Behavior Plan For Students - Susanna's Program

Behavior Plan For Students

The kind of program that we set up for Susanna could be applied to a forty-two year old, a sixty year old, or even an eighty year old. The key is discovering each person's interests and passions and then using them as motivation to carry out the steps in a way that is enjoyable for her.
 
Motor Planning. To work on what she called her "clumsiness," we wanted to start with the Evolution Game - slithering first, then crawling, walking in a more coordinated way, then hopping, skipping, jumping, and doing some trampoline work. Susanna made these exercises into a workout routine with music. She had already been doing activities to music to keep fit and was following an exercise show on TV. She had some of the audio recordings from that show, which she used to get herself going in the mornings, so she could easily incorporate her new exercises, setting the Evolution Game to music, into her routine. She found this amusing and fun, and it helped get her started every day.
 

Gradually, we added more complex left-right movements and sequencing. Susanna was never a good dancer, but she loved to dance. So she tried to master new dance routines using DVDs that had both visual and auditory instruction on how to do the latest dances. That helped her learn to sequence - she could see it, and she could hear it. To further her sequencing abilities, she set up some simple obstacles and combined them with the Evolution Game. She had to crawl through hula hoops and furniture and climb over different barriers, all of which helped her coordinate her body. Behavior Plan For Students

When it came to balancing activities, Susanna liked the idea of standing on balance boards and moving to music. She then combined tossing a ball up in the air with standing on a balance board and doing it rhythmically with music. We worked that into her basic routine.
 
To help further with balance, Susanna also did some yoga work. She had tried yoga once or twice before but found it quite hard to do because the different postures required muscle tone that she really didn't have. Now she approached yoga with a renewed vigor, feeling that it was going to help her pay attention. She attended yoga classes and did routines at home along with her dancing. Susanna attended some dance classes, too, once she felt she wouldn't be "embarrassed" and had gotten to a certain level of competency. All these activities together improved her motor functioning.
 
Sensory Modulation. Susanna recognized that she was very overreactive to sounds and had a hard time staying focused and attentive in noisy environments. It was easy for her to become overwhelmed and overloaded. So she identified, with my help, the different frequencies of sound that bothered her - low-pitched sounds like grumbling, sounds of a heating system going on, and motorized sounds were the most distracting for her.
 
High-pitched noises weren't pleasant to her either, but they weren't as distracting. Gradually, Susanna exposed herself to these distracting sounds as part of activities that were very calming and regulating, like listening to music and rhythmic activities. Susanna liked soft country-and-western music with a slow pace. She could expose herself to different sounds as part of this music or while doing yoga movements that relaxed her. This helped her get habituated to them. Gradually, while these sounds still bothered her, they bothered her less, and over time she was less distracted by them.
 
Visual-Spatial Thinking. As I mentioned before, it was hard for Susanna to picture her house from different angles or picture things she had read. She couldn't turn stories into visual images. When I asked Susanna to picture her boyfriend and her best friends in a certain place as though she had just taken a picture of them, she couldn't do it. Susanna read a descriptive paragraph, and I asked her to picture what she had just read. She would always say she saw a blur.
 
Working on this visual-spatial area was more difficult for Susanna. We worked with blocks and different block designs. We worked with quantity concepts (because she always had a hard time with math, even picturing "big" and "little" was not easy for her). We did exercises with water in different-shaped glasses, the same basic conservation tasks that kids do in school but that she had never quite fully mastered. We helped her make more and more sense of what she was seeing and develop a sense of quantity by doing these exercises. Finally, she "got it," as she put it. This was basically hard work on her part, and we couldn't figure out an appropriate activity, that would make it fun for her. However, she enjoyed where the journey was leading her.
 
To further strengthen her visual-spatial ability, Susanna started doing two things. When she wrote short stories or poems, she treated them like screenplays or stage plays and tried to picture how each scenario was hid out. Starting out with one or two characters and very simple dramas, over a period of six to eight months she built up to the point where she could actually picture things that she had written. From there, she became able to picture things that she was reading.
 
To apply all this to the tasks of her life, each morning Susanna would draw on a chart what the sequence of her day was going to be. Using little stick figures, she mapped out her activities or plans in terms of things she had to accomplish at work, things she was going to do for leisure activities, things she was going to do with her boyfriend or girlfriends, and so on. Rather than write them out as she had always done (she had pen marks all over her hands because she wrote things down to remember them), we had her draw her tasks using simple stick figures. This way she had a visual road map and timeline of what she needed to accomplish in a given day. She would keep checking this road map throughout the day, every half hour or so. Behavior Plan For Students
 
She could see where she was in the timeline and where she had gotten off course. From that, the goal was to help her internalize the timeline, to create an internal road map with activities so that she could picture her progress and mentally check off tasks or activities as she completed them. Over a period of about four months, she was gradually able to do this. She kept working back and forth between the things she would say to herself and the things she would picture. The picturing was the hard part, but it provided a more cohesive guide for her. Although she was very motivated to do all of this, she also required a fair amount of encouragement. Sometimes she slipped and went backward and gave up on it, but then came back and persevered.
 
As Susanna improved the visual-spatial part of her thinking, she found that she was a better abstract thinker in general. She always saw herself as a person who had an eye for detail. She retained this ability, but she also became a better big-picture thinker.
 
As I met with her, I encouraged Susanna always to ask the question, "How does this all fit together? How do you put all of this into one big picture?" Whether it was a policy paper or a speech she was working on, what was the overall goal? What were the subgoals? Even though she was always a good creative writer, she often had trouble keeping the overall goal in mind. Now, when Susanna had to do a paper, she actually created a visual design with boxes and arrows going from the main point to the supporting points and realized how important it was to see things, not just to have the words in mind.
 

Over about a year, Susanna gradually improved her ability to stay on task, to follow through, to solve problems, to be less distracted and more focused. Her overall thinking abilities and the quality of her relationships and her life also improved because she was less frazzled, less harried, less fragmented. Her emotions were less chaotic, too, because she could understand her own feelings better and not feel pulled "all over the place." Feeling more calm and engaged, she could now gain some perspective when she was upset with her boyfriend or her parents or with something at work. She could see how the different feelings she was having might be related to larger issues.
 
Susanna made a lot of progress and really mastered the problems that she came in with a year earlier. She is a very good example of how adults with attentional difficulties can adapt the approach that we take for children and make it work for them. To learn more, you can check out Behavior Plan For Students.

IEP For ADHD - Adults With ADHD

IEP For ADHD

The approach to ADHD that we have described can be applied to adults as well, from teenagers to adults of any age. Adults can be in a better position to help themselves because they can assess their strengths and weaknesses more easily than children can. Just as parents and therapists profile a child's strengths and weaknesses - basic motor functioning, sensory processing, levels of thinking, visual-spatial thinking, auditory processing, and sequencing - so can adults monitor these areas for themselves. For example, a forty-two year old can take stock of himself and say, "I've always been inattentive and fidget a lot. I don't follow through on my projects as well as I would like to, and I'm always getting distracted. I never figured out why, but maybe I have ADHD."
 

Adults who find that this may be their problem often consider whether they should ask for medication. One man who consulted me said that when he was a child his parents tried Ritalin with him, but he became irritable and was reluctant to try it again. He had been told there are other medications available now, but he was reluctant to try them because he tended to be very sensitive to medications and their side effects. This almost middle-aged individual wanted to know if there was a program that would heap him learn to focus and pay attention without medication. He was able to follow the guidelines that we have been talking about and take stock of his own abilities. He was then able to institute his own program, similar to the one recommended for children with attention problems. IEP For ADHD
 
One difference between adults and children in applying our program is the need to make the activities interesting for the adult. Whether you are doing a balance activity - standing on one leg and throwing and catching a ball, doing an activity for motor coordination in which you are trying to use the left and right parts of the body together, or doing a sequencing activity in which you have to follow five or six complex steps in a row - try to make it interesting, taking into account your age, your abilities, and what your general interests are. For example, an adult who loves dancing might want to use dance for some of the activities. An adult who loves sports might use different kinds of sports practice and explore what sport will help with balance, what sport will sharpen visual skills, and so forth.

A Young Adult with ADHD 

A very interesting case for which I consulted might bring this adult experience alive. A young woman I'll call Susanna who was twenty-eight years old came to see me. I had helped her younger brother with "ADHD" years earlier before I had formalized the program that I've been describing. She was impressed with how well her brother was doing. Susanna felt she might also have ADHD because, as she described it, "I'm very distracted by almost anything that goes on - it keeps me from focusing, and now it is beginning to interfere with work." 

She had managed to finish college and had a job on Capitol Hill working in a senator's office. Susanna was a very creative person and a good writer, but was being criticized increasingly for not following through, not finishing tasks, or going from one thing to another. In discussing her problem with friends, she was told that she may have ADHD and ought to consider taking medication. Like the man I mentioned earlier, she became very concerned because her brother had reacted poorly to medication. 

One time, Susanna confessed to me that she took one of his pills to see what it would do, and she felt kind of irritable and hyper and understood why he didn't react to it well. She wanted to know if a program could be developed for her similar to the one that worked for her younger brother. She needed to learn to stay on task and follow through. Susanna knew what her strengths were; her analytical abilities and writing skills were excellent. As part of her role in the senator's office she wrote speeches and helped articulate policy positions on domestic and international issues.
 
What could we do for Susanna? As we reviewed her functioning, she identified a number of areas where she felt strong. It was evident that Susanna was gifted verbally and had a large vocabulary. She shared some poems and short stories she had written. Interestingly, both her poems and her short stories had a scattered quality to them - they went off in all directions. Although she said that was all part of the creative intent, I think she was also justifying a natural tendency to be distracted and unfocused.
 
Susanna also revealed that she has always been "clumsy." She had had a hard time learning how to ride a bicycle and didn't ride a two-wheeler until she was ten years old because balance was always hard for her. Learning sports was very difficult for her, as was learning to dance. She also didn't like high places, didn't like roller coasters or similar rides, tended to get overloaded easily at parties and noisy environments, and was easily distracted by any sort of sound. Susanna could be working and hear a whisper from across the room and would stop what she was doing and eavesdrop a little bit to see what was being talked about. A bright light coming through the window would easily distract her. At a light touch on her shoulder, she would startle. Susanna was dearly hypersensitive to all kinds of sensations. IEP For ADHD

Susanna had had a hard time with math and difficulty understanding how things operated in space. For example, when asked to describe her house from different angles she found it hard to do. I gave her a little task with blocks, constructing a design that was the mirror image of one that she was shown. This stymied her. When she read something and I asked her if she could picture the things she read, that was a very hard thing for her to do, as were a number of other visual-spatial tasks.

At the same time, Susanna was a creative and logical thinker and adept at the higher levels of thinking, like "comparative thinking" (comparing two government policies, for example) and gray-area thinking (able to tell you how much better one was than the other), and was clearly able to be reflective about her own weaknesses and strengths. However, when it came to applying these same levels of thinking to the things she saw, Susanna wasn't able to do complex visual-spatial thinking. For example, when she looked at different designs and was asked to describe how they were similar or different and explain why, Susanna just gave up. She said her thoughts just ran all over the place. So she became fragmented and couldn't be logical. Susanna couldn't connect her verbal abilities with making sense out of the world that she saw. To find out more, you can check out IEP For ADHD.

Learning With ADD - Airborne Chemicals and Toxins

Learning With ADD

In addition to the chemicals in foods, a third aspect of the physical environment pertains to things that the child may be inhaling. What is in the atmosphere or in the air can also affect your child's behavior. These airborne substances get into the lungs and then into the bloodstream and are metabolized. Cleaning products, for example, and soaps, toothpaste, pesticides, paint, rug cleaners, or new products, such as rugs and mattresses, all have chemicals that can get into the atmosphere in your home or the school environment and affect a child's behavior. 

Clothing or bedding or upholstery with fire retardants can also affect a child. For example, a new carpet will have all kinds of chemicals at the level where a child might play, even though you may not notice it as much while standing in the room. If you just cleaned a carpet or just had your wood floors redone, you'll smell those chemicals. Learning With ADD

Many adults get headaches and a lot of children get more active if rooms of the house have just been painted. It can take a couple of months to fully air out the rooms. Oil-based paints take the longest, whereas latex-based paints take a shorter amount of time. There are special paints now that are nontoxic and air out in a day or two.

What you use to wash the children's clothes is mother factor to watch. There are web sites listed that look at chemicals that can affect children's physical environments and how they can affect health. It is not only attention and hyperactivity that can be a problem, but also proneness to illness, including infectious disease and cancer. Parents would do well to look at these Web sites to learn what to watch for in the physical environment.

Perhaps the school has recently completed some construction, and the materials may be giving off a lot of toxic substances. Pesticides in and out of the home are a concern because children will play on the floor or in the grass. There is no question that products like pesticides have toxic substances in them because their purpose is to kill bugs and pests. There are alternatives to these pesticides. Remember, children are going to be playing closer to where these substances have been applied, and they have a smaller body with which to absorb toxins. These toxins tend to get into the fat tissue and stay there for some time.

As we pointed out, there is controversy around all these kinds of chemicals and substances because they don't cause problems for all children. Some children will handle them better than others. Some will experience a reaction when the house is painted or new carpeting is installed, bur others may not have any reaction. The reactions can range from lethargy, depressed moods, and inattention to hyperactivity and impulsiveness.
 
Light and Sound Noise and lighting levels, and different types of lights, can also have a strong effect on children.
A child who has been very sweet, attentive, focused, and regulated goes to preschool where he is in a large, noisy class with a lot of activity and a lot of visual and auditory stimulation. All of a sudden he becomes overly active and very, very distractible. Mom and Dad get reports about their child different from those they have ever heard before. This change in behavior may be a reaction to the new physical environment - the noise level, the lighting level, the way children bump into each other.
 
It is important to look at the actual physical environment where your child spends time. The child's classroom might be near the boiler room from which the child, who may be very sensitive to low-pitched noises, hears a low rumbling noise coming from the furnace. Or the child may be near an environment that has high-frequency or high-pitched noises, or the teacher may have a high-pitched tone of voice. These are all things that need to be looked at when being a good detective. Learning With ADD
 
The key point is to look at the child's physical environment systematically. Stay up-to-date on new research and findings, but regard your child as an individual, as unique, and don't rely too heavily on statistics. If the child's pediatrician makes specific recommendations, ask him or her, "Has the research behind that recommendation looked at subgroups of children, or has it just looked at children in general?"

As you investigate the child's physical environment, while creating an optimal learning and family environment, take time to see how he does. Give him a fair period to adjust. You may be surprised to see that over time you have a more regulated, attentive, and focused child. The effects of many of these aspects of a child's environment on his behavior are controversial, and you should take the attitude that what matters to you is the effect on your individual child. Watch for new research, but seek the measures that help your child. Be a good detective, considering all possibilities. To learn more, you have to check out Learning With ADD.
 

Jobs For Adults With ADD - Aspects of the Physical Environment

Jobs For Adults With ADD

What are the aspects of the physical environment that we need to take into account? Again, I want to underscore the importance of identifying and looking at subgroups. In the meantime, until the research is done, each family should look at their child as distinct and unique. He is the n of one (n meaning the number of subjects in the research being carried out). The key is to look at how your child, or a particular child if you are a caregiver or clinician, responds to his physical environment. Rather than starting with the working assumption of "Many children respond in this way to a noisy environment or a bright, highly lit environment or a crowded environment," ask yourself, "How does this child respond to this particular aspect of his physical environment?" Here are some aspects of the physical environment that we need to focus on and take into account.
 

Sugars and Processed Carbohydrates. Controversy surrounds the question of whether sugar can make children inattentive. Some studies have suggested sugar doesn't make children more inattentive or more active, and other studies, published in respectable journals like the British Journal Lancet have suggested that it can and does. There is a little-known study, for example, showing that glucose (sugar when it is metabolized) stirs epinephrine, or adrenaline, as it is more commonly known, in the body, and that certainly would give a person an energy boost. The question then becomes: Does this create more inattentiveness or increase the activity level in children? For some children it probably wouldn't, but for others it might. Jobs For Adults With ADD
 
What is the amount of sugar or processed carbohydrates in your child's diet? Processed carbohydrates, like white rice, as opposed to complex ones, like brown rice or other whole grains, convert quickly to glucose or sugar in the body, as do fruit juices compared to whole fruits, which take a little longer. Many vegetables take even longer. So foods that convert very quickly create a very quick glucose load for the body that some children may handle very easily, but it may throw children with a low threshold off balance. Also, it may stimulate some adrenaline release that may, in turn, stimulate increased activity or distractibility in some children. Again, look for a pattern for your individual child.
 
Additives, Preservatives, Colorings, and Dyes. The next area, again a very controversial one, is that of additives, preservatives, food colorings, and dyes. Some people believe these ingredients contribute to inattention and hyperactivity, and some people disagree. Here, too, I see a lot of individual variation among different children. For some children, red dye number 40 drives them wild as soon as they ingest something containing this dye. Some adults have this problem as well. For other children and adults, ingesting foods containing this dye has no on them at all. This doesn't happen only to children with ADHD or ADD but may have to do with a particular sensitivity. It may not be a "food allergy" in the conventional sense of allergies. It may be a sensitivity, just like some individuals are sensitive to coffee or sensitive to wine, as mentioned before.
 
Here, too, you have to look not just at the load of artificial substances - chemicals in the diet - but you have to look at, in particular, what may affect your child. So additives, preservatives, food colorings, dyes, and anything that is not natural to the food, as well as particular foods - for some children, corn or eggs or dairy or gluten products - could be a culprit or cause a problem. Look for particular food groups as well as artificial substances that your child may be sensitive or allergic to.
 
There are more and more artificial substances being added to our food, including antibiotics added to feed to keep bacteria out of meat and poultry. There are hormones that are used to create more muscle in cattle. Any of these substances can be a problem for a child. Compare how your child does on an organic versus nonorganic diet and see if that makes a difference in the child's behavior. Jobs For Adults With ADD
 

When you are looking at these things, a useful way of doing your detective work is doing two weeks on and two weeks off a diet in which you have the child free of the substance you are checking for two weeks and then two weeks during which the child consumes products containing that particular substance. See if there is a difference in the child's behavior. Set up your own 1-10 scale on the behavior you are interested in tracking - the child's cooperativeness, ability to follow directions, ability to focus and attend and stay calm (assuming the family circumstances and the emotional triggers are the same and you are not going through a particularly rough time at home or the child is not having a particularly difficult time at school). To learn more, you can check out Jobs For Adults With ADD.

Careers For People With ADD - Role Of Physical Environment

Careers For People With ADD

Perhaps the most controversial aspect of attention and hyperactivity problems in children is the role of the physical environment. This includes what the child eats (sugar, other foods, food additives, chemicals), exposure to airborne pollution, and light and sound stimuli. Does the physical environment have an important influence on the attention capacities of children, and are some children more sensitive than others? Before getting into specifics, let me share some general principles related to the controversies.
 

When there are competing or controversial results from studies looking at an issue as simple as whether sugar has an effect on attention, we have to consider the problem of subgroups. In other words, when you look at a large population or even a smaller group of thirty or forty children, you're usually mixing children with different profiles. They may share a common problem like inattentiveness or a high activity level, but may have different sensitivities. For example, one group of children may have a low threshold for excitement, and a little bit of extra adrenaline in their systems might cause them to be quite inattentive and active. But then there might be another group of children with a high threshold for excitement and containment, and the sugar might just give them a pleasant boost of energy that they enjoy and that actually helps them focus and attend even better. Similarly, a couple of cups of coffee will cause some adults to be jittery, while for others it just gets their day going. Careers For People With ADD
 
They may feel more organized and focused and more competent in what they do. It's the same with wine - two or three glasses of a fine red wine with dinner makes some people nice and relaxed and social, while it may get others a little tipsy to the point of stumbling or slurring their words, or they may become argumentative because they are very sensitive to the effects of alcohol. For still others, it may have no effect at all until they have their fifth drink.
 
There are also a lot of individual differences in the way people respond to different environmental factors. That is because everybody's nervous system is different. When the research looks inconsistent, it is often because we haven't considered the possible subgroups. Often, we haven't looked at subgroups because we haven't really known how to categorize them.

As we've shown in earlier posts, we can divide groups of children based on their underlying ability to plan and sequence, to modulate sensations, to comprehend what they hear or see. We can look at children with one of these different profiles and see how they respond to elements in their physical environment. If we are going to resolve some of the controversies, as a general principle we need research that looks at subgroups in clinically meaningful ways, based on children's developmental profiles and patterns. If research studies treat all children who meet criteria for a certain problem on some questionnaire or some observational scale or test in the same way, we won't know what the results of these studies mean. Unfortunately, we are still in the Dark Ages when it comes to many of these questions.
 
First Steps Be a Good Detective 

Start off by investigating, looking for patterns. After a birthday party, for example, where your child has eaten all kinds of sweets and sugary things, how does she behave? When your child is in a very stimulating environment with a lot of noise and visual stimulation, how does she behave? When she is in a very dull, low-key environment with not much going on, how does she behave? This is your first step and will give you clues to things you may want to investigate more closely.

Get a Thorough Physical Examination. As part of a good pediatric evaluation, have the child's thyroid functioning (hypothyroidism can produce low energy and inattentiveness, and hyperthyroidism can produce a lot of activity and distractibility). Anemia can cause low energy levels, along with sluggishness and inattentiveness. A recent pediatric examination is very important to rule out any physical basis for the child's problems that can be corrected through proper medical treatment and management. Careers For People With ADD
 
As part of the general pediatric evaluation it is also very important to rule out things like blood levels of lead and other toxic metals. These can be injurious to the child's overall health, affect attention and the way the child focuses, as well as affect the way the child is able to maintain a state of calm regulation, even in the face of a lot of stimulation.
 

Overall Nutritional Status. Next, look at the child's overall nutritional status. Does he have a reasonably healthy diet with a balance of proteins, fats, and carbohydrates, and plenty of vegetables and fruits? Many children don't have this type of balanced diet. Is the child getting proper vitamins and minerals in his diet or through supplements? A child who is not eating a balanced diet or isn't getting the proper vitamins and minerals can be subject to physiological challenges that will certainly contribute to behavior. To learn more about ADHD, you must check out Careers For People With ADD.