ISSN: 0973-5755 EFFECTIVENESS OF INTERVENTION PROGRAM FOR THE CHILDREN WITH ADHD Jayanthi. M* and S. Kadhiravan** ABSTRACT Attention Deficit Hyperactive Disorder [ADHD] is a disruptive behavior disorder characterized by levels of inattention, impulsivity and over activity that are well beyond what is expected and appropriate for the children. ADHD is a condition that becomes apparent in children in the preschool and early school years. ADHD children have difficulties with work completion, productivity, planning, remembering, etc. which are needed for school, and meeting deadlines. In the present study an attempt is made to assess the impact of behavioral techniques and sensory integration for ADHD children. A pre-post non-equivalent experimental groups design was used in this study. 35 children in the age group of 5-10 years were given Behavioral training and Sensory Integration training for a period of one month. Results revealed reduction inseverity of inattention and hyperactivity after the intervention program. The findings emphasize on the importance of intervention programs for ADHD. Key Words: ADHD, Behavioural Training, Sensory Integration Attention-Deficit/Hyperactivity Disorder (ADHD) previously known as Attention Deficit Disorder (ADD) is generally considered to be a developmental disorder, largely neurological in nature, affecting about 5% of the population. This disorder, typically, present during childhood, and is characterized by a persistent pattern of inattention and/or hyperactivity as well as impulsivity. Children with ADHD are often easily distracted and have difficulty in paying attention or following directions. These children also experience feelings of restlessness marked by fidgeting. They tend to be impulsive and may call out answers or * Research Scholar, Mother Teresa Women s University, Kodaikanal (T. N) ** Reader, DDE, Annamalai University Annamalainagar (T. N)
100 Jayanthi. M and S. Kadhiravan leave their seats without permission (Gardill, Du Paul & Kyle, 1996). The behavioral problems experienced by children with ADHD cause classroom disruption and contribute to low rates of academic involvement. Students with ADHD are at-risk for academic underachievement, school drop out, peer rejection and the development of antisocial behavior patterns (DuPaul, Eckert & McGoey, 1997). The principal characteristics of ADHD are inattention, hyperactivity and impulsivity. These symptoms appear early in a child s life. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR,2000), there are three patterns of behavior viz. inattention, hyperactivity and impulsivity which indicate ADHD. People with ADHD may show several signs of being consistently inattentive. They may have a pattern of being hyperactive and impulsive far more than others of their age or they may show all three types of behavior. There are three subtypes of ADHD recognized by professionals. These are the predominantly hyperactive-impulsive type, the predominantly inattentive type and the combined type that displays both inattentive and hyperactiveimpulsive symptoms. Hyperactivity and Impulsivity: Hyperactive children always seem to be on the go or constantly in motion. They fall frequently, touching or playing with whatever is available in their sight and tend to talk incessantly. Sitting throughout a school lesson or story can be a difficult task for them. They fidget in their seats or roam around the room. Impulsive children seem unable to curb their immediate reactions or to think before they act. They often blurt out inappropriate comments, display their emotions without restraint, and act without regard for the later consequences of their conduct. Their impulsivity may make it hard for them to wait for things they want or to take their turn in games. They may grab a toy from another child or hit when they are upset. Some important signs of hyperactivity-impulsivity are: Feeling restless, often fidgeting with hands or feet, or squirming while seated. Running, climbing, or leaving a seat in situations where sitting or quiet behavior is expected. Blurting out answers before hearing the whole question. Having difficulty waiting in line or taking turns. Inattention: Children who are inattentive have a hard time keeping their minds on any one thing and may get bored with a task after only a few minutes. If they are doing something they really enjoy, they have no trouble in paying attention. But focusing or deliberate, conscious attention to organize and complete a task or learning something new is difficult.homework is particularly hard for these children. They will forget to write down an assignment, or leave it at school. They will forget to bring a book from home, or bring the wrong one. The homework, if finally finished, is full of errors and erasures. Homework is
Effectiveness of Intervention Program for the Children with ADHD 101 often accompanied by frustration for both parent and child. Some important signs of inattention are: Often becoming easily distracted by irrelevant sights and sounds. Often failing to pay attention to details and making careless mistakes. Rarely following instructions carefully and completely losing or forgetting things like toys, books or pencils and tools needed for a task. Often skipping from one incomplete activity to an other. Wu, Kitty, Anderson & Castiello (2002) investigated multiple aspects of executive functioning in children with attention deficit/hyperactivity disorder (ADHD), including attentional components, impulsiveness, planning, and problem solving. The findings of the study claimed that children with ADHD have slower verbal responses and sustained attention deficit. On the other hand, Koschack, Kunert & Derichs (2003) examined the symptom domain of inattention in Attention Deficit/Hyperactivity Disorder (ADHD) suggested that there are neuropsychological fields of attention in which subjects with ADHD express deficits. The study also suggested the differential pattern rather than a deficit pattern of attentional functions in ADHD. Bulut (2005) reported Attention-Deficit/Hyperactivity Disorder is a developmental disorder characterized by a persistent pattern of inattention, hyperactivity, and impulsivity. They made observations in a classroom and found that this disorder presents a unique set of hurdles that must be overcome by a child with ADHD to succeed educationally. It was also observed that attention deficit hyperactivity disorder is the most frequently diagnosed childhood disorder, affecting 3-5% of the school-aged population. In addition to behavioral and social difficulties, children with ADHD often experience academic failure (Sterling, 2006). Existing practices indicates that ADHD requires care and training programs should concentrate more on these areas. Hence, the present study on Effectiveness of intervention programs for the children with ADHD assumes importance. Most of the studies emphasized the immediate need for identifying a unique intervention program for ADHD. There are a number of treatment programs for ADHD that have proven to be effective among children. Researchers have identified effective strategies which include behavioral, pharmacological and multimodal methods. Behavioral approaches represent a broad set of specific interventions that have the common goal of modifying the physical and social environment to alter or change behavior (American Academy of Pediatrics, 2001). Behavioral techniques include response cost, punishment, time-out and rewards. They are used in the treatment of ADHD to provide structure for the child and to reinforce appropriate behavior. Pharmacological treatment includes the use of psychostimulants, antidepressants, anti-anxiety medications, antipsychotics, and mood stabilizers (National Institute Journal of Indian Health Psychology
102 Jayanthi. M and S. Kadhiravan of Mental Health, 2000). Multimodal methods are combined type with medication and behavior treatment for reducing the symptoms of ADHD. It was also realized that each and every approach has its own merits as well as limitations. Intervention Programs used in the study:the effective instruction for children with ADHD involves the use of behavioral interventions. Time-out is probably the most popular behavioral technique to stop inappropriate behavior. Time-out is simply putting the child somewhere when the child is doing something wrong. A behavioral technique that often works quickly is over-learning. It works best on simple behaviors (e.g., closing doors properly) and can also be used on complex behaviors (e.g., toilet training). Response cost is simply taking something away from the child when an identified negative behavior is performed. This technique can be used for a wide variety of misbehaviors and situations. Unorganized sensory input creates an obstacle in the brain making it difficult to pay attention and learn for the children with ADHD. Learning and paying attention is dependent upon the ability to integrate and organize information from our five basic senses i.e. seeing, hearing, taste, smell and touch. But there are other senses that are not as familiar including the sense of movement (vestibular), and sense of muscle awareness (proprioception). To be a successful learner, one s senses must work together in an organized manner. Children with ADHD experience a disconnect between the brain and the body (PNS and CNS) and have difficulty in processing sensory information. This makes it difficult for them to filter out nonessential information, background noises or visual distraction and focus on what is essential. Hence sensory integration technique is considered to be an important one for ADHD. METHOD Design: The present study adopted a quasi-experimental design. The pretest & post-test method was utilized in this study. Sample: Incidental sampling method was used in the study, 35 subjects with ADHD, in the age group 5-10 years were selected in the study. Tools: Colour Cancellation Test by Kapur [1974] was used for both pre as well as post test. The subjects were instructed to cross out all the red and yellow dots within the time limit of one minute. The reliability for the entire check list was tested by sampling Interclass Correlation Co-efficient (ICC) via analysis of variance. The ICC was 0.965. Procedure: The selected subjects were administered the Colour Cancellation Test (pre-test). The intervention program was given for a period of one month. The present intervention program comprises the following techniques which were conducted in individual settings for each: Joining the dots games, threading beads, colouring within lines, cutting within boundaries and cutting pictures and sticking them were given for a period of 25-30 minutes each day thrice a week and subjects
Effectiveness of Intervention Program for the Children with ADHD 103 were instructed to follow the same every day at home for a period of one month. The family members were requested to supervise the instructed activities at home. These activities would help them to improve concentration, sitting tolerance and fine motor skills. Sensory Integration technique was given to the subjects to improve their vestibular input with the help of ball pit, sand pit, swing, ladder and crawling tunnel. With the help of different equipments these techniques were given for about 15-20 minutes daily and subjects were instructed to relax their muscles, which in turn helped them to improve their attention span. The performance scores of the subjects were again measured on Colour Cancellation Task during post-testing. RESULTS AND DISCUSSION TABLE-1 Showing the comparison of pre-test and post-test scores of ADHD children Test variables Pre-test Post-test t value Mean S.D Mean S.D (Df=34) No. of correct response 23.6 3.77 32.7 4.83 6.79* No. of wrong response 3.5 2.65 2.4 1.60 1.61 No. of omission 32.9 4.48 25.8 4.38 5.10* Table 1 shows that the t values were significant for two of the three dependent variables i.e. number of correct response, wrong and omission. The number of correct response increased from pre-test to post-test while, the number of omissions came down. This shows that the steps followed in intervention programs reduced the severity of the symptoms of hyperactivity and impulsivity and attention span increased. Factors such as clear instructions, material used, time spent and individual therapy could have resulted in improved attention and concentration of ADHD subjects. ADHD is a neurological condition that involves problems with inattention and hyperactivity-impulsivity that are developmentally inconsistent with the age of the child. Chhabildas, Pennington and Willcuitt (2001) compared the neuropsychological profiles of children without Attention Deficit Hyperactivity Disorder (ADHD) and children who met symptom criteria for Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) and suggested that symptoms of inattention, rather than symptoms of hyperactivity/impulsivity were associated with the neuropsychological impairment. The effectiveness of intervention programs for ADHD has been studied. Identification of effective intervention methods for ADHD is a challenging process because every person with ADHD Journal of Indian Health Psychology
104 Jayanthi. M and S. Kadhiravan is different. To be effective these interventions need to focus on each individual s strengths and weaknesses and have the flexibility to change with the needs of an individual. Once students are identified as ADHD, they will require specific intervention and ongoing support that they are not further hindered in their learning. Behavioral approaches are used in the treatment of ADHD to provide structure for the child and to reinforce appropriate behavior and sensory integration is the ability to take in, process, organize and assimilate sensory information so that the child feels comfortable and secure and the vestibular and proprioceptive senses commonly function improperly among children with ADHD disorders. McGoey, EcKert and DuPaul (2002) studied the efficacy of pharmacological, parent training, and behavioral interventions designed to manage the disruptive behavior of preschool children with ADHD. It was found that Pharmacological intervention and parent-training methods were found to be effective in the home setting. The use of behavioral interventions helped to prepare the preschool-age child with ADHD for kindergarten. Miranda, Persentacion and Soriano (2002) also evaluated the efficacy of a multicomponent program for treating ADHD viz behavior modification techniques, cognitive behavior strategies, and instructional management strategies. Parents and teachers ratings detected improvements in inattention, hyperactivity-impulsivity. Furthermore, the results showed increased academic scores, enhanced classroom behavioral observations, and improved teachers knowledge about the strategies directed toward responding to the children s educational needs. O Connell, Bellgrove and Dockree (2006) investigated the efficacy of periodic non-informative alerting cues for improving sustaining attention in ADHD. It was found that sustained attention performance can be enhanced in children with ADHD using a simple behavioral and cognitive training strategy. The result of this study revealed that the intervention programs reduced the severity of ADHD disorder. The steps used in the present study through behavior therapy and sensory integration have been found to be effective. The children s concentration and attention span have improved as well as severity of the hyperactivity has come down. Gradually the number of correct responses increased and number of wrong response decreased after intervention program. Hence, it is concluded that the adopted intervention programs have been effective for the children with ADHD. Conclusion: Over the years a large amount research on Attention Deficit Hyperactivity Disorder has been undertaken but how these findings fit together to form an overall picture still remains elusive. The results indicate that intervention had an effect on the children with ADHD. The present techniques used in the study were effective and further researchers can incorporate these techniques in their treatment for ADHD children.
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