idle time
Give instructions clearly and simply, standing in front of the blank overhead screen to eliminate background distractions
Structure every moment of the day

75. More Strategies Manage the daily antecedents
Know what they are – usually:
Being told “no”
Being told to stop doing something
Hearing a sharp directive to begin doing something
Seeing any facial expression/gesture that conveys disapproval
Having idle time
Individual children also have their own antecedents – get to understand what these are and avoid them if possible

76. Strategies, Ct’d
Antecedents to enhance: allowing choice and foreshadowing activities.
Continue to try to involve the parents, BUT DO SO IN A NONJUDGMENTAL WAY. If you convey any judgment toward the parent, this will only serve to drive them away – even if the child developed ODD as a direct result of their personal qualities as a parent:
They certainly didn’t do it on purpose!
They feel frustrated themselves at being unsure how to help their child

77. Some Idealistic Realism
Governmental reforms are not the easiest or most likely resolution to the disjuncture between the quality of childcare prior to age 5 and entry into the public school system.
Resource Teachers/Guidance Counsellors/School Administration – could consider contacting daycares near the school to host a 1-hour evening session to talk about positive parenting strategies – this is part of being a leader.

78. Other Ideas
Schools need to do more to encourage parents to come in to meet the teachers – why not a Fun Fair, a barbecue, etc. The relationship with parents is absolutely crucial to the success of students with severe behaviour disorders
Teachers – we cannot diagnose, we cannot suggest conditions… we can report symptoms. So why not keep a selection of brochures available in the classroom – then at parent-teacher night, parents may feel more inclined to grab some reading material than to feel as though they’re being judged on the quality of their parenting

79. Lastly…
More needs to be done during teacher training programs to prepare new teachers for these realities. Teachers who don’t immediately return to school for a PBDE are missing out on a lot of important information!
References – see hard copy of final assignment

80. Diagnostic Criteria for ADHD
5 symptom-related criteria for diagnosis
Use modified version of DSM-IV for general public found on Center for Disease Control and Prevention website (

81. A. Either 1 (Inattention) or 2 (Hyperactivity-impulsivity):

82. (1) Inattention:
six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

83. (1) Inattention:
(a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
(b) often has difficulty sustaining attention in tasks or play activities
(c) often does not seem to listen when spoken to directly
(d) often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
(e) often has difficulty organizing tasks and activities

84. (1) Inattention continued
(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
(g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
(h) is often easily distracted by extraneous stimuli
(i) is often forgetful in daily activities

85. (2) Hyperactivity-impulsivity:
six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive inconsistent with developmental level:

86. : Hyperactivity
(a) often fidgets with hands or feet or squirms in seat
(b) often leaves seat in classroom or in other situations in which remaining seated is expected
(c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
(d) often has difficulty playing or engaging in leisure activities quietly
(e) is often "on the go" or often acts as if "driven by a motor"
(f) often talks excessively

87. Impulsivity
(g) often blurts out answers before questions have been completed
(h) often has difficulty awaiting turn
(i) often interrupts or intrudes on others (e.g., butts into conversations or games)

88. B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years. C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home). D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

89. E. The symptoms do not occur exclusively during the course of:
a Pervasive Developmental Disorder
Schizophrenia, or other Psychotic Disorder
are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).