Smart Speech Therapy LLC

It is a well known fact that institutionalization has been linked to increased mental health difficulties in internationally adopted children.  These difficulties frequently manifest as symptoms of inattention, impulsivity and hyperactivity and affect the post-institutionalized children’s executive function skills particularly their ability to initiate tasks, sustain attention, self-monitor, as many as many other aspects of behavior  regulation (Beverly, McGuinness, & Blanton, 2008; Stevens et al., 2008).  Many parents of post-institutionalized children in my private practice often ask me for ways in which they can better manage their children behavior at home especially when their children are doing homework, preparing for projects, or studying for tests.

Consequently, today I will be offering some suggestions of how parents can better manage behavior of children with inattention, hyperactivity and impulsivity in the home environment. Notice, I do not use the term ADHD or Attention Deficit Hyperactivity Disorder to refer to these symptoms.  That is because not every child who presents with these symptoms has ADHD.  In my previous posts and downloads, I have went over in considerable detail how children with a wide variety of disorders and diagnoses (e.g., Traumatic Brain Injury (TBI), Sensory Processing Disorder (SPD), Auditory Processing Disorder (APD) can present with symptoms of inattention, hyperactivity and impulsivity.  For the purpose of this post, I will be focusing not on a specific diagnosis but on how to address the above symptoms via a number of modification techniques aimed at managing interfering behaviors.  These techniques include modifications of: physical space, session structure, as well as child’s behavior.

Physical Space Modifications: This involves setting up the room to eliminate visual distractions, making sure that the space is free of clutter. You’ll also want to eliminate any unnecessary auditory distractions (e.g., noise from an air conditioner/heater) as well as modify the child’s seating arrangements. Have the child face a wall vs. the window and if you are monitoring the child’s performance you may want to seat next to them instead of across from them in order to provide gestural or tactile (shoulder touch) reminders to stay on task (homework).

Structure Modifications: There are a number of structural modifications that parents can provide their children during study times. For starters they can use written schedules to identify order of activities.  Timers are useful for specifying how long the child has to work on a task until break time. You may want to limit homework/study time to specific time blocks (e.g., 30 minutes) to reduce fatigue and frustration. Simple seat modifications may significantly reduce hyperactivity and impulsivity. Occupational (and speech) therapists frequently use these modifications in their sessions and so can parents. Placing the child on a therapy ball or a zuma rocker may allow for better trunk positioning as well as trunk stability for some kids, while allowing other children to fidget “appropriately” in their seat.  Don’t be afraid to offer your kids some handheld sensory manipulatives to squeeze or shake.  Allow a few minutes for sensory breaks when the kids could move for 2-3 minutes to music or do some jumping jacks.

Modifying Child’s Behavior: There is a number of ways in which this could be accomplished. For starters, you may want to allow your child greater control by offering choices: “do you want to do the math homework or the science project first? If you are working on explaining new material to your child try to incorporate known with new information in order not to increase complexity too rapidly. You may also work with your child to create a list of predetermined strategies such as he/she can say to you when they are having trouble while working on a task.

If you have implemented the discussed modifications and the undesirable behaviors continue to escalate, consider reducing the task complexity. Perhaps you can do a review vs. homework? This will allow you to still maintain some semblance of control over the situation vs. giving up working on tasks all together.

In cases when behaviors are very extreme (aggression, withdrawal, etc) try build the child’s tolerance in small time increments (e.g., we’ll do 5 more minutes, one last activity before ending task). To increase self esteem, catch the child “being good” and praise for specific vs. general positive behaviors such as staying on task or completing an activity (e.g., “Great job on reading that page all by yourself!”). You may also want to use cause/effect sticker charts to increase your child’s compliance and motivation during study periods (have the child earn a sticker for every appropriate 15 minute study period; then when the sticker chart is full, the child may earn a desirable activity or item).

The last thought regarding behavior management that I wanted to leave you with is the importance of consistency. Whichever behavior modification techniques you are implementing, remember to be consistent with the execution and follow through, across all settings and activities, in order to optimize your child’s success learning!

To download your FREE copy of “Strategies of Asking for Help”, click HERE. If you are an SLP looking for more detailed information on “Behavior Management Strategies for Speech Language Pathologists” click HERE.

References:

• Beverly BL, McGuinness TM, Blanton DJ. Communication and academic challenges in early adolescence for children who have been adopted from the former Soviet Union. Language, Speech, and Hearing Services in Schools. 2008;39:303–313.
• Brooks, A (1991) Behavior Problems and the Power Relationship. Language, Speech, and Hearing Services in Schools, (22), 89-91.
• Carr, E. G., et al (1994). Communication-based intervention for problem behavior: A user’s guide for producing positive change. Baltimore, MD: Paul H. Brooks.
• Currie, P. S., Melville, G. A., & Stiegler, L. N. (1997). Behavior management strategies for clinical or educational settings. The Clinical Connection, 10(1), 18-22.
• Hodgdon, L. (1995).  “Visual Strategies for Improving Communication”. Michigan: Quirk Roberts Publishing.
• Johnston, S and Reichle, J (1993) Language and Social Skills in the School-Age Population: Designing and Implementing Interventions to Decrease Challenging Behavior. Language, Speech, and Hearing Services in Schools, (24), 225-235.
• Savner, J., & Myles, B. (2000). “Making Visual Supports Work in the Home and Community”. Kansas: Autism Asperger Publishing Co.
• Stevens SE, Sonuga-Barke E, Kreppner JM, Beckett C, Castle J, Colvert E, Groothues C, Hawkins A, Rutter M. Inattention/overactivity following early severe institutional deprivation: Presentation and associations in early adolescence. Journal of Abnormal Child Psychology.2008;36:385–398.