Intervention

Managing ADD/ADHD in the classroom

Teachers know what many professionals do not: that there is no one syndrome of ADD (Attention Deficit Disorder) but many; that ADD rarely occurs in "pure" form by itself, but rather it usually shows up entangled with several other problems such as learning disabilities or mood problems; that the face of ADD changes with the weather, inconstant and unpredictable; and that the treatment for ADD, despite what may be serenely elucidated in various texts, remains a task of hard work and devotion. There is no easy solution for the management of ADD in the classroom, or at home for that matter. after all is said and done, the effectiveness of any treatment for this disorder at school depends upon the knowledge and persistence of the school and the individual teacher.

Here are a few tips on the school management of the child with ADD. The following suggestions are intended for teachers in the classroom, teachers of children of all ages. Some suggestions will be obviously more appropriate for younger children, others for older, but the unifying themes of structure, education, and encouragement pertain to all.

First of all, make sure what you are dealing with really is ADD. It is definitely not up to the teacher to diagnose ADD, but you can and should raise questions. Specifically, make sure someone has tested the child's hearing and vision recently, and make sure other medical problems have been ruled out. Make sure an adequate evaluation has been done. Keep questioning the SENCo until you are convinced.

Second, build your support. Being a teacher in a classroom where there are two or three kids with ADD can be extremely tiring. Make sure you have the support of the school and the parents. Make sure there is a knowledgeable person with whom you can consult when you have a problem (learning specialist, child psychiatrist, social worker, educational psychologist, pediatrician - the person's degree doesn't really matter. What matters is that he or she knows lots about ADD, has seen lots of kids with ADD, knows their or her way around a classroom, and can speak plainly.) Make sure the parents are working with you. Make sure your colleagues can help you out.

Third, know your limits. Don't be afraid to ask for help. You, as a teacher, cannot be expected to be an expert on ADD. You should feel comfortable in asking for help when you feel you need it.

ASK THE CHILD WHAT WILL HELP. Children can often tell you how they can learn best if you ask them. They are often too embarrassed to volunteer the information because it can be rather eccentric. But try to sit down with the child individually and ask how he or she learns best. By far the best "expert" on the how the child learns best is the child himself or herself. It is amazing how often their opinions are ignored or not asked for. In addition, especially with older kids, make sure the child understands what ADD is. This will help both of you a lot.

Having taken the aboveinto account, try the following:

Remember that ADD kids need structure. They need their environment to structure externally what they can't structure internally on their own. Make lists. Children with ADD benefit greatly from having a table or list to refer back to when they get lost in what they're doing. They need reminders. They need previews. They need repetition. They need direction. They need limits. They need structure.

REMEMBER THE EMOTIONAL PART OF LEARNING. These children need special help in finding enjoyment in the classroom, mastery instead of failure and frustration, excitement instead of boredom or fear. It is essential to pay attention to the emotions involved in the learning process.

Post rules. Have them written down and in full view. The children will be reassured by knowing what is expected of them.

Repeat directions. Write down directions. Speak directions. Repeat directions. People with ADD need to hear things more than once.

Make frequent eye contact. You can "bring back" an ADD child with eye contact. Do it often. A glance can retrieve a child from a daydream or give permission to ask a question or just give silent reassurance.

Seat the ADD child near your desk or wherever you are most of the time. This helps stave off the drifting away that so bedevils these children.

Set limits, boundaries. This is containing and soothing, not punitive. Do it consistently, predictably, promptly, and plainly. DON'T get into complicated, lawyer-like discussions of fairness. These long discussions are just a diversion. Take charge.

Have as predictable a schedule as possible. Post it on the blackboard or the child's desk. Refer to it often. If you are going to vary it, as most interesting teachers do, give lots of warning and preparation. Transitions and unannounced changes are very difficult for these children. They become discombobulated around them. Take special care to prepare for transitions will in advance. Announce what is going to happen, then give repeat warnings as the time approaches.

Try to help the kids make their own schedules for after school in an effort to avoid one of the hallmarks of ADD: procrastination.

Eliminate or reduce frequency of timed tests. There is no great educational value to timed tests, and they definitely do not allow many children with ADD to show what they know.

Allow for escape valve outlets such as leaving class for a moment. If this can be built into the rules of the classroom, it will allow the child to leave the room rather than "lose it," and in so doing begin to learn important tools of self-observation and self-modulation.

Go for quality rather than quantity of homework. Children with ADD often need a reduced load. As long as they are learning the concepts, they should be allowed this. They will put in the same amount of study time, just not bet buried under more than they can handle.

Monitor progress often. Children with ADD benefit greatly from frequent feedback, it helps keep them on track, lets them know what is expected of them and if they are meeting their goals, and can be very encouraging

Break down large tasks into small tasks. This is one of the most crucial of all teaching techniques for children with ADD. Large tasks quickly overwhelm the child and he recoils with an emotional "I'll-NEVER-be-able-to-do-THAT" kind of response. By breaking the task down into manageable parts, each component looking small enough to be do-able, the child can sidestep the emotion of being overwhelmed. In general, these kids can do a lot more than they think they can. By breaking tasks down, the teacher can let the child prove this to himself or herself. With small children this can be extremely helpful in avoiding tantrums born of anticipatory frustration. And with older children it can help them avoid the defeatist attitude that so often gets in their way. And it helps in many other ways, too. You should do it all the time.

Let yourself be playful, have fun, be unconventional, be flamboyant. Introduce novelty into the day. People with ADD love novelty. They respond to it with enthusiasm. It helps keep attention - the kids' attention and yours as well. These children are full of life - they love to play. And above all they hate being bored. So much of their "treatment" involves boring stuff like structure, schedules, lists, and rules, you want to show them that those things do not have to go hand in hand with being a boring person, a boring teacher, or running a boring classroom. Every once in a while, if you can let yourself be a little bit silly, that will help a lot.

Still gain, watch out for overstimulation. Like a pot on the fire, ADD can boil over. You need to be able to reduce the heat in a hurry. The best way of dealing with chaos in the classroom is to prevent it in the first place.

Seek out and underscore success as much as possible. These kids live with so much failure, they need all the positive handling they can get. This point cannot be overemphasized: these children need and benefit from praise. They love encouragement. They drink it up and grow from it. And without it, they shrink and wither. Often the most devastating aspect of ADD is not the ADD itself, but the secondary damage done to self-esteem. So water these children well with encouragement and praise.

Memory is often a problem with these kids. Teach them little tricks like mnemonics, flashcards, etc. They often have problems with what Mel Levine calls "active working memory", the space available on your minds table, so to speak. Any little tricks you can devise - cues, rhymes, codes and the like- can help a great deal to enhance memory.

Use outlines. Teach outlining. Teach underlining. These techniques do not come easily to children with ADD, but once they learn the techniques it can help a great deal in that they structure and shape what is being learned as it is being learned. This helps give the child a sense of mastery DURING THE LEARNING PROCESS, when he or she needs it most, rather than the dim sense of futility that is so often the defining emotion of these kids' learning process.

Announce what you are going to say before you say it. Say it. Then say what you have said. Since many ADD children learn better visually than by voice, if you can write what you're going to say as well as say it, that can be most helpful. This kind of structuring glues the ideas in place.

Simplify instructions. Simplify choices. Simplify scheduling. The simpler the verbiage the more likely it will be comprehended. And use colourful language. Like colour coding, colourful language keeps attention.

Use feedback that helps the child become self-observant. Children with ADD tend to be poor self-observers. They often have no idea how they come across or how they have been behaving. Try to give them this information in a constructive way. Ask questions like, "Do you know what you just did?" or "How do you think you might have said that differently?" or "Why do you think that other girl looked sad when you said what you said?" Ask questions that promote self-observation.

Make expectations explicit.

A point system is a possibility as part of behavioural modification or reward system for younger children. Children with ADD respond well to rewards and incentives. Many are little entrepreneurs.

If the child seems has trouble reading social cues - body language, tone of voice, timing and the like - try discreetly to offer specific and explicit advice as a sort of social coaching. For example, say, "Before I tell your story, ask to hear the other person's first," or, "Look at the other person when he's talking." Many children with ADD are viewed as indifferent or selfish, when in fact they just haven't learned how to interact. This skill does not come naturally to all children, but it can be taught or coached.

Teach test-taking skills.

Make a game out of things. Motivation improves ADD.

Separate pairs and trios, whole clusters even, that don't do well together. You might have to try many arrangements.

Pay attention to connectedness. These kids need to feel engaged, connected. As long as they are engaged, they will feel motivated and be less likely to tune out.

Try a home-to-school home notebook. This can really help with the day-to-day parent-teacher communication and avoid the crisis meetings. It also helps with the frequent feedback these kids need.

Try to use daily progress reports.

Encourage and structure for self-reporting, self-monitoring. Brief exchanges at the end of class can help with this. Consider also timers, buzzers, etc.

Prepare for unstructured time. These kids need to know in advance what is going to happen so they can prepare for it internally. If they are suddenly given unstructured time, it can be over-stimulating.

Prepare for unstructured time. These kids need to know in advance what is going to happen so they can prepare for it internally. If they suddenly are given unstructured time, it can be over-stimulating.

Praise, stroke, approve, encourage, nourish.

With older kids, have then write little notes to themselves to remind them of their questions. In essence, they take notes not only on what is being said to them, but what they are thinking as well. This will help them listen better.

Handwriting is difficult for many of these children. Consider developing alternatives. Learn how to use a keyboard. Dictate. Give tests orally.

Be like the conductor of a symphony. Get the orchestra's attention before beginning (You may use silence, or the tapping of your baton to do this.) Keep the class "in time" , pointing to different parts of the room as you need their help.

When possible, arrange for student to have a "study buddy" in each subject, with phone number (adapted from Gary Smith).

Explain and normalize the treatment the child receives to avoid stigma.

Meet with parents often. Avoid pattern of just meeting around problems or crises.

Encourage reading aloud at home. Read aloud in class as much as possible. Use story-telling. Help the child built the skill of staying on one topic.

Repeat, repeat, repeat.

Exercise. One of the best treatments for ADD in both children and adults, is exercise, preferably vigorous exercise. Exercise helps work off excess energy, it helps focus attention, it stimulates certain hormones and neurochemicals that are beneficial, and it is fun. Make sure the exercise IS fun, so the child will continue to do it for the rest of his or her life.

With older children, stress preparation prior to coming into class. The better idea the child has of what will be discussed on any given day, the more likely the material will be mastered in class.

Always be on the lookout for sparking moments. These kids are far more talented and gifted than they often seem. They are full of creativity, play, spontaneity, and good cheer. They tend to be resilient, always bouncing back. They tend to be generous of spirit, and glad to help out. They usually have a "special something" that enhances whatever setting they're in. Remember, there is a melody inside that cacophony, a symphony yet to be written.

ASD Links

Cerebral Palsy

The best site we have found is www.cerebralpalsyguidance.com

Cerebralpalsyguidance.com is a comprehensive informational website on cerebral palsy and behavioral health. The founder is someone who’s lived with cerebral palsy since infancy, he knows how critical it is for parents of a child with CP to have access to reliable and comprehensive information on this complex condition.

Site includes advice about a wide range of therapies aimed at treating and maintaining the physical and mental well being of children and adults with cerebral palsy and/or behavioral and cognitive disorders. 

 

Mind Mapping (spider Diagrams)

Mind mapping or spider diagrams are a very useful way of recording information.  It is a useful revision technique as well as being an excellent way of encouraging processing of information into chunks.  It is often recommended for children who experience writing difficulties.  Furthermore, it is a useful technique for children who have some form of language disorder, as the chunking of information helps them develop comprehension skills and assists in the formation of mental links. 

If you find it difficult to persuade your child's school to adopt this or other alternative methods of recording it may be helpful seek advice from an Educational Psychologist. The resulting recommendations may prove helpful to the school and help facilitate changes that help the child fully access the curriculum.

Follow this link which demonstrates very good free mind mapping software

Find an Educational Psychologist read more about Alternative methods of recording 

Seek e mail advice 

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Relaxation Therapy

The use of a relaxation programme can be a very powerful instrument for change.  If you decide to use this technique, it is crucial that it is done at least six times per week.  It is a useful tool when dealing with children who are anxious, either generally, or in a specific context such as exam rooms.  It is useful when dealing with children who tend to present regular or occasional acts of extreme anger in the wrong context, and when anger is an inappropriate reaction to the offence if used as part of an anger management programme. 

 

As part of a conservative approach to the treatment of ADHD, or as part of a treatment programme that includes medication; it can be a crucial part of the overall intervention.  You can hear an example of how to deliver the script on this Youtube video. Use the script to make a recording for the child to use..  The child should commit to engaging in this activity every day.  After one month the child will have become skilled at checking for tension in their body.  At this point, a cue is needed for the child to check themselves for tension.  Usually a red dot on their watch.  If they do not wear a watch, then perhaps a mark on their school bag or for very young children a toy placed in the classroom in a place where they will tend to look fairly regularly.  Particularly with young children, active and regular intervention by the teacher and parent should be undertaken. Gently touching the child on the shoulder and saying "go floppy" is a useful technique for this.  Whenever the cue is heard or seen the child should take a moment to check themselves for tension and then let go of it.  After a period of time, approximately three to six months the intervention will die naturally.  The child will be automatically checking themselves for tension and releasing it without the use of a prompt.  The use of the tape can then be stopped. Some children like to listen to the tape whilst laying on a bean bag, although this is fine, the activity is best done whilst sitting.

Should this intervention not produce the desired results, or if you feel your child needs a more complex intervention, it may be useful to seek advice.

Seek advice from a psychologist        

Relaxation Script

Sit comfortably close your eyes and think of nothing. 

Now make your hands into fists, go on really squeeze those fists.  Feel that tight feeling,----- feel that tight feeling. ------ And now relax/go floppy. ----- Think of that lovely feeling of relaxation (or think of that lovely floppy feeling for younger children.) 

Make your hands into tight fists again and bring your hands up to touch your shoulders. Feel that tight feeling along your arms.  Feel the tight feeling and relax, think of that lovely feeling of relaxation (or think of that lovely floppy feeling.) 

Now relax your arms, let them hang loosely by your side.  Push your shoulders up and try and touch your ears.  Go on really push upwards. Feel that tight feeling in your shoulders.  Feel the tight feeling and relax, think of that lovely feeling of relaxation (or think of that lovely floppy feeling.) 

This time scrunch up your face.  Really scrunch up your face. Feel that tight feeling in you face and relax, think of that lovely feeling of relaxation (or think of that lovely floppy feeling). 

Now make your tummy muscles tight go on really tighten those muscles. Feel that tight feeling.  Feel the tight feeling and relax, think of that lovely feeling of relaxation (or think of that lovely floppy feeling.) 

Push your tummy forward this time, make your back arch, feel the tight feeling all along your back, feel that tight feeling and relax, think of that wonderful feeling of relaxation. 

Tighten the muscles in your legs, feel those muscles tightening, feel that tight feeling and relax. Feel that tight feeling along your arms.  Feel the tight feeling and relax, think of that lovely feeling of relaxation (or think of that lovely floppy feeling.) 

Now make yours toes into fists, really scrunch up those toes.  Feel that tight feeling.  Feel the tight feeling and relax, think of that lovely feeling of relaxation (or think of that lovely floppy feeling.) 

Take a deep breath hold that breath, feel that tight feeling in your lungs, feel the tight feeling now let the breath out slowly and feel all the tightness go away.   Think of that lovely feeling of relaxation (or think of that lovely floppy feeling.) 

Keep your eyes closed, we are going to check each part of your body to see if there is any tightness.  Think of your hands and arms if there is any tightness just let go of it.  Now check your shoulders, neck and face.  If you find any tightness just let go.  Check your back and shoulders, your legs and feet.  If you find any tension just let go.   

You should now be feeling wonderful and relaxed/floppy.  Just enjoy that wonderful feeling and when you feel ready open your eyes.

Reading With Your Child

General Tips for Reading Together

 

  • Allow your child to see you reading.
  • Read with expression; read slowly.
  • The more your child participates in the story, the greater the understanding.
  • Encourage your child to participate by asking open ended questions that make your child think, such as, "What would you do?"
  • Alternate reading with your child; take turns reading a page or chapter each.
  • Along with a read aloud time, plan an independent reading time also.
  • Keep plenty of reading materials around the house.
  • Involve your child in selecting books as much as possible.
  • Matching the right book with the right child takes time. Be patient!
  • Make sure that you, as the reader, enjoy the story.
  • If a story isn't working, STOP READING!

FIND AN EDUCATIONAL  PSYCHOLOGIST

    Paired Reading

    Paired reading

    Paired reading is a very powerful technique, particularly with children who have lost confidence.  The pair comprises a skilled reader and a learner; they read the text together. When the learner wants to take over reading they give a signal, usually by tapping on the page. It is best to ask the learner what signal they would like to use. The essence of this technique is that the learner can decide when to read, it therefore follows that there should be no pressure, overt or covert, for the learner to read.  This will allow confidence to develop, as there is no fear of failure.  

    This technique can also be used to allow access to reading material that would ordinarily be beyond the learner.

    Process of Paired Reading

    1. Read along with the learner
    2. Adjust your speed so that you stay together.
    3. Repeat each misread word until the learner reads it correctly.
    4. Look for a prearranged signal to indicate the learner wants to read an easier section alone.
    5. Stop reading along when the learner gives the signal
    6. If the learner makes an error: say the word correctly, and read along again until the learner signals you to stop.
    7. Praise the learner frequently for correct reading

    Follow this link to see a video demonstration of paired reading

    FIND AN EDUCATIONAL  PSYCHOLOGIST

    Multisensory Teaching

    The following is an example of a very simple to use programme:

    A master list should be kept of all the words the child has difficulty reading or spelling.  Two words should be selected to work on each day and no more.  A selection of trays should be purchased, perhaps five, and they should be filled with dry ingredients such as rice, lentils, beans, etc.  Some magnetic plastic letters, a scratchy chalk board and chalk, some plasticine and a large squeaky non-permanent felt tip should also be purchased.  

    The first word is selected and the child should write this word in the sensory trays with their finger, make it with the magnetic letters (on the 'fridge perhaps), make it with plasticine and write it on the chalk board, and then on the fridge or a white board with the squeaky marker.  There are many other derivatives such as typing the word, writing the word in the air, running/walking the shape of the word in the garden, etc.  

    At the conclusion of the learning stage the child should be asked to read the word and to spell it when shown to him on a card.   They should be tested the next day, after one week, two weeks and a month and at that point if they have been correct at every stage the word will have become high frequency.  It can then be pinned on to a notice board where friends and relatives can see it and the child can show off his/her newly acquired reading and spelling skill and receive much acclaim.

    FIND AN EDUCATIONAL  PSYCHOLOGIST

    Managing Pupil Behavior- A Framework For Staff Problem Solving: Ideas For Initial Session

    A Framework for Staff Problem Solving: Ideas for an Initial Session

    AIMS

    To offer teaching staff involved with a specified group of pupils, i.e. class or year group, an opportunity to :

    1. Collectively consider, agree and start to plan behaviour management strategies

    2. Employ a problem solving model which is solution focused

    3. Think in a different way about the behaviour which pupils present

    PREPARATORY WORK FOR SESSION

    All staff involved will receive a brief questionnaire prior to the session, and are asked to answer 3 questions spontaneously and briefly:

    • What is your priority concern?
    • What strategy/approach have you found most helpful?
    • Can you briefly describe one idea for addressing X group’s difficulties?

    An example summary of responses from one group of staff  (15 teachers) is as follows:

    The problem/s (as seen by staff) were

     Pupils capacity to:

    • Work independently
    • To approach written assignments sensibly
    • To treat each other with respect
    • To cope with frustration, anger, anxiety
    • To remain seated
    • To be organised and equipped for lessons
    • To concentrate
    • To understand
    • To listen

    Individual pupils: Ju , Le, Jo, C, La

    Teachers ability to:

    • Maintain classroom control
    • Delivery of the curriculum (explanation of work)

    HELPFUL SUPPORT/STRATEGIES

    • In-class support from teacher colleagues
    • Lessons which entail pupils being ‘on task’ as soon as possible
    • Firm classroom rules and routines
    • Basic task instructions
    • Individual pupils on report
    • Differentiated curriculum tasks
    • Reduction of movement around the classroom
    • Organisation which entails all equipment and materials being ready on pupils’ tables
    • Withdrawal work for individual pupils
    • Oral and group work

     IDEAS

    • Splitting up difficult pupil groups
    • Individualised and differentiated learning tasks
    • Praise, positive teacher commentary
    • Regular in-class support
    • Use of drama/role-play
    • Opportunities for teacher colleagues to both observe and be observed
    • Group work for both curriculum and social development purposes

    THE SESSION

    This begins with a presentation of a collation of the responses received from questionnaires. The important message here is that staff already possess a huge amount of information and many ideas with regards to the problem/s. This exercise is designed to empower and facilitate a realistic and practical optimism within the staff group. Having done this, it is then possible to establish first order principles and core ideas re the task being engaged in, for example:

    PROBLEM SOLVING

    Some core ideas

    • if you’re not a part of the solution, you’re a part of the problem
    • Not everything can be tackled at once
    • Teaching and learning are continuous problem solving enterprises
    • The problem/s is/are somebodys' solution/s
    •  The problem/solution holder is the expert in the problem/solution

    The next part of the session looks at and addresses the question:

    WHERE TO START ?

    1. Concerns - collectively agree the priority

    Nominal group technique.

    Returning to the summary of staff responses to the question ‘what is your priority concern?’; staff are asked to pick three items from the list and rank each item in order of importance.

    The item which they consider to be most important gets three points, the next receives two points; the third and most important receives one point.

    The presenter collects staff points and records them on a flip chart or overhead and adds them up. This allows for a collectively prioritised concern or concerns (no more than three) to be identified for subsequent work in the session.

    2. Personal Construct Psychology

    It is suggested that at this point the presenter has some theoretical input; background reading by the presenter is strongly advised in preparation for this part of the session.

    • Alternative Constructivism. George Kelly, social psychology (1955) Social construct theory social and systematic theory of human behaviour
    • This theory has implications for action, change and growth through experience.
    • We see each and every person as a personality theory in action.
    • Each individual has an attitude to others; this is informed by his theory of persons, understanding and stance in relation to change.
    • Humans as inherently socially referenced - constant interaction with others, some supportive and enabling, others a state of antagonism.
    • It is the extremes perhaps on both sides who offer many opportunities for growth of understanding and personal development

    Ravenette, A.T. (1997) Selected Papers. Personal Construct Psychology and the Practice of an Educational Psychologist London: Personal Construct Association Publications.

    Staff are then asked to consider:

    What solution does this problem allow ?*

    (Tom Ravenette questions)

    Staff are asked to look at their collectively agreed priority concern/s and to ask the question as above*. This will probably be fairly challenging as it requires them to de-centre from their position as a teacher, and to look at the problem from the pupils’ perspective. The presenter may well need to model/demonstrate at first.

    3. Mind-map (brainstorm) of ideas - include the improbable, unfeasible, innovative, impossible.

    This is the final part of the session. Working in pairs, staff complete the sheet (see below **). These are then collected, and the presenter concludes by re-visiting main themes of the session. This will include an explanation that a summary of the session, and the ideas generated by staff, will be compiled and returned to senior management for follow-up. It may also be useful to inform staff that a subsequent session can be arranged on request.

    **

    A theory about X group

    How can this theory be tested? 

    What will be apparent if the theory is correct ?

    List Of Nouns

    Using a list of nouns when children are beginning to read is helpful in making teaching easier. Nouns are one of the first parts of speech that children learn when they begin to read. Use the following list of nouns for each age group to help your child learn about the ideas things, people and places that surround them.

    Year R
    ball
    bat
    bed
    book
    boy
    bun
    can
    cake
    cap
    car
    cat
    cow
    cub
    cup
    dad
    day
    dog
    doll
    dust
    fan
    feet
    girl
    gun
    hall
    hat
    hen
    jar
    kite
    man
    map
    men
    mom
    pan
    pet
    pie
    pig
    pot
    rat
    son
    sun
    toe
    tub
    van

    Year 1
    apple
    arm
    banana
    bike
    bird
    book
    chin
    clam
    class
    clover
    club
    corn
    crayon
    crow
    crown
    crowd
    crib
    desk
    dime
    dirt
    dress
    fang
    field
    flag
    flower
    fog
    game
    heat
    hill
    home
    horn
    hose
    joke
    juice
    kite
    lake
    maid
    mask
    mice
    milk
    mint
    meal
    meat
    moon
    mother
    morning
    name
    nest
    nose
    pear
    pen
    pencil
    plant
    rain
    river
    road
    rock
    room
    rose
    seed
    shape
    shoe
    shop
    show
    sink
    snail
    snake
    snow
    soda
    sofa
    star
    step
    stew
    stove
    straw
    string
    summer
    swing
    table
    tank
    team
    tent
    test
    toes
    tree
    vest
    water
    wing
    winter
    woman
    women

    Year 2
    alarm
    animal
    aunt
    bait
    balloon
    bath
    bead
    beam
    bean
    bedroom
    boot
    bread
    brick
    brother
    camp
    chicken
    children
    crook
    deer
    dock
    doctor
    downtown
    drum
    dust
    eye
    family
    father
    fight
    flesh
    food
    frog
    goose
    grade
    grandfather
    grandmother
    grape
    grass
    hook
    horse
    jail
    jam
    kiss
    kitten
    light
    loaf
    lock
    lunch
    lunchroom
    meal
    mother
    notebook
    owl
    pail
    parent
    park
    plot
    rabbit
    rake
    robin
    sack
    sail
    scale
    sea
    sister
    soap
    song
    spark
    space
    spoon
    spot
    spy
    summer
    tiger
    toad
    town
    trail
    tramp
    tray
    trick
    trip
    uncle
    vase
    winter
    water
    week
    wheel
    wish
    wool
    yard
    zebra

    Year 3
    actor
    airplane
    airport
    army
    baseball
    beef
    birthday
    boy
    brush
    bushes
    butter
    cast
    cave
    cent
    cherries
    cherry
    cobweb
    coil
    cracker
    dinner
    eggnog
    elbow
    face
    fireman
    flavor
    gate
    glove
    glue
    goldfish
    goose
    grain
    hair
    haircut
    hobbies
    holiday
    hot
    jellyfish
    ladybug
    mailbox
    number
    oatmeal
    pail
    pancake
    pear
    pest
    popcorn
    queen
    quicksand
    quiet
    quilt
    rainstorm
    scarecrow
    scarf
    stream
    street
    sugar
    throne
    toothpaste
    twig
    volleyball
    wood
    wrench

    Year 4
    advice
    anger
    answer
    apple
    arithmetic
    badge
    basket
    basketball
    battle
    beast
    beetle
    beggar
    brain
    branch
    bubble
    bucket
    cactus
    cannon
    cattle
    celery
    cellar
    cloth
    coach
    coast
    crate
    cream
    daughter
    donkey
    drug
    earthquake
    feast
    fifth
    finger
    flock
    frame
    furniture
    geese
    ghost
    giraffe
    governor
    honey
    hope
    hydrant
    icicle
    income
    island
    jeans
    judge
    lace
    lamp
    lettuce
    marble
    month
    north
    ocean
    patch
    plane
    playground
    poison
    riddle
    rifle
    scale
    seashore
    sheet
    sidewalk
    skate
    slave
    sleet
    smoke
    stage
    station
    thrill
    throat
    throne
    title
    toothbrush
    turkey
    underwear
    vacation
    vegetable
    visitor
    voyage
    year

    Year 5
    able
    achieve
    acoustics
    action
    activity
    aftermath
    afternoon
    afterthought
    apparel
    appliance
    beginner
    believe
    bomb
    border
    boundary
    breakfast
    cabbage
    cable
    calculator
    calendar
    caption
    carpenter
    cemetery
    channel
    circle
    creator
    creature
    education
    faucet
    feather
    friction
    fruit
    fuel
    galley
    guide
    guitar
    health
    heart
    idea
    kitten
    laborer
    language
    lawyer
    linen
    locket
    lumber
    magic
    minister
    mitten
    money
    mountain
    music
    partner
    passenger
    pickle
    picture
    plantation
    plastic
    pleasure
    pocket
    police
    pollution
    railway
    recess
    reward
    route
    scene
    scent
    squirrel
    stranger
    suit
    sweater
    temper
    territory
    texture
    thread
    treatment
    veil
    vein
    volcano
    wealth
    weather
    wilderness
    wren
    wrist
    writer

    General List of Common Nouns
    account
    achiever
    acoustics
    act
    action
    activity
    actor
    addition
    adjustment
    advertisement
    advice
    aftermath
    afternoon
    afterthought
    agreement
    air
    airplane
    airport
    alarm
    amount
    amusement
    anger
    angle
    animal
    answer
    ant
    apparatus
    apparel
    apple
    apples
    appliance
    approval
    arch
    argument
    arithmetic
    arm
    army
    art
    attack
    attempt
    attention
    attraction
    aunt
    authority

    babies
    baby
    back
    badge
    bag
    bait
    balance
    balloon
    ball
    balls
    banana
    band
    base
    baseball
    basin
    basket
    basketball
    bat
    bath
    battle
    bead
    beam
    bean
    bear
    bears
    beast
    bed
    bedroom
    beds
    bee
    beef
    beetle
    beggar
    beginner
    behavior
    belief
    believe
    bell
    bells
    berry
    bike
    bikes
    bird
    birds
    birth
    birthday
    bit
    bite
    blade
    blood
    blow
    board
    boat
    boats
    body
    bomb
    bone
    book
    books
    boot
    border
    bottle
    boundary
    box
    boy
    boys
    brain
    brake
    branch
    brass
    bread
    breakfast
    breath
    brick
    bridge
    brother
    brothers
    brush
    bubble
    bucket
    building
    bulb
    bun
    burn
    burst
    bushes
    business
    butter

    cabbage
    cable
    cactus
    cake
    cakes
    calculator
    calendar
    camera
    camp
    can
    cannon
    canvas
    cap
    caption
    car
    card
    care
    carpenter
    carriage
    cars
    cart
    cast
    cats
    cattle
    cat
    cause
    cave
    celery
    cellar
    cemetery
    cent
    chain
    chair
    chairs
    chalk
    chance
    change
    channel
    cheese
    cherries
    cherry
    chess
    chicken
    children
    chin
    church
    circle
    clam
    class
    clock
    clocks
    cloth
    cloud
    clouds
    clover
    club
    coach
    coal
    chickens
    coast
    coat
    cobweb
    coil
    collar
    color
    comb
    comfort
    committee
    company
    comparison
    competition
    condition
    connection
    control
    cook
    copper
    copy
    cord
    cork
    corn
    cough
    country
    cover
    cow
    cows
    crack
    cracker
    crate
    crayon
    cream
    creator
    creature
    credit
    crib
    crime
    crook
    crow
    crowd
    crown
    crush
    cry
    cub
    cup
    current
    curtain
    curve
    cushion 

    dad
    daughter
    day
    death
    debt
    decision
    deer
    degree
    design
    desire
    desk
    destruction
    detail
    development
    digestion
    dime
    dinner
    dinosaurs
    direction
    dirt
    discovery
    disgust
    distance
    distribution
    division
    dock
    doctor
    dog
    dogs
    doll
    dolls
    donkey
    disease
    discussion
    door
    downtown
    drain
    drawer
    dress
    drink
    driving
    drop
    drug
    drum
    duck
    ducks
    dust

    ear
    earth
    earthquake
    edge
    education
    effect
    egg
    eggnog
    eggs
    elbow
    end
    engine
    error
    event
    example
    exchange
    existence
    expansion
    experience
    expert
    eye
    eyes

    face
    fact
    fairies
    fall
    family
    fan
    fang
    farm
    farmer
    father
    father
    faucet
    fear
    feast
    feather
    feeling
    feet
    fiction
    field
    fifth
    fight
    finger
    finger
    fire
    fireman
    fish
    flag
    flame
    flavor
    flesh
    flight
    flock
    floor
    flower
    flowers
    fly
    fog
    fold
    food
    foot
    force
    fork
    form
    fowl
    frame
    friction
    friend
    friends
    frog
    frogs
    front
    fruit
    fuel
    furniture

    game
    garden
    gate
    geese
    ghost
    giants
    giraffe
    girl
    girls
    glass
    glove
    glue
    goat
    gold
    goldfish
    good-bye
    goose
    government
    governor
    grade
    grain
    grandfather
    grandmother
    grape
    grass
    grip
    ground
    group
    growth
    guide
    guitar
    gun

    hair
    haircut
    hall
    hammer
    hand
    hands
    harbor
    harmony
    hat
    hate
    head
    health
    hearing
    heart
    heat
    help
    hen
    hill
    history
    hobbies
    hole
    holiday
    home
    honey
    hook
    hope
    horn
    horse
    horses
    hose
    hospital
    hot
    hour
    house
    houses
    humor
    hydrant

    ice
    icicle
    idea
    impulse
    income
    increase
    industry
    ink
    insect
    instrument
    insurance
    interest
    invention
    iron
    island

    jail
    jam
    jar
    jeans
    jelly
    jellyfish
    jewel
    join
    joke
    journey
    judge
    juice
    jump

    kettle
    key
    kick
    kiss
    kite
    kitten
    kittens
    kitty
    knee
    knife
    knot
    knowledge

    laborer
    lace
    ladybug
    lake
    lamp
    land
    language
    laugh
    lawyer
    lead
    leaf
    learning
    leather
    leg
    legs
    letter
    letters
    lettuce
    level
    library
    lift
    light
    limit
    line
    linen
    lip
    liquid
    list
    lizards
    loaf
    lock
    locket
    look
    loss
    love
    low
    lumber
    lunch
    lunchroom

    machine
    magic
    maid
    mailbox
    man
    manager
    map
    marble
    mark
    market
    mask
    mass
    match
    meal
    measure
    meat
    meeting
    memory
    men
    metal
    mice
    middle
    milk
    mind
    mine
    minister
    mint
    minute
    mist
    mitten
    mom
    money
    monkey
    month
    moon
    morning
    mother
    motion
    mountain
    mouth
    move
    muscle
    music

    nail
    name
    nation
    neck
    need
    needle
    nerve
    nest
    net
    news
    night
    noise
    north
    nose
    note
    notebook
    number
    nut

    oatmeal
    observation
    ocean
    offer
    office
    oil
    operation
    opinion
    orange
    oranges
    order
    organization
    ornament
    oven
    owl
    owner
    page

    pail
    pain
    paint
    pan
    pancake
    paper
    parcel
    parent
    park
    part
    partner
    party
    passenger
    paste
    patch
    payment
    peace
    pear
    pen
    pencil
    person
    pest
    pet
    pets
    pickle
    picture
    pie
    pies
    pig
    pigs
    pin
    pipe
    pizzas
    place
    plane
    planes
    plant
    plantation
    plants
    plastic
    plate
    play
    playground
    pleasure
    plot
    plough
    pocket
    point
    poison
    police
    polish
    pollution
    popcorn
    porter
    position
    pot
    potato
    powder
    power
    price
    print
    prison
    process
    produce
    profit
    property
    prose
    protest
    pull
    pump
    punishment
    purpose
    push

    quarter
    quartz
    queen
    question
    quicksand
    quiet
    quill
    quilt
    quince
    quiver

    rabbit
    rabbits
    rail
    railway
    rain
    rainstorm
    rake
    range
    rat
    rate
    ray
    reaction
    reading
    reason
    receipt
    recess
    record
    regret
    relation
    religion
    representative
    request
    rest
    reward
    rhythm
    rice
    riddle
    rifle
    ring
    rings
    river
    road
    robin
    rock
    rod
    roll
    roof
    room
    root
    rose
    route
    rub
    rule
    run

    sack
    sail
    salt
    sand
    scale
    scarecrow
    scarf
    scene
    scent
    school
    science
    scissors
    screw
    sea
    seashore
    seat
    secretary
    seed
    selection
    self
    sense
    servant
    shade
    shake
    shame
    shape
    sheep
    sheet
    shelf
    ship
    shirt
    shock
    shoe
    shoes
    shop
    show
    side
    sidewalk
    sign
    silk
    silver
    sink
    sister
    sisters
    size
    skate
    skin
    skirt
    sky
    slave
    sleep
    sleet
    slip
    slope
    smash
    smell
    smile
    smoke
    snail
    snails
    snake
    snakes
    sneeze
    snow
    soap
    society
    sock
    soda
    sofa
    son
    song
    songs
    sort
    sound
    soup
    space
    spade
    spark
    spiders
    sponge
    spoon
    spot
    spring
    spy
    square
    squirrel
    stage
    stamp
    star
    start
    statement
    station
    steam
    steel
    stem
    step
    stew
    stick
    sticks
    stitch
    stocking
    stomach
    stone
    stop
    store
    story
    stove
    stranger
    straw
    stream
    street
    stretch
    string
    structure
    substance
    sugar
    suggestion
    suit
    summer
    sun
    support
    surprise
    sweater
    swim
    swing
    system

    table
    tail
    talk
    tank
    taste
    tax
    teaching
    team
    teeth
    temper
    tendency
    tent
    territory
    test
    texture
    theory
    thing
    things
    thought
    thread
    thrill
    throat
    throne
    thumb
    thunder
    ticket
    tiger
    time
    tin
    title
    toad
    toe
    toes
    tomatoes
    tongue
    tooth
    toothbrush
    toothpaste
    top
    touch
    town
    toy
    toys
    trade
    trail
    trees
    trick
    trip
    trouble
    trousers
    truck
    trucks
    tub
    turkey
    turn
    twig
    twist
    train
    trains
    tramp
    transport
    tray
    treatment
    tree

    umbrella
    uncle
    underwear
    unit
    use

    vacation
    value
    van
    vase
    vegetable
    veil
    vein
    verse
    vessel
    vest
    view
    visitor
    voice
    volcano
    volleyball
    voyage

    walk
    wall
    war
    wash
    waste
    watch
    water
    wave
    waves
    wax
    way
    wealth
    weather
    week
    weight
    wheel
    whip
    whistle
    wilderness
    wind
    window
    wine
    wing
    winter
    wire
    wish
    woman
    women
    wood
    wool
    word
    work
    worm
    wound
    wren
    wrench
    wrist
    writer
    writing

    yak
    yam
    yard
    yarn
    year
    yoke

    zebra
    zephyr
    zinc
    zipper
    zoo

    Listening Skills

    The "Listening Skills" course details how to form and manage a small group where the focus of the work is the development of listening skills.  The central assumption is that just as with every other skill people seek to acquire, some people are great and others find it very difficult, with most people falling somewhere in between.  The approach taken is very much along the lines of we all find some things difficult and need extra help to learn how to do it.  It's no big deal.  The games are fun, yet increasingly demanding.  The intention of the pack is to offer an approach with a number of pre-planned sessions to get things started.  The facilitator is encouraged to investigate the actual problems the child/children are experiencing in the context they live and study in.  Games will then be generated to address specific difficulties by the group facilitator.

    Ritalin

    Pharmacology

    CNS Stimulant

    Methylphenidate is a mild CNS stimulant.

    The mode of action in man is not completely understood, but methylphenidate presumably activates the brain stem arousal system and cortex to produce its stimulant effect.

    There is neither specific evidence which clearly establishes the mechanism whereby methylphenidate produces its mental and behavioral effects in children, nor conclusive evidence regarding how these effects relate to the condition of the CNS.

    Methylphenidate is rapidly and extensively absorbed from the tablets following oral administration; however, owing to extensive first-pass metabolism, bioavailability is low (approx. 30%) and large individual differences exist (11 to 52%).

    In one study, the administration of methylphenidate with food accelerated absorption, but had no effect on the amount absorbed.

    Peak plasma concentrations of 10.8 and 7.8 ng/mL were observed, on average, 2 hours after administration of 0.30 mg/kg in children and adults, respectively. However, peak plasma concentrations showed marked variability between subjects. Both the area under the plasma concentration curve (AUC), and the peak plasma concentrations (C(max)) showed dose-proportionality.


    Methylphenidate is eliminated from the plasma with a mean half-life of 2.4 hours in children and 2.1 hours in adults. The apparent mean systemic clearance is 10.2 and 10.5 L/hr/kg in children and adults, respectively for a 0.3 mg/kg dose. These data indicate that the pharmacokinetic behavior of methylphenidate in hyperactive children is similar to that in normal adults. The apparent distribution volume of methylphenidate in children was approximately 20 L/kg, with substantial variability (11 to 33 L/kg).

    Following oral administration of methylphenidate, 78 to 97% of the dose is excreted in the urine and 1 to 3% in the feces in the form of metabolites within 48 to 96 hours. The main urinary metabolite is ritalinic acid (alpha-phenyl-2-piperidine acetic acid, PPAA); unchanged methylphenidate is excreted in the urine in small quantities (<1%). Peak PPAA plasma concentrations occurred at approximately the same time as peak methylphenidate concentrations, however, levels were several-fold greater than those of the unchanged drug. The half-life of PPAA was approximately twice that of methylphenidate.

    In blood, methylphenidate and its metabolites are distributed between plasma (57%) and erythrocytes (43%). Methylphenidate and its metabolites exhibit low plasma protein binding (approx. 15%).

    Methylphenidate in the extended-release tablets is more slowly but as extensively absorbed as in the regular tablets. Relative bioavailability of the Ritalin SR tablet, compared to the Ritalin tablet, measured by the urinary excretion of the methylphenidate major metabolite (PPAA), was 105% (49 to 168%) in children and 101% (85% to 152%) in adults. The time to peak rate in children was 4.7 hours (1.3 to 8.2 hours) for the extended-release tablets and 1.9 hours (0.3 to 4.4 hours) for the regular tablets. The elimination half-life and the cumulative urinary excretion of PPAA are not significantly different between the two dosage forms. An average of 67% of the extended-release tablet dose was excreted in children as compared to 86% in adults.


    Indications
    Attention-Deficit Hyperactivity Disorder (ADHD), previously known as Attention-Deficit Disorder. Other terms being used to describe this behavioral syndrome include: minimal Brain Dysfunction in Children, Hyperkinetic Child Syndrome, Minimal Brain Damage, Minimal Cerebral Dysfunction, Minor Cerebral Dysfunction.

    Methylphenidate is indicated as an integral part of a total treatment program which typically includes other remedial measures (psychological, educational, social) for a stabilizing effect in children with a behavioral syndrome characterized by the following group of developmentally inappropriate symptoms: moderate-to-severe distractibility, short attention span, hyperactivity, emotional lability, and impulsivity. The diagnosis of this syndrome should not be made with finality when these symptoms are only of comparatively recent origin. Non-localizing (soft) neurological signs, learning disability, and abnormal EEG may or may not be present, and a diagnosis of CNS dysfunction may or may not be warranted.

    Special Diagnostic Considerations:
    Specific etiology of this syndrome is unknown, and there is no single diagnostic test. Adequate diagnosis requires the use not only of medical but of special psychological, educational and social resources.

    Characteristics commonly reported include:
    Chronic history of short attention span, distractibility, emotional lability, impulsivity, and moderate-to-severe hyperactivity; minor neurological signs and abnormal EEG. Learning may or may not be impaired. The diagnosis must be based upon a complete history and evaluation of the child and not solely on the presence of one or more of these characteristics.

    Drug treatment is not indicated for all children with this syndrome. Stimulants are not intended for use in the child who exhibits symptoms secondary to environmental factors and/or primary psychiatric disorders, including psychosis. Appropriate educational placement is essential and psychosocial intervention is generally necessary. When remedial measures alone are insufficient, the decision to prescribe stimulant medication will depend upon the physician's assessment of the chronicity and severity of the child's symptoms.

    Narcolepsy.

    Contraindications

    Anxiety, tension, agitation, thyrotoxicosis, tachyarrhythmias, severe angina pectoris and glaucoma. Hypersensitivity to methylphenidate. Also contraindicated in patients with motor tics or with a family history or diagnosis of Tourette's syndrome.

    Warnings
    Methylphenidate should not be used in children under 6 years of age, since safety and efficacy in this age group have not been established.

    Although a causal relationship has not been established, suppression of growth (i.e. weight gain and/or height) has been reported with the long-term use of stimulants in children. Therefore, patients requiring long-term therapy should be carefully monitored. In addition, the use of "Drug Holidays" is recommended, that is, withholding the drug on weekends and during school holidays in as much as the clinical situation permits.

    Methylphenidate should not be used for severe depression of either exogenous or endogenous origin. Clinical experience suggests that in psychotic children, administration of methylphenidate may exacerbate symptoms of behavior disturbance and thought disorder.

    Methylphenidate should not be used for the prevention or treatment of normal fatigue states.

    There is some clinical evidence that methylphenidate may lower the convulsive threshold in patients with prior history of seizures, with prior EEG abnormalities in absence of seizures and, very rarely, in patients with no prior EEG evidence nor history of seizures. Safe concomitant use of anticonvulsants and methylphenidate has not been established. In the presence of seizures, the drug should be discontinued.

    Use cautiously in patients with hypertension. Blood pressure should be monitored at appropriate intervals in all patients taking methylphenidate, especially those with hypertension.

    Pregnancy:
    Adequate animal reproduction studies to establish safe use of methylphenidate during pregnancy have not been conducted. Therefore, until more information is available, the use of methylphenidate in pregnancy is not recommended.

    Lactation:
    It is not known whether the active substance of methylphenidate and/or its metabolites pass into breast milk. For safety reasons, mothers taking methylphenidate should refrain from breast feeding their infants.

    Drug Dependence:
    Methylphenidate should be given cautiously to emotionally unstable patients, such as those with a history of drug dependence or alcoholism, because such patients may increase dosage on their own initiative.

    Chronically abusive use can lead to marked tolerance and psychic dependence with varying degrees of abnormal behavior. Frank psychotic episodes can occur, especially with parenteral abuse. Careful supervision is required during drug withdrawal, since severe depression as well as the effects of chronic overactivity can be unmasked. Long-term follow-up may be required because of the patient's basic personality disturbances.

    Available clinical data indicate that treatment with methylphenidate during childhood and/or adolescence does not seem to result in increased predisposition for addiction.

    Precautions
    Patients with an element of agitation may react adversely; discontinue therapy if necessary.


    Periodic CBC, differential, and platelet counts are advised during prolonged therapy.

    Drug treatment is not indicated in all cases of Attention Deficit Hyperactivity Disorders and should be considered only in light of the complete history and evaluation of the child. The decision to prescribe methylphenidate should depend on the physician's assessment of the chronicity and severity of the child's symptoms and their appropriateness for his/her age. Prescription should not depend solely on the presence of one or more of the behavioral characteristics. When these symptoms are associated with acute stress reactions, treatment with methylphenidate is usually not indicated.

    Long-term effects of methylphenidate in children have not been well established.

    Occupational Hazards:
    Because methylphenidate may affect performance, patients should be cautioned against engaging in hazardous activities such as operation of automobiles or dangerous machinery.

    Drug Interactions:
    Methylphenidate may decrease the hypotensive effect of guanethidine. Use cautiously with pressor agents and MAO inhibitors.

    Human pharmacologic studies have shown that methylphenidate may inhibit the metabolism of coumarin anticoagulants, anticonvulsants (phenobarbital, diphenylhydantoin, primidone), phenylbutazone and tricyclic antidepressants (imipramine, desipramine). Downward dosage adjustments of these drugs may be required when given concomitantly with methylphenidate.

    Adverse Effects
    Nervousness and insomnia are the most common adverse reactions reported with methylphenidate but are usually controlled by reducing dosage and omitting the drug in the afternoon or evening. Decreased appetite is also common but usually transient.

    Central and Peripheral Nervous System:
    Dizziness, drowsiness, headache, and dyskinesia may occur. Isolated cases of the following have been reported: hyperactivity, convulsions, muscle cramps, choreo-athetoid movements, tics, or exacerbation of pre-existing tics, Tourette's syndrome, and psychotic episodes including hallucinations which subsided when methylphenidate was discontinued. Psychic dependence in emotionally unstable persons has occurred rarely with chronic treatment. Although a definite causal relationship has not been established, isolated cases of transient depressed mood have been reported.

    Symptoms of visual disturbances have been encountered in rare cases. Difficulties with accommodation and blurring of vision have been reported.

    Gastrointestinal:
    Nausea and abdominal pain may occur at the start of treatment and may be alleviated if taken with food.

    Cardiovascular:
    Palpitations, blood pressure and pulse changes (both up and down), tachycardia, angina and cardiac arrhythmias.

    Skin and/or Hypersensitivity:
    Rash, pruritus, urticaria, fever, arthralgia, and alopecia. Isolated cases of exfoliative dermatitis, erythema multiforme with histopathological findings of necrotizing vasculitis, and thrombocytopenic purpura.

    Hematologic:
    Isolated cases of leukopenia, thrombocytopenia and anemia.

    Other:
    Weight loss during prolonged therapy.

    In children, loss of appetite, abdominal pain, weight loss during prolonged therapy, insomnia, and tachycardia may occur more frequently; however, any of the other adverse reactions listed above may also occur. Minor retardation of growth may also occur during prolonged therapy in children (see Warnings).

    Overdose
    Symptoms:
    Signs and symptoms of acute overdosage, resulting principally from CNS overstimulation and from excessive sympathomimetic effects, may include the following: vomiting, agitation, tremors, hyperreflexia, muscle twitching, convulsions (may be followed by coma), euphoria, confusion, hallucinations, delirium, sweating, flushing, headache, hyperpyrexia, tachycardia, palpitations, cardiac arrhythmias, hypertension, mydriasis and dryness of mucous membranes.

    Treatment:
    Appropriate supportive measures. The patient must be protected against self-injury and against external stimuli that would aggravate overstimulation already present. If signs and symptoms are not too severe and the patient is conscious, gastric contents may be evacuated by induction of emesis or gastric lavage. In the presence of severe intoxication, use a carefully titrated dosage of short-acting barbiturate before performing gastric lavage.

    Intensive care must be provided to maintain adequate circulation and respiratory exchange; external cooling procedures may be required for hyperpyrexia.

    Efficacy of peritoneal dialysis or extracorporeal hemodialysis for methylphenidate overdosage has not been established.

    Dosage
    Dosage should be individualized according to the needs and responses of the patient.

    Social Skills

    The "Social Skills" package details how to form and run a small group where the focus of the work is the development of social skills.  There are a number of ready made group sessions as an aid to starting off in this type of work.  The central aim, however, is to providethe user with sufficient skills to begin to plan and run a group using information gained from the context that the child lives and studies in, and by identifying the particular difficulties that the child is experiencing.

    The Fry Readability Program

    The Fry Readability Program

    • Number of Syllables
       
    • Number of Words
       
    • Number of Sentences
       
    • Readability so far

    To use the program:

    Follow the link:

     

    http://www.csudh.edu/fisher/FryGraph.html

     

    I have checked this programme against some common UK primary reading schemes such as Ginn 360 and Oxford Reading Tree and it seems to agree quite well with the publisher's age/level recommendations (within about a year). I also looked at the readability levels for the passages of the Neale Reading Analysis (Neale, 1989) and found that these were within about one year of the comprehension norms.

    I would recommend using readability only to compare the levels of different texts and to watch out for major mismatches, rather than make any precise judgements. Doing this, some primary schools have found that their general library books were at much too high a reading level for their average pupils (Hill, 1981). Studies of the readability of secondary textbooks (particularly Science) have also found that some are too hard for many pupils (Chiang-Soong and Yager, 1993).

    Readability is not just the result of word and sentence length and you can find out more from an excellent on-line article written by Keith Johnson. This is practical as well as academically-based (with references) and looks at a number of readability measures with their benefits and drawbacks.

     

    References:

    Chiang-Soong, B. and Yager, R (1993) Readability levels of the science textbooks most used in secondary schools, School Science and Mathematics, 93, 1, p 24-27.

    Fry, E. (1968), A readability formula that saves time. Journal of Reading, 11 (7), 265-71.

    Hill, L. (1981) A readability study of junior school library provision related to children’s interests and reading abilities. British Journal of Educational Psychology, 51, 102-104.

    Neale, M. (1989) Neale Analysis of Reading Ability - revised British edition. Berkshire: NFER-NELSON.

    Treating ADHD Without Medication?

    Extract from this package: "Before I became an educational psychologist I was, for about five years, a member of a behaviour support team.  We worked intensively with children, each of us having around six on our case-load; each child was visited twice per week.  It seemed that there was perennially a restless child as part of the weekly case load, known affectionately within the team as "Wiggle bums".  Observing these children was quite an experience, for instance, when seated on the carpet at the beginning or end of the day they would wiggle from one side of the carpet to the other in about 15 minutes. To be honest, I cannot remember any member of the team thinking this was difficult with regards to intervention; we had a clear approach and just got on with it.  

    I distinctly remember a member of the team coming in one day and telling us about this thing called ADHD, and that many children in America were taking some form of medication for this disorder.  The speculation was that it would catch on over here soon enough.

    The approach we took with our "Wiggle bums" was fairly straight forward; a relaxation technique was taught to the parents to use with the children on a daily basis, and a concentration development and social skills development programme was put in place.  The children were seen twice per week for about 40 minutes on each occasion; this didn't work with every child, but the success rate was substantial."

    As an educational psychologist and with the benefit of substantial extra training and experience, I would be of the opinion that many of those "Wiggle bums" would now be diagnosed as having ADHD.  

    I have seen at first hand on many occasions the dramatic effect medication can have on children who arediagnosed as ADHD.  I would have no hesitation in allowing my own child to be medicated for this condition taking into account the full cost and benefits.  However, I would not under any circumstances allow my child to be medicated without a more conservative approach be tried first.

    Attention Seeking Behavior

    A child that wants attention will obtain it by some means. This is usually done in a positive way; they do a drawing, or perform a play. By offering an adult the best of what they have to offer, they seek attention, and this will hopefully allow them to obtain it.  In general, children who are well adjusted tend to need attention on a little and not very often basis.  As long as attention is given when needed, which is usually the case, things run smoothly.  However, some children seem to have an insatiable desire for attention; they get positive attention galore yet they want more.  They misbehave and quickly realise that certain behaviors can't be ignored by adults, meaning they engage in them. The class teacher will likely tell you that they spend vast quantities of their time with the child yet it is never enough.  The child if observed in class, will be engaging in a whole host of activities, all of which appear geared toward getting attention.  It would be nothing noteworthy for children like this to have the teacher intervene with every 2-3 minutes.

    Often parents and teachers are confused. They will tell the psychologist that the child gets lots of attention, much more than any other member of the class, something that is supported by observation. The important thing to remember with humans, in such cases, is that we are never dealing with concrete realities; we are dealing with perceptions.  It is rather convenient to see the childs' thinking in terms of there being a black box through which all thinking must pass.  The black box contains one simple instruction that is, "I do not get enough attention" . If we take on board this simple assumption, we can now see why the child will behave in an attention seeking way. For example, after being taken out for a wonderful day out, and absolutely showered with attention, they come home and do something totally silly that guarantees more attention, albeit negative.  So what to do?

    Intervention

    The following intervention is extraordinarily powerful.  It works just about every time and the only reason it fails is because the adult stops.  Children never tire of this intervention.  The intervention takes about ten minutes each day and is focussed on the childs' perceptual system.

    Special Time:

     

    • Tell the child that they will be getting a special time each day.
    • Then each day tell them that special time will start in 2 minutes.  
    • Tell the child that special time will start now.
    • Engage in special time.  
    • Tell the child that special time will end in 2 minutes.
    • Tell the child that special time will end now.

     

    You have therefore told the child four times that they are getting special time.

    During special time, the child may choose to do anything that is reasonable.  They may want to watch a video with you, or make a cake for instance.  Do not teach, simply watch the child, helping if they request it, but never offering help. The adult watches the child, and every so often sums up what the child is doing with praise for the skills shown.  For instance 'I love the way you cuddle me'; 'I love the way you are mixing that cake mix'.  This shows that the adult is paying attention. The analogy usually used is bathing the child in a warm bath of positive attention.

    Do this every day.
    Do not under any circumstances take away the special time as a sanction.
    Even if the child has had an awful day, special time must occur.

    FIND AN EDUCATIONAL  PSYCHOLOGIST

    Anger Management

    The "Anger Management" pack is a guide aimed at training children in how to manage their anger.  It takes, as an assumption, that anger is a normal and healthy reaction.  However, some people just haven't understood that there are different degrees of anger, and that each culture will have an appropriate level of anger in a given context.  For instance, if a child was unfortunate enough to witness their parent being attacked, it would be quite appropriate for them to be very angry and hit the attacker with a stick.  The same level of anger and reaction is inappropriate if the offence is of a much lower level, being sworn at in the playground for instance.  The whole thrust of the work is to help the children in the group readjust their responses in line with prevailing cultural norms.

    Treating ADHD Without Medication?

     

    Extract from this package: "Before I became an educational psychologist I was, for about five years, a member of a behaviour support team.  We worked intensively with children, each of us having around six on our case-load; each child was visited twice per week.  It seemed that there was perennially a restless child as part of the weekly case load, known affectionately within the team as "Wiggle bums".  Observing these children was quite an experience, for instance, when seated on the carpet at the beginning or end of the day they would wiggle from one side of the carpet to the other in about 15 minutes. To be honest, I cannot remember any member of the team thinking this was difficult with regards to intervention; we had a clear approach and just got on with it.  

    I distinctly remember a member of the team coming in one day and telling us about this thing called ADHD, and that many children in America were taking some form of medication for this disorder.  The speculation was that it would catch on over here soon enough.

    The approach we took with our "Wiggle bums" was fairly straight forward; a relaxation technique was taught to the parents to use with the children on a daily basis, and a concentration development and social skills development programme was put in place.  The children were seen twice per week for about 40 minutes on each occasion; this didn't work with every child, but the success rate was substantial."

    As an educational psychologist and with the benefit of substantial extra training and experience, I would be of the opinion that many of those "Wiggle bums" would now be diagnosed as having ADHD.  

    I have seen at first hand on many occasions the dramatic effect medication can have on children who are diagnosed as ADHD.  I would have no hesitation in allowing my own child to be medicated for this condition taking into account the full cost and benefits.  However, I would not under any circumstances allow my child to be medicated without a more conservative approach be tried first.

    FIND AN EDUCATIONAL  PSYCHOLOGIST