HOW TO TREAT ATTENTION DEFICIT/HYPERACTIVITY DISORDER (ADHD) (THE EXAMPLE CASE OF 8 YEAR OLD CHANTEL)

            According to (Hunt, Marshall, 2005), “attention deficit/hyperactivity disorder (ADHD) is a disorder that affects an individual’s ability to attend or focus on tasks and that may involve high levels of motoric activity. Between 3 and 5 percent of children in the United States are identified as having ADHD” (p. 256). Research has shown that many of these children are also diagnosed with a learning disability or possible conduct-related behavioral disorder. As a child development specialist, my current goal is to assist a young girl who has recently been diagnosed with ADHD. In order to successfully accomplish this goal, I will need to design an in-depth step-by-step treatment process. These steps will also be addressed within two written sections which are as follows:

1. Part I: Analysis

2. Part II: Intervention

PART I: ANALYSIS

             8 year old Chantel has recently been diagnosed with ADHD. She is exhibiting specified behavioral issues which may be devastating to her overall growth, functioning, and development. These issues are also affecting 5 specific domains which include cognitive, social/emotional, and physical, along with her home and school environments. Some of the specific issues within each domain are as follows: Chantel’s cognitive issues are hyperactivity, lack of focus, forgetfulness and/or poor memory skills. She may be experiencing social/emotional issues due to exile from fellow classmates. This constant isolation could also be causing inner feelings of inadequacy, loneliness and despair. Chantel’s major physical issue is that she’s sometimes aggressive toward classmates and does occasionally use excessive force. If this continues then she may eventually harm herself, a teacher, fellow classmate, family member or animal. It is also possible that she may be physically acting out in an attempt to communicate or manipulate an environment that she doesn’t fully understand. Although this is a major source of concern, she is also a fast runner, who is physically flexible, strong and athletic. Since she possesses these physical attributes, her peers usually pick her first in gym class. She is also experiencing issues within her home environment. Her parents have expressed a major concern about her level of hyperactivity, forgetfulness, impulsive behavior, late poor quality work, history with behavioral incidents, scapegoating occurrences and lack of social skill.

How Do These Behavioral Issues Affect Chantel’s School Environment?

Since, cognitive, social/emotional, physical and home environmental issues are occurring I believe that they are drastically affecting Chantel’s overall performance at school. Some of these issues may also coincide with her parent’s concerns, along with unique school related issues. These include difficulty retaining or remembering information, completing tasks, unsatisfactory work and some physical altercations with fellow classmates. She is also required to complete the same grade curriculum and time frames as “normal” peers who don’t have ADHD.

PART II: INTERVENTION

            Since several issues are present, implementing an intervention plan will be the next important step during this process. This step will also give me the opportunity to implement a treatment plan which is specifically designed to assist Chantel. The intervention plan that I have designed for Chantel is also “based on the principles of applied behavioral analysis; these programs involve the systematic instruction of discreet skills” (Hunt, Marshall, 2005. p. 309). An individualized ABA program plan is normally implemented to modify behaviors that may be viewed as undesirable to the client and/or society. There are also many cases when the undesirable behaviors are actually due to underlying symptoms of a disability, like ADHD. Since this is one of those cases, I have designed a 3 step process plan for Chantel, which includes early intervention, implementing specific techniques, and measuring and monitoring. This overall plan has also been designed to identify how to properly assist Chantel based on her individual needs and can be viewed below:

STEP 1. EARLY INTERVENTION

This first step is a key factor in order to properly assess and treat Chantel’s actual behavioral issues. This initial assessment is also when I will decide which techniques should be used to address the behaviors that are causing major distress.

STEP 2. IMPLEMENTING SPECIFIC TECHNIQUES

The second step is to implement techniques which can modify behaviors that are affecting specific domains. These 5 domains and recommended techniques are as follows:

Cognitive – She is experiencing hyperactivity, lack of focus, forgetfulness and/or poor memory skills within this area. Techniques that I can use which may improve cognitive development are individualized instruction programs and strategies. These can include a self management program and assistive technology.

Social/Emotional – Chantel wants to play with other children but she lacks proper social skill. Therefore, she will need techniques that build and/or develop these valuable skills. Once this process is completed, Chantel may also be able to interact with family members, teachers, and peers on a much healthier social and emotional level. Two techniques that I can use to help her develop these skills are implementation of monitored play dates and child counseling sessions. 
Physical - It‘s crucial that I provide a plan which can reduce Chantel’s desire to be aggressive. The techniques to address this issue will also first be implemented within her school environment.  

Home Environment – When a child is diagnosed with a behavioral disorder, this can cause many feelings within the family. Some of these include stress, guilt, helplessness and anger. It is important to implement techniques which will foster a positive and supportive home environment, while eliminating some of these family emotions. Chantel’s parents also revealing some of these feelings due to her ADHD. It is important that we support these concerns by keeping her parents informed through every step of the implementation/treatment process. They must also be informed about any plan changes or modifications so they can support and practice treatment consistency. If this is completed, then the level of stress and other feelings may decrease over time. Two techniques that I can implement which may initiate family support and consistency are effective communication skills and appropriate family intervention classes.

School Environment – Chantel needs comprehensive processes that may improve her issues with late homework, problems retraining or remembering information, unsatisfactory or incomplete work. She also tries to complete the same curriculum and time frames as “normal” peers even though she has ADHD. Below, there are 4 techniques that may address each one of these issues:

1. Proper Assessment - I will recommend that Chantel is immediately assessed by the appropriate staff members. This will determine if she should be completing the same curriculum as normally developed peers. If she is diagnosed with a learning disability due to her ADHD, then she may benefit greatly, from assistive technology or special education classes.

2. Weekly Reporting - The second technique that I will implement to address and/or modify these behaviors while at school is the addition of weekly reporting. Weekly reports can be used as a way to record how many issues occur and the details of each event. This process can also generate valuable information that may help with her treatment plan and possibly prevent any scapegoating issues that her parents are concerned about. 

3. Behavior Chaining/Differential Reinforcement of Alternative Behavior - The third technique that I will recommend is the implementation of behavior chaining. According to (Cooper, Heron, Heward, p. 435), “a behavior chain is a sequence of discrete responses, each associated with a particular stimulus condition. Each discrete response and the associated stimulus condition serve as an individual component of the chain. When individual components are linked together, the result is a behavior chain that produces a terminal outcome.”

Since, Chantel has ADHD she may require a world which is extremely routine and/ or structured. I believe that if she could slowly learn different chains of desirable behavior, she will begin to perform these rituals on a regular and permanent basis. Behavior chaining can also be conducted on a single individual our within a group setting. An alternate procedure that could also be used in Chantel’s classroom and recess settings is known as Differential Reinforcement of Alternative Behavior. According to (Cooper, Heron, Heward), this procedure “reinforces occurrences of behavior that provides a desirable alternative to the problem behavior but is not necessarily incompatible with it” (p. 471). An example of this process is as follows:

“When an incident begins to occur, the teacher will tell Chantel that it is unacceptable behavior. The teacher will than re-direct Chantel to hug her friend instead, and then go swing together.”

4. Parent/Teacher Conferences – I will also implement weekly parent/teacher conferences as a required technique. This will offer an opportunity to disclose all results or details which are pertinent to her treatment plan. These will include the weekly report and other factors. 

STEP 3. MEASURING AND MONITORING

This final step can be very exciting after implementing a program plan! This is because information will be shared which can determine if the implemented program plan and/or techniques are beneficial to Chantel’s treatment process. These results will also be gathered through weekly reports that identify any new behavioral changes or other issues.

CONCLUSION

               As stated in my initial introduction, according to (Hunt, Marshall, 2005), "attention deficit/hyperactivity disorder (ADHD) is a disorder that affects an individual’s ability to attend or focus on tasks and that may involve high levels of motoric activity. Between 3 and 5 percent of children in the United States are identified as having ADHD” (p. 256). Research has shown that many of these children are also diagnosed with a learning disability or possible conduct-related behavioral disorder.

As a child development specialist, my initial goal was to assist 8 year old Chantel, who has recently been diagnosed with ADHD. She was also exhibiting behaviors within 5 specific domains. In order to successfully accomplish this goal, I chose to address these behaviors within two specific sections. These included a lengthy analysis of observable details and creation of a final intervention and treatment plan.

I am confident that this overall process would modify some of Chantel’s undesirable behaviors. This is because my plan included the use of techniques that are based on principles of ABA to strengthen development within specified areas. The major domains of concern for Chantel’s case were cognitive, social/emotional, physical, and home and school environments. Some of my chosen techniques to modify behavior within these domains were the implementation of behavior chaining, differential alternative reinforcement, mandatory parent/teacher conferences, and parental communication to ensure plan consistency. The results of Chantel’s intervention and treatment plan would also be closely measured and monitored through weekly reporting. These results would also keep her “intervention/treatment team” informed about any new behavioral changes or other concerns. One example of this would be results that show where her undesirable aggressive behavior has been modified through “Differential Reinforcement of Alternative Behavior” to reflect desirable hugging behavior!

     

REFERENCES:

Hunt, N., & Marshall, K. (2005). Exceptional children and youth (4th ed.). Belmont, CA: Wadsworth.

Cooper, J. O., Heron, T. E., Heward, W. L. (2007). Applied Behavior Analysis (2^nd ed). New Jersey: The Lehigh Press, Inc.