Attention Deficit and Hyperactivity Disorder (ADHD) is a group of disorders that include inattentiveness, over-activity, and/or impulsivity. Daycare providers must recognize the signs of symptoms of ADHD as well as how to manage children diagnosed with the disorder.
Part 3 of our interview with child neurologist Dr. Sara J. Dorison provides tips for child care center educators dealing with ADHD behaviors.
OwnADaycare: Could you give a few tips to help preschool teachers or daycare providers help manage ADHD behaviors?
Dr. Dorison: It is often difficult for a preschool teacher to know how to manage an ADHD child. This is especially true of the teacher has a large class, an assistant who is not highly trained or if there are several ADHD children together in one class.
1. Set expectations that the child can meet. For example, insisting that a child sit for extended periods of time is likely to be unattainable and for this reason a teacher would be wise to allow ADHD children a bit more leeway in terms of physical activity. If the child is not able to meet expectations, then the expectations need to be changed or accommodations can be made such as allowing a child to run class errands or hand out snacks (instead of trying to wait quietly).
2. Identify one or two “problem behaviors” to target. For example, if an ADHD child is physically aggressive, then the teacher and child can sit down and talk about “angry hands don’t touch.” If all behaviors are targeted at once, the child will be confused and unable to meet the demands. This will result in frustration and poor cooperation. Other behaviors such as not cleaning, fidgeting, etc. should be dealt with after the aggression has resolved.
3. Set up a positive reward system that might be done at first every hour (depending on how bad the problem is). So, a child might receive a sticker every hour if she did not push/hit another child. Then, the system would be changed to a sticker for before lunch behavior and after lunch behavior. The important thing is that the child feels that the teacher feels warmly towards her and that the teacher be encouraging with comments such as, “Well, this morning did not go well since you pushed Jacob, but let’s try this afternoon to have no angry touching. I know you can do it!”
4. It is essential that the teacher comment positively at unexpected on times regarding good behavior. “Catching” an ADHD child being good and complementing her will help tremendously in terms of increasing the positive behavior and the child’s interest in complying. It will keep the child motivated to succeed.
5. Keep close communication with parents without a negative overtone. So many times parents come to pick up their children and the teacher starts to run down a full list of negative behaviors the ADHD child had during the day. A simple, “She had a tough day today, but tomorrow will be better!” Negative comments should be written in a note or discussed over the phone and not in the presence of the ADHD child who will feel confused and sad to hear his teacher convey negative comments. Frequent negative remarks from a preschool teacher often result in school anxiety and worsening of ADHD symptoms.
6. A preschool teacher might ask for a professional behavioral consultant to come and help make a behavioral plan for an ADHD child. This might be a psychologist that works in the school or the community.
7. The teacher should keep the class feeling positively towards an ADHD child. Often the other children in the class feel negatively towards a child that hits and gets reprimanded by the teacher. When an ADHD child has a good day, the teacher can say to the class, “Let’s all cheer for Jane since she had a great day with no angry hands touching!”
8. Give intermittent and unexpected rewards. If an ADHD child has a good morning, for example, perhaps she can be the line leader to recess or pass out the snacks. Compliments and positive reinforcement are the best ways to increase good behaviors.
9. Make the ADHD child feel special. Often days are full of frustrations for ADHD children since they can elicit so many negative interactions from other children and teachers (as well as parents). Parents frequently report that 90% of their verbal interactions with their ADHD child is negative. A preschool teacher should be sure to give the ADHD child a special hug in the mornings and special compliments when the child does something well. The teacher should make an effort to recognize something in which the child excels such as art, athletics, helping, etc. Increasing an ADHD child’s confidence will decrease anxiety, frustration and improve her behavior.
10. Avoid telling parents that you feel the child has ADHD and definitely do not mention the possibility of medications. Most parents feel upset when a teacher suggests a medical diagnosis and even more upset when a teacher suggests that the parents begin medication. Even though the experienced preschool teacher will likely recognize ADHD, most parents appreciate a discussion of the symptoms with a suggestion to discuss it with a pediatrician.
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