INTERNATIONAL SCENARIO ON THE DEVELOPMENT OF LAWS IN THE FIELD OF DISABILITY REHABILITATION

                                                

                                               By Mrs .Pragya Verma

1. Americans with Disability Act (ADA) (1990)

Extended civil rights similar to those of the Civil Rights Act of 1964 to the people with disabilities Act, “Prohibits discrimination on the basis of disability in: private sector employment, service rendered by state and local governments, places of public accommodations, transportation and telecommunications relay system”. Integration is the fundamental to the purpose of the ADA. Regulations state that ‘a public entity may not deny a qualified individual with a disability – the opportunity to participate in services, programmes or activities that are not separate or different, despite the existence of permissibly separate or different programmes or activities”.

2 The standard rules on the equalization of opportunities for persons with disability (1993)
The declaration clearly stated that general education authorities are responsible for the education of persons with disabilities in integrated settings. Education of persons with disabilities should form an integral part of national education planning, curriculum development and school organization.

Article -26 (Introduction) states that “the persons with disabilities should receive the support of employment and social services”.

3 The Salamanca Statement and Framework for action on Special Needs Education (1994)

The Salamanca statement states,

·  Every child has a fundamental right to education and must be given the opportunity to achieve and maintain acceptable level of learning.

·  Every child has unique characteristics, interests, abilities and learning needs.

·  Education systems should be designed and educational programmes implemented to take into account the wide diversity of these characteristics and needs.

·  Those with special educational needs must have access to regular schools which should accommodate them within child center pedagogy capable of meeting these needs.

·  Regular schools with this inclusive orientation are most effective means of combating discriminatory attitudes, creating welcoming communities, building an inclusive society and achieving education for all; moreover they provide an effective education to the majority of the children and improve the efficiency and ultimately the cost effectiveness of the entire education system.

·  Educational policies at all levels should stipulate that children with special needs should attend their neighborhood school that is the school that would be attended if the child did not have the disability.

·  The Salamanca Framework for action further points through its Article – 6 that “ Experience in many countries demonstrates that the integration of the children and youth with special needs is best achieve with in inclusive schools that serve all the children with in a community. It is within this context that those with special educational needs can achieve the fullest educational progress and social integration.

4 United Nation Convention on the Rights of Persons with Disabilities (2008)

Article 3 - General principles

The principles of the present Convention shall be:

a. Respect for inherent dignity, individual autonomy including the freedom to make one’s own choices, and independence of persons;

b.Non-discrimination;

c. Full and effective participation and inclusion in society;

d.Respect for difference and acceptance of persons with disabilities as part of human diversity and humanity;

e. Equality of opportunity;

f.  Accessibility;

g. Equality between men and women;

h. Respect for the evolving capacities of children with special needs and respect for the right of children with special needs to preserve their identities.

Article 5 - Equality and non-discrimination

1. States Parties recognize that all persons are equal before and under the law and are entitled without any discrimination to the equal protection and equal benefit of the law.
2. States Parties shall prohibit all discrimination on the basis of disability and guarantee to persons with disabilities equal and effective legal protection against discrimination on all grounds.

3. In order to promote equality and eliminate discrimination, States Parties shall take all appropriate steps to ensure that reasonable accommodation is provided.

4. Specific measures which are necessary to accelerate or achieve de facto equality of persons with disabilities shall not be considered discrimination under the terms of the present Convention.

Article 6 - Women with disabilities

1. States Parties recognize that women and girls with disabilities are subject to multiple discrimination, and in this regard shall take measures to ensure the full and equal enjoyment by them of all human rights and fundamental freedoms.
2. States Parties shall take all appropriate measures to ensure the full development, advancement and empowerment of women, for the purpose of guaranteeing them the exercise and enjoyment of the human rights and fundamental freedoms set out in the present Convention.

Article 7 - Children with special needs

1. States Parties shall take all necessary measures to ensure the full enjoyment by children with special needs of all human rights and fundamental freedoms on an equal basis with other children.

2. In all actions concerning children with special needs, the best interests of the child shall be a primary consideration.

3. States Parties shall ensure that children with special needs have the right to express their views freely on all matters affecting them, their views being given due weight in accordance with their age and maturity, on an equal basis with other children, and to be provided with disability and age-appropriate assistance to realize that right.

Article 9 – Accessibility

1. To enable persons with disabilities to live independently and participate fully in all aspects of life, States Parties shall take appropriate measures to ensure to persons with disabilities access, on an equal basis with others, to the physical environment, to transportation, to information and communications, including information and communications technologies and systems, and to other facilities and services open or provided to the public, both in urban and in rural areas. These measures, which shall include the identification and elimination of obstacles and barriers to accessibility, shall apply to, inter alia:

a.       Buildings, roads, transportation and other indoor and outdoor facilities, including schools, housing, medical facilities and workplaces;

b.      Information, communications and other services, including electronic services and emergency services.

2. States Parties shall also take appropriate measures to:

a.       Develop, promulgate and monitor the implementation of minimum standards and guidelines for the accessibility of facilities and services open or provided to the public;

b.      Ensure that private entities that offer facilities and services which are open or provided to the public take into account all aspects of accessibility for persons with disabilities;

c.       Provide training for stakeholders on accessibility issues facing persons with disabilities;

d.      Provide in buildings and other facilities open to the public signage in Braille and in easy to read and understand forms;

e.       Provide forms of live assistance and intermediaries, including guides, readers and professional sign language interpreters, to facilitate accessibility to buildings and other facilities open to the public;

f.        Promote other appropriate forms of assistance and support to persons with disabilities to ensure their access to information;

g.       Promote access for persons with disabilities to new information and communications technologies and systems, including the Internet;

h.       Promote the design, development, production and distribution of accessible information and communications technologies and systems at an early stage, so that these technologies and systems become accessible at minimum cost.

Article 12 - Equal recognition before the law

1. States Parties reaffirm that persons with disabilities have the right to recognition everywhere as persons before the law.

2. States Parties shall recognize that persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life.

3. States Parties shall take appropriate measures to provide access by persons with disabilities to the support they may require in exercising their legal capacity.
4. States Parties shall ensure that all measures that relate to the exercise of legal capacity provide for appropriate and effective safeguards to prevent abuse in accordance with international human rights law. Such safeguards shall ensure that measures relating to the exercise of legal capacity respect the rights, will and preferences of the person, are free of conflict of interest and undue influence, are proportional and tailored to the person’s circumstances, apply for the shortest time possible and are subject to regular review by a competent, independent and impartial authority or judicial body. The safeguards shall be proportional to the degree to which such measures affect the person’s rights and interests.

5. Subject to the provisions of this article, States Parties shall take all appropriate and effective measures to ensure the equal right of persons with disabilities to own or inherit property, to control their own financial affairs and to have equal access to bank loans, mortgages and other forms of financial credit, and shall ensure that persons with disabilities are not arbitrarily deprived of their property.

Article 13 - Access to justice

1. States Parties shall ensure effective access to justice for persons with disabilities on an equal basis with others, including through the provision of procedural and age-appropriate accommodations, in order to facilitate their effective role as direct and indirect participants, including as witnesses, in all legal proceedings, including at investigative and other preliminary stages.

2. In order to help to ensure effective access to justice for persons with disabilities, States Parties shall promote appropriate training for those working in the field of administration of justice, including police and prison staff.

Article 19 - Living independently and being included in the community

States Parties to this Convention recognize the equal right of all persons with disabilities to live in the community, with choices equal to others, and shall take effective and appropriate measures to facilitate full enjoyment by persons with disabilities of this right and their full inclusion and participation in the community, including by ensuring that:

a.       Persons with disabilities have the opportunity to choose their place of residence and where and with whom they live on an equal basis with others and are not obliged to live in a particular living arrangement;

b.      Persons with disabilities have access to a range of in-home, residential and other community support services, including personal assistance necessary to support living and inclusion in the community, and to prevent isolation or segregation from the community;

c.       Community services and facilities for the general population are available on an equal basis to persons with disabilities and are responsive to their needs.

Article 24 - Education

1. States Parties recognize the right of persons with disabilities to education. With a view to realizing this right without discrimination and on the basis of equal opportunity, States Parties shall ensure an inclusive education system at all levels and life long learning directed to:

a.       The full development of human potential and sense of dignity and self-worth, and the strengthening of respect for human rights, fundamental freedoms and human diversity;

b.      The development by persons with disabilities of their personality, talents and creativity, as well as their mental and physical abilities, to their fullest potential;

c.       Enabling persons with disabilities to participate effectively in a free society.

2. In realizing this right, States Parties shall ensure that:

a.       Persons with disabilities are not excluded from the general education system on the basis of disability, and that children with special needs are not excluded from free and compulsory primary education, or from secondary education, on the basis of disability;

b.      Persons with disabilities can access an inclusive, quality and free primary education and secondary education on an equal basis with others in the communities in which they live;

c.       Reasonable accommodation of the individual’s requirements is provided;

d.      Persons with disabilities receive the support required, within the general education system, to facilitate their effective education;

e.       Effective individualized support measures are provided in environments that maximize academic and social development, consistent with the goal of full inclusion.

3. States Parties shall enable persons with disabilities to learn life and social development skills to facilitate their full and equal participation in education and as members of the community. To this end, States Parties shall take appropriate measures, including:

a.       Facilitating the learning of Braille, alternative script, augmentative and alternative modes, means and formats of communication and orientation and mobility skills, and facilitating peer support and mentoring;

b.      Facilitating the learning of sign language and the promotion of the linguistic identity of the deaf community;

c.       Ensuring that the education of persons, and in particular children, who are blind, deaf or deafblind, is delivered in the most appropriate languages and modes and means of communication for the individual, and in environments which maximize academic and social development.

4. In order to help ensure the realization of this right, States Parties shall take appropriate measures to employ teachers, including teachers with disabilities, who are qualified in sign language and/or Braille, and to train professionals and staff who work at all levels of education. Such training shall incorporate disability awareness and the use of appropriate augmentative and alternative modes, means and formats of communication, educational techniques and materials to support persons with disabilities.

5. States Parties shall ensure that persons with disabilities are able to access general tertiary education, vocational training, adult education and lifelong learning without discrimination and on an equal basis with others. To this end, States Parties shall ensure that reasonable accommodation is provided to persons with disabilities.

Article 26 - Habilitation and rehabilitation

1. States Parties shall take effective and appropriate measures, including through peer support, to enable persons with disabilities to attain and maintain maximum independence, full physical, mental, social and vocational ability, and full inclusion and participation in all aspects of life. To that end, States Parties shall organize, strengthen and extend comprehensive habilitation and rehabilitation services and programmes, particularly in the areas of health, employment, education and social services, in such a way that these services and programmes:

a.       Begin at the earliest possible stage, and are based on the multidisciplinary assessment of individual needs and strengths;

b.      Support participation and inclusion in the community and all aspects of society, are voluntary, and are available to persons with disabilities as close as possible to their own communities, including in rural areas.

2. States Parties shall promote the development of initial and continuing training for professionals and staff working in habilitation and rehabilitation services.
3. States Parties shall promote the availability, knowledge and use of assistive devices and technologies, designed for persons with disabilities, as they relate to habilitation and rehabilitation.

Article 27 - Work and employment

1. States Parties recognize the right of persons with disabilities to work, on an equal basis with others; this includes the right to the opportunity to gain a living by work freely chosen or accepted in a labour market and work environment that is open, inclusive and accessible to persons with disabilities. States Parties shall safeguard and promote the realization of the right to work, including for those who acquire a disability during the course of employment, by taking appropriate steps, including through legislation, to, inter alia:

a. Prohibit discrimination on the basis of disability with regard to all matters concerning all forms of employment, including conditions of recruitment, hiring and employment, continuance of employment, career advancement and safe and healthy working conditions;

b.Protect the rights of persons with disabilities, on an equal basis with others, to just and favourable conditions of work, including equal opportunities and equal remuneration for work of equal value, safe and healthy working conditions, including protection from harassment, and the redress of grievances;

c. Ensure that persons with disabilities are able to exercise their labour and trade union rights on an equal basis with others;

d.Enable persons with disabilities to have effective access to general technical and vocational guidance programmes, placement services and vocational and continuing training;

e. Promote employment opportunities and career advancement for persons with disabilities in the labour market, as well as assistance in finding, obtaining, maintaining and returning to employment;

f.  Promote opportunities for self-employment, entrepreneurship, the development of cooperatives and starting one’s own business;

g. Employ persons with disabilities in the public sector;

h. Promote the employment of persons with disabilities in the private sector through appropriate policies and measures, which may include affirmative action programmes, incentives and other measures;

i.   Ensure that reasonable accommodation is provided to persons with disabilities in the workplace;

j.  Promote the acquisition by persons with disabilities of work experience in the open labour market;

k.Promote vocational and professional rehabilitation, job retention and return-to-work programmes for persons with disabilities.

2. States Parties shall ensure that persons with disabilities are not held in slavery or in servitude, and are protected, on an equal basis with others, from forced or compulsory labour.

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The tem Specific Learning Disability (SLD): Tracing the Historical Evolution and confusion

           Dr. Renu Malaviya,

        Associate Prof, Deptt. Of Education,Lady Irwin College    (University of Delhi)

 The evolution of definitions of LD can be traced to the turn of the last century and is closely linked concepts of organically based behavioural disorders.  The concept of LD arose from observations of children who were hyperactive and impulsive; it was often presumed that the cause of these unexpected behaviour disorders was constitutional in origin. Thus, these children were described with terms such as organic driveness syndrome, minimal brain injury,   (Doris, 1993; Rutter, 1982; Satz & Fletcher, 1980)

Way back in the 18^th and the 19^th century, children with learning disabilities were often diagnosed and considered to have “minimal brain dysfunction”. Further testing would indicate that the children tended to show some neurological difficulties. Yet these neurological difficulties seem to vary from child to child and in unpredictable ways. The experts of that era realized that there appeared to be no predictable structure to these neurological difficulties. Attempts at correlations with reference to the size of the brain, pattern of blood flow to the brain, nerve impulse to the brain and so on were studied. Yet no consistent structures were indentified. Sometimes the diagnosis would indicate, perceptual deficits’. Yet attempts to improve on the eye-hand coordination or on the visual scanning skills would not work. All this did leave the scientific world a little perplexed.

Terms such as “ minimum brain dysfunction”, “ stephosymbolia” ( reversal of letters), hyperactive and impulsive, organic driveness syndrome and so on were extensively being used for these children. (Doris, 1993; Rutter, 1982; Satz & Fletcher, 1980)

In 1963 Samual Kirk at Chicago coined the term “learning disability”. (1962, cited in Streissguth, Bookstein, Sampson, & Barr, 1993, p.144). He urged the scientific community to throw away the other previously used terminologies. The term learning disability had its advantages:

·         It was a term which parents and teachers could understand

·         It moved the concepts out of the realm of only neurology and medicine towards the field of education.

·         Now the focus could be more towards the issues related to information and language processing.

·         The educators begin to work upon finding special education techniques.

According to Samuel Kirk, (1962):

‘A learning disability refers to a retardation, disorder, or delayed development in one or more of the processes of speech, language, reading, spelling, writing, or arithmetic resulting from a possible cerebral dysfunction and/or emotional or behavioral disturbance and not from mental retardation, sensory deprivation, or cultural or instruction factors.’

 [Kirk, S. A. (1962). Educating exceptional children. Boston: Houghton Mifflin. (p. 261).]

As the term gained rapid acceptance, it facilitated another important move. The  establishment of the term LD ( Learning Disability) as a special education category, enabled children with LD to be included in being provided special  services related to education and beyond.  As of earlier they were excluded from the special services as their learning characteristics did not correspond to existing categories.  This in itself was a major step in the perspectives related to this disability.

In 1963, Samuel Kirk addressed a gathering of anxious parents in Chicago, (Streissguth, Bookstein, Sampson, & Barr, 1993) at which for the first time used publicly the term learning disabilities to describe the children. He stated at the gathering

Dyslexics are a specific group of children, adolescents and adults who have problems in learning. These problems are generally in the area of reading, writing, spellings and mathematics. A learning disability is found across all ages and in all socio-economic classes. It is not a-typical of mental retardation as is mistaken by many people; in fact the IQ scores of these children can be very high.

At the end of 1950’s and early 1960’s the need to focus on, ‘Education for all” started to emerge in Great Britain and the United States of America in the 1960s. At that time the difficulty that children were facing with learning in the school system began to attract the attention of educationist and psychologist seriously. As the momentum of getting each and every child into school increased, the number of ‘intelligent’ and “able bodied” children, who were unable to cope with learning in school especially with reading, writing and mathematics also increased. These children were otherwise bright, fairly articulate and had no sensory or visual handicap.

As “Education for All” gained momentum in Great Britain,  experience as well as effective school teachers and principals observed that their were children who otherwise appeared bright, were articulate and generally appeared to be learning, yet when it came to examinations they would repeatedly not do well. They would not be able to read well and it may be remembered that at that point of time getting the children to read aloud in class was a major way of teaching . There are documentations of school principals of that era who have indicated their concern about these children who according to them were defiantly intelligent but yet were failing repeatedly. Hence came in the term “dyslexia” (Dys means difficulty and lexia means words). Gradually as each and every child was now in the school system in Great Britain, there came in a realization that there were another set of children who even if they were okay with the age standard norm for reading, just could not write well. No amount of training helped them become really better. The new term that came into existence was dysgraphia (Dys means difficulty and graphia indicating writing)  and further as the school system improved and more resources were pumped into the school system another set of children were identified who came to be known as dyscalculia (Dys means difficulty and calculia indicating arithmetic).

Now the first term was dyslexia, and hence just as a petname/family name that many of us have, dyslexia in the mass memory continued to used as the umbrella term for dyslexia, dysgraphia, dyscalculia, aphasia and so on.

Now around this time there was a lot of migration from Great Britain to the new land called USA. The psychologist, educationist who migrated there for greener pastors took with them the knowledge. They also took with the knowledge related to the term MR (mental retardation). Therein the term MR was being reconsidered as the terminology retardation was being now considered belittling. Therein the term MR was being replaced with LD (learning disabilities).

Now as the awareness increased in South Asia, it lead to  certain amount of confusion. There was a intermixing of the terminologies Mental Retardation (MR), Learning Disabilities (LD) and Learning Difficulties (LD). Hence came in the confusion that a MR is also LD or vice a versa. It needs a bit of minute observation as to why this happened and continues to happen. The abbreviation LD stands for both learning disabilities (LD) and learning difficulty (LD).

When we say learning difficulty it implies that there is a difficulty in learning which can be removed or which may not be possible to remove. For example if I am new to learning a language say French, I will have learning difficulty (LD) and NOT learning disability (LD). If my teacher does not know how to teach well than I will face learning difficulty (LD) and NOT learning disability (LD).

So a child with Mental retardation ( Intellectual disability) will have a learning disability and so will a child with dyslexia have a learning disability.

Oh! Can you now observe that type of confusion that the terminologies have created? Is dyslexia only dyslexia or is dyslexia also dygraphia, dyscalculia , aphaisa and others???? Hence as of now in South Asia the umbrella term used for ‘disability’ in reading, writing, arithmetic etc is Specific Learning Disability (SLD).  

         The confusion has not ended as yet. I can almost hear many of you saying SLD is NOT a disability and so even ASD is NOT a disability. Well! Well ! I completely agree with you, these are the off shoots of diversities in the brain structures. In my next article I will deal with the brain diversities and whether it is learning difficulties (LD), learning disabilities (LD) or Learning diversities (LD).

Before if I sign off, I would also want to touch on the term “Slow Learner” . This it as of now a sub-classification of Intellectual Disability or is it any one who is learning slowing. If it is anyone who is learning slowing than could it be the cause of faculty teaching, limitations of the child’s physical-socio-economic- cultural environment??? If yes than who is the “slow”, the child or the teacher or the parent?????

Slow learner

Learning disability

Learning difficulty

Learning deviance

Sp learning disability

MR

ASDD

Management of ADHD

Attention Deficit Hyperactive Disorder (ADHD) is the most serious behavioural problems not only among the children with special needs, but also among the normal children. It requires timely and effective interventions. Most of the professional especially clinical psychologists are less aware about different modalities of effective treatment. This paper orients them about the different modalities of treatment with details.

Comprehensive Treatment for ADHD should always include a strong psychosocial component. Most professionals believe that effective psychosocial treatment is the backbone of good treatment for ADHD. Apart from pharmacotherapy, following psychosocial modalities are found most effective in the treatment of ADHD.

(1)   Behavioural Intervention:

There are three parts of effective behavioural interventions for ADHD children—

(i)                 parent training,

(ii)               school interventions, and

(iii)             child-focused treatments.

Four points apply to all three parts:

(1) Always start with goals that the child can achieve and improve in small steps (e.g., “baby steps”);

(2) Always be consistent—across different times of the day, different settings, and different people;

 (3)ADHD is a chronic problem for the individual and treatments need to be implemented over the long duration—not just for a few months; and

(4) Teaching and learning new skills take time, and children’s improvement will be gradual with behaviour modification.

(i) Parent Training:

The first session is often devoted to an overview of the diagnosis, causes, nature, and prognosis of ADHD. Thereafter, in group or individual sessions, parents learn a variety of techniques, some of which they may be already using at home but not as consistently or correctly as needed. Parents go home and implement what they learn in sessions during the week, and return to the parenting session the following week to discuss progress, problem solve, and learn a new technique.

The topics covered in a typical series of parent training sessions include the following topics in sequence.

1. Establishing house rules and structure

Ø  Posted chore lists

Ø  Posted morning and evening routines

Ø  Posted House Rules

Ø  Review until child has learned them

2. Learning to praise appropriate behaviours (praise good behaviour at least five times as often as bad behaviour is criticized) and ignore mild inappropriate behaviours.

3. Using appropriate commands

o   Obtain the child's attention: say the child's name first

o   Use command not question language (“Don’t you want to be good” is a bad command!)

o   Be specific, describing exactly what the child is supposed to do (at the grocery checkout line “be good” is not a good command! “Stand next to me and do not touch anything” is more specific!)

o   Be brief and appropriate to the child's age

o   State consequences and always follow through (praise compliance and provide consequences for noncompliance)

o   Have a firm but neutral (not angry) tone of voice

4. Using when………..then contingencies

o   Give access to desired activities when the child has completed a less desired activity (e.g., ride bike when finished homework; watch TV when finished evening chores, going out with friends after completed yard work)

o   For younger children, important to have rewarding activity occur immediately

5. Planning ahead and working with children in public places

o   Explain situation to child before activity occurs

o   Establish ground rules, rewards, and consequences

6. Time out from positive reinforcement

o   Assign short times away from preferred activities when the child has violated expectations or rules

o   Give time off for appropriate behaviour during time out and lengthen time for noncompliance with time out

o   Base times on children's ages—shorter for younger children—e.g., one minute for each year of age

7. Daily Charts—Point/token systems with rewards and consequences

o   Make charts with home rules/goals and post prominently in house

o   Establish system for rewards for following home rules and consequences for violations

o   Nickel jar for noncompliance or talking back (e.g., put a nickel in for each compliance, remove two for noncompliance)

o   Home Daily Report Card (see target list and creating a Daily Report Card for the home

8. School-home note system for rewarding behaviour at school and tracking homework (see description below in School Interventions)

There are many other techniques that are part of a good behavioural parenting program. Those listed above are included in almost all of the good programs. Some families can learn these skills quickly in the course of 8 or 10 meetings, while other families—often those with the most severely impaired children—require more time and energy.

(ii) School Interventions

The following list includes typical classroom behavioural management procedures. They are arranged in order from mildest and least restrictive to more intensive and most restrictive procedures. Some of these programs may be included in Individualized Educational Programs that may apply to ADHD children

Typically an intervention is individualized and consists of several components based on the child’s needs, the classroom resources, and the teacher’s skills and preferences.

1. Classroom rules and structure

o   Typical classroom rules:

Ø  Be respectful of others

Ø  Obey adults

Ø  Work quietly

Ø  Stay in assigned seat/area

Ø  Use materials appropriately

Ø  Raise hand to speak or ask for help

Ø  Stay on task/complete assignments

o   Post rules and review before each class until learned

o   Make rules objective and measurable

o   Number of rules depends on developmental level

o   Establish a predictable environment

o   Enhance children’s organization (folders/charts for work)

o   Evaluate rule-following and give feedback/consequences consistently

o   Tailor frequency of feedback to child’s developmental level

2. Praise appropriate behaviours and ignore mild inappropriate behaviours that are not reinforced by peer attention

o   Use at least five times as many praises as negative comments.

o   Use commands/reprimands to cue positive comments for children who are behaving appropriately—that is, find children who can be praised each time a reprimand or command is given to a child who is misbehaving.

3. Appropriate commands (clear, specific, manageable) and private reprimands (at child’s desk as much as possible)—same characteristics as for good commands for parents described above.

4. Accommodations and structure for individual child (e.g., desk placement, task sheet)

o   Structure the classroom to maximize the child’s success

o   Sit by teacher to facilitate monitoring

o   Pair with peer to help copy assignments from board

o   Break assignments into small chunks

o   Give frequent and immediate feedback

o   Require corrections before new work

5. Increase academic performance

o   Focus on increasing completion and accuracy on work

o   Provide task choices

o   Peer tutoring

o   Computer-assisted instruction

Such interventions have the advantage of being proactive (i.e., could prevent problematic behaviour from occurring) and can be implemented by individuals other than the classroom teachers (e.g., peers, classroom aide). When disruptive behaviour is not the primary difficulty, academic interventions sometimes lead to improvements in behaviour that are equivalent to gains associated with more intensive classroom behavioural strategies.

6. When…….then contingencies (e.g., recess time contingent upon completing work, staying after school to complete work before dismissal, assigning less desirable work prior to more desirable assignments, require assignment completion in study hall before allowing free time) (same guidelines as for parents described above)

7. Daily School-Home Report Card - Means of identifying, monitoring, and changing classroom problems

o   Tool for parents and teacher to communicate regularly

o   Individualized target behaviours determined by teacher

o   Teachers evaluate targets at school and send DRC home with the child

o   Parents provide home-based rewards; more rewards for better performance and fewer for lesser performance

o   Continually monitor and make adjustments to targets and criteria as behavior improves or new problems develop

o   Always used in the context of other behavioral components (commands, praise, rules, academic programs)

o   Cost little and take minimal teacher time

8. Behaviour chart/reward and consequence program (point or token system) for the target child

o   Establish target behaviours and ensure child knows behaviours and goals (e.g., list on index card taped to desk)

o   Establish rewards for meeting target behaviours

o   Monitor child and give feedback

o   Reward immediately for young children

o   Use points, tokens, stars that can later be exchanged for rewards

9. Class wide interventions and group contingencies

o   Establish goals for the class as well as the individual

o   Establish rewards for appropriate behaviour that anyone in class can earn (e.g., class lottery, jelly bean jar, wacky bucks)

o   Establish reward system in which whole class (or subset of class) earns rewards based on entire class functioning (e.g., Good Behaviour Game) or ADHD child’s functioning (e.g., class earns reward if ADHD child makes goals)

o   Encourages children to help one another because everyone can be rewarded

o   Easier for teacher than individual programs because improves whole class

o   Tailor frequency of rewards/consequences to children’s developmental level

10. Time out (classroom, office); a program in which a child is removed from the ongoing activity for a few minutes (less for younger children and more for older) when he or she misbehaves (same guidelines as for parents described above)

11. School-wide programs—e.g., discipline plans that are school-wide can be structured to minimize the problems experienced by ADHD children at the same time as they help manage the behaviour of all children in a school.

(iii) Child Interventions

Nonspecific talk or play therapy in a therapist’s office is not a form of treatment with scientific support for children with ADHD. Instead, child-based treatments for ADHD with a scientific basis are those that focus on peer relationships and that typically occur in group settings outside of the therapist’s office. Very often, children with ADHD have serious disturbances in peer relationships, and those problems are very strong predictors of long-term outcomes. Children whose difficulties with peers are overcome will have considerably better long-term outcomes than those whose peer relationships remain problematic. Thus, intervention for peer relationships is a critical component of treatment for children with ADHD and it is the focus of child-based treatments.

There are five forms of intervention for peer relationships, listed below.

1. Systematic teaching of social skills

o   Cooperation

o   Communication

o   Being positive and friendly

o   Participation

o   Helping/sharing

o   Giving compliments

o   Coping with teasing

2. Social problem solving

o   Identifying problem

o   Brainstorming solutions

o   Choosing best solution

o   Planning implementation

o   Evaluating outcome

3. Teaching other behavioural competencies that other children consider important

o   Sports skills

o   Rules of sports

o   Board game rules

o   Good sportsmanship and good team membership

4. Decreasing undesirable and antisocial behaviours

o   Target bossy, intrusive, aggressive, and other disruptive behaviours that children with ADHD exhibit with peers

o   Establish reward/consequence program to reduce these behaviours and to replace with prosocial behaviours taught in social skills training

5. Developing a close friendship

o   Develop program to help child with ADHD develop a close friendship with another child

o   Work with family and teacher to facilitate the relationship

o   May serve an important role in improving long-term outcomes

(2)   Working memory training

Many of the problems shown by children with ADHD are linked with deficits in working memory (or short-term memory). Training this memory may diminish some of symptoms of ADHD. In a study by Klingberg et al., children with ADHD who completed a computerized training program for working memory reported a decrease in ADHD symptoms and performed better on working memory tests than the control group. Some researchers attribute this to an improvement in working memory generally, while others believe it is merely the natural effect of practice.

(3)   Timers

Timers have been found to be effective for allowing people with ADHD to concentrate more effectively on the task at hand. When a target is set, one method is to only turn the timer on whilst working on the given task. A physical stopwatch or an online timer may be used.

(4)   Neurofeedback

Neurofeedback (NF) or EEG biofeedback is a treatment strategy used for children, adolescents and adults with ADHD. The human brain emits electrical energy which is measured with electrodes. Neurofeedback alerts the patient when beta waves are present. This theory believes that those with ADHD can train themselves to decrease ADHD symptoms.

No serious adverse side effects from neurofeedback have been reported. Research into neurofeedback has been limited and of low quality. While there is some indication on the effectiveness of biofeedback it is not conclusive: several studies have yielded positive results, however the best designed ones have either shown reduced effects or non-existing ones.

(5)   Aerobic fitness

Aerobic fitness may improve cognitive functioning and neural organization related to executive control during pre-adolescent development, though more studies are needed in this area. One study suggests that athletic performance in boys with ADHD may increase peer acceptance when accompanied by fewer negative behaviors.

(6)   Massage Therapy

For children and adolescents with ADHD, pediatric massage therapy has been found to improve mood and increase on-task behaviors, while reducing anxiety and hyperactivity.

(7)   Art Therapy

Art is thought by some to be an effective therapy for some of the symptoms of ADHD^.

(8)   Media

Preliminary studies have supported the idea that playing video games is a form of neurofeedback, which helps those with ADHD self-regulate and improve learning. On the other hand ADHD may experience great difficulty disengaging from the game, which may in turn negate any benefits gained from these activities, and time management skills may be negatively impacted as well.

(9)   Nature:

Children who spend time outdoors in natural settings, such as parks, seem to display fewer symptoms of ADHD, which has been dubbed "Green Therapy".

(10)                       Dietary supplements:

Omega-3 supplementation (seal, fish or krill oil) may reduce ADHD symptoms.

Magnesium and vitamin B₆ (pyridoxine) - In 2006, a study demonstrated that children with autism/ADHD had significantly lower magnesium than controls, and that the correction of this deficit was therapeutic. Mousain-Bosc et al. showed that children with ADHD (n =46) had significantly lower red blood cell magnesium levels than controls (n =30). Intervention with magnesium and vitamin B₆ reduced hyperactivity, /aggressiveness and improved school attention.