With Mark, we instituted an ambitious program that we phased in gradually. We wanted to see if we could help him overcome his attentional difficulties and do it without medication. We would keep medication on the shelf to try at some later point if necessary. We focused on the areas where he needed work, and also on giving him confidence in his strengths.
Sequencing. As we saw earlier, Mark had trouble with carrying out complex directions. Working with his parents and with an occupational therapist, we designed treasure-hunt games with two-step directions and then three-step and then four-step verbal instructions. We gave him pictorial instructions with diagrams and maps to help him with his visual-spatial thinking as well. In these exercises, we let him succeed about 75 to 80 percent of the time so we didn't overload him. We built the challenges up gradually with two- or three-step directions in which he could be successful and then added on a fourth and a fifth step until he achieved a 75 to 80 percent success rate. School For ADD
Eventually, like an Indiana Jones character, he had to go through a complex course requiring planning, like getting three chairs or a board to put over the chairs to cross a pretend moat that he wasn't allowed to step into to reach the treasure. We got a lot of new fairly inexpensive magic tricks from the variety shop to use as prizes, so he was very motivated to pay attention.
Planning. Mark also liked to draw. To help him with things like getting his homework done and turning it in, each day we had him actually draw, not write out in words, a little map of what he was going to do that evening and what was due the next day. We arranged for his teenage helper or Mom to do that with him after school. He would make a diagram, showing some playtime and then some before-dinner work and some after-dinner work and what was due the next day, and he would check each activity off himself.
He would add little drawings, or sometimes he would choose to use words - we let him decide. He did all this on a big blackboard so that at the end of the day when he got all his checks done, he could erase it and put up a new list for the next day. Whenever Mom or Dad was worried that he wasn't getting his work done or wasn't going to hand it in on time, rather than nagging him, they would just say, "Let's go look at the board together" and "Oh, boy! You have a lot of check marks today! Is there anything else you need to do?" Mark enjoyed tracing his progress on the big board.
Balance and Coordination. We also noticed that Mark was, as I mentioned, having some trouble with balance, though he was pretty good at throwing, catching, skipping, hopping, and jumping. We made balance exercises part of his play with his mentor/big brother who would come over and sometimes do this with him and a friend. Mark was actually rather popular. Even though other kids made fun of him at times, he had many friends. The high school student, who was a good athlete, would have a balance beam and Koosh pads to use with Mark and a friend.
Each took turns being the leader. Mark could do some of the things really easily, like just standing on a Koosh pad or standing on a balance beam. It was when they got into the more complex balance exercises - like throwing and catching a ball while standing on a balance beam or Koosh pad, and then talking while throwing and catching the ball, and then throwing and catching the ball with one hand while standing on a Koosh pad and talking and telling jokes, and so on - that Mark had some challenges. Eventually, we had him doing magic tricks while standing on a Koosh pad or balance beam. He enjoyed that thoroughly and got better with his balance and coordination. School For ADD
Mark's program also included plenty of running, jumping, hopping, skipping, throwing, and catching kinds of games, too, just to reinforce things he already did reasonably well, as well as his sense of competence, Because Mark didn't have a lot of fundamental problems in motor coordination and he had good muscle tone, we didn't have to work on some of the more basic exercises that we outlined earlier.
Regulation Games. We also played many regulation games with Mark - going fast, slow, superslow; playing the drums loud, soft, supersoft. Also, we exposed him to different environments - just a little bit of noise and a little bit of commotion and a little bit of touching, then in groups with friends banging into him, then more and more stimulation until he learned to regulate himself and not overreact in those situations, not become overloaded.
The Modulation Games - fast, slow, superslow; playing the drums; running fast, slow, then in superslow motion - were geared to deal with his sensory craving, the moments when he became impulsive and sped from 0-60 in two seconds. He learned to enjoy slow motion. All this occurred over a period of many months. As we were doing this, we often asked him how he felt, and he became more and more able to reflect on his feelings. To learn more, you can check out School For ADD.
