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INTERVENTION WITH HYPERACTIVE CHILDREN A Case Study Approach
INTERVENTION WITH HYPERACTIVE CHILDREN A Case Study Approach
Marvin J. Fine, Ph.D. School Psychology Training Program University of Kansas Lawrence, Kansas
MTP:!iUMITED International Medical Publishers
Published in the UK and Europe by MTP Press Limited Falcon House Lancaster, England
Published in the US by SPECTRUM PUBLICATIONS, INC. 175-20 Wexford Terrace Jamaica, N.Y. 11432
Copyright © 1980 Spectrum Publications, Inc. Softcover reprint of the hardcover 1st edition 1980
All rights reserved. No part of this book may be reproduced in any form, by photostat, microform, retrieval system, or any other means without prior written permission of the copyright holder or his licensee.
ISBN-13: 978-94-011-6286-9 e-ISBN-13: 978-94-011-6284-5 DOl: 10.1007/978-94-011-6284-5
Acknowledgment
Appreciation is expressed to the many contributors to this book. They all share a genuine concern for the hyperactive child and are making their respective contributions to assisting this child and his family.
I have benefited from the stimulation and support of my colleagues. In particular, John Poggio and Neil Salkind, through their own research with hyperactivity, have demonstrated a high standard of scholarship. They have both been readily available to discuss issues and to share ideas.
Jacalyn Wright assisted me greatly in the editing of manuscripts, as did Penni Holt and Roger Maitland. Peggy Miller and Gayle Robb were kind and patient with me as they typed and retyped the manuscript.
The result of the efforts and contributions of these individuals is a book that should be of great value to persons working with hyperactive children.
M.J.F.
JOAN E. BACKMAN Department of Psychology Carleton University Ottawa, Ontario
JOy PATRICIA BURKE, Ed.D. Human Development and Psychological
Services University of North Carolina
Chapel Hill Chapel Hill, North Carolina
STEPHEN T. DBMERS, Ed.D. School Psychology Program University of Kentucky Lexington, Kentucky
NORMA ESTRADA, Ph.D. Psychology Department Everett Gladman Hospital Oakland, California
H. BRUCE FERGUSON, Ph.D. Department of Psychology Carleton University Ottawa, Ontario
Contributors
A. J. FINCH, Ph.D. Department of Psychology Virginia Treatment Center for Children Medical College of Virginia Virginia Commonwealth University Richmond, Virginia
MARVIN J. FINE, Ph.D. Department of Educational
Psychology and Research University of Kansas Lawrence, Kansas
LINDA HALL JACKSON, M.D. Child Psychiatry The Menninger Foundation Topeka, Kansas
PHILIP C. KENDALL, Ph.D. Department of Psychology University of Minnesota Minneapolis, Minnesota
KATHERINE GLENN KENT, M.S. Family Therapy Training Program The Menninger Foundation Topeka, Kansas
MIMI LUPIN, M.A. Self Management Tapes Houston, Texas
lEAN MAYO, M.S. Feingold Association of the U.S.A. Houston, Texas
CHRISTOPHER R. MILAR, Ph.D. Division for Disorders of Development
and Learning University of North Carolina
Chapel Hill Chapel Hill, North Carolina
MARY MIRA, Ph.D. Children's Rehabilitation Unit University of Kansas Medical Center Kansas City, Kansas
EUNICE NELSON, M.Ed. Department of Educational Psychology Wichita State University Wichita, Kansas
A. LEE PARKS, Ph.D. Department of Special Education University of Idaho Moscow, Idaho
NANCY L. PETERSON, Ph.D. Department of Special Education University of Kansas Lawrence, Kansas
JOHN P. POGGIO, Ph.D. Department of Educational
Psychology and Research University of Kansas Lawrence, Kansas
JEAN L. PYFER, P.E.D. Department of Health, Physical
Education and Recreation University of Kansas Lawrence, Kansas
HERBERT l. RIETH, Ed.D. Department of Special Education Indiana State University Bloomington, Indiana
NEIL l. SALKIND, Ph.D. Department of Educational
Psychology and Research University of Kansas Lawrence, Kansas
R. L. SHERBENOU, Ph.D. Department of Special Education Purdue University Lafayette, Indiana
BARBARA l. THOMPSON, M.A. Department of Education Baker University Baldwin, Kansas
RONALD TRITES, Ph.D. Department of Psychiatry and Psychology University of Ottawa Neuropsychology Laboratory Royal Ottawa Hospital Ottawa, Ontario
HELEN TRYPHONUS, M.Sc. Department of Health and Welfare Health Protection Branch Ottawa, Ontario
FRED H. W ALLBROWN, Ph.D. Department of Counseling and
Personnel Services Kent State University Kent, Ohio
VIVIEN J. WORSTER, M.A. Indiana Department of Public
Instruction Division of Innovative Education Indianapolis, Indiana
Preface
Hyperactivity has historically been a major concern of parents and teachers. Over the years, the term has come to mean many things to different persons. For some, the term is synonymous with "brain damage," and the prescribed course of treatment is medical. For others, the term is a catchall, covering almost any behaviors that are found to be obtrusive or disruptive by the child's caretakers. In recent years, there has been a great outcry by some over the use and abuse of the term as a justification for controlling the child. Others have expressed great concern over the excessive, inappropriate, or poorly monitored use of drug therapy with regard to hyperactivity.
The current interest in hyperactive children is reflected in several major books (Cantwell, 1975; Feingold, 1975; Fine, 1977; Ross and Ross, 1976; Wender, 1973; Safer and Allen, 1976; Stewart and Olds, 1973). The number of published papers and symposia over the last several years is also voluminous.
The main questions posed by practitioners revolve around intervention with the hyperactive child. The growing literature on intervention has identified a variety of approaches with demonstrated utility; including drug therapy, behavior modification, biofeedback, sensory-motor training, cognitive training, environmental manipulations, and family therapy.
The major text sources cited include recommendations and descriptions of intervention approaches with the hyperactive child. But most fall short of extensive case-study material that details the thinking behind the inter-
vention and the specific steps that were actually followed. For the school psychologist, counselor, learning consultant, and teacher looking for specific direction, there is a void of good resources. Blanco's text on program prescriptions (Blanco, 1972) is a model of one kind of a "how-to-do-it" approach; while this approach has demonstrable value, the reader is required to have an already functional frame of reference into which specific and unelaborated suggestions can fit. In contrast, the booklet by Conner (1974) presents an extensive detailing of classroom procedures; the activities discussed, however, seem to be more of a novel, attention-getting nature to be used with an entire class of students, rather than specific children whose hyperactivity may interfere with extensive and cooperative group involvement.
This book of case studies is intended to meet the needs of persons working with hyperactive children who are interested in learning about specific intervention approaches. The book should serve as a source book of concepts and procedures on intervention, with enough detailing of rationale and intervention to expand the practitioner's repertoire of strategies for intervention. It emphasizes intervention in educational as well as home settings, and as such, places emphasis on the kinds of interventions that non-medical persons can affect. The book should also be of great value to physicians who may be seeking alternatives or supplements to a pharmaceutical approach. Accordingly, drug studies per se were omitted, although drug treatment is discussed.
The orientation of the chapters is first to present an initial introduction to literature on hyperactivity; touching on the historical issues, treatment efficacy studies, and the current scene; with regard to concepts of etiology, developmental course, and intervention. This is followed by several chapters concerned with specific intervention themes. For example, there are chapters that give detailed case studies on intervention via behavioral strategies, sensory-motor training, biofeedback and relaxation procedures, psychotherapeutic approaches, and classroom curriculum modifications. The usefulness of the book as a sourcebook is enhanced by the organization of the case studies. Each case study is presented in the following framework: 1. Current Problem, 2. Background Information, 3. Intervention, and 4. Conclusions. This framework should provide the reader with ample information to correlate the case study child with the children he is concerned about. Each chapter has an orienting introduction, with key references cited.
The measurement of hyperactivity is important if we are to determine whether changes have occurred as a result of an intervention. The chapter
by Salkind and Poggio represents a compendium and critical analysis of instruments for assessing hyperactivity. The last chapter of the book summarizes some important considerations in diagnosis and intervention; the need to view the child holistically, the importance of a comprehensive and differential diagnosis, and collaborative planning by the involved persons are stressed.
References
BUNCO, R. F. Prescriptions for Children with Learning and Adjustment Problems. Springfield, lit: Charles C Thomas, 1972.
CANTWELL, D. P. (Ed.) The Hyperactive Child. New York: Spectrum Publications, 1975.
CONNER, J. P. Classroom Activities for Helping Hyperactive Children. New York: Center For Applied Research in Education, 1974.
FINE, M. J. (Ed.) Principles and Techniques of Intervention with Hyperactive Children. Springfield, Ill.: Charles C Thomas, 1977.
FEINGOLD, B. F. Why Your Child is Hyperactive. New York: Random-House, 1975. Ross, D. M. and Ross, S. A. Hyperactivity: Research, Theory, and Action. New
York: John Wiley, 1976. SAFER, D. J. and ALLEN, R. P. Hyperactive Children: Diagnosis and Management.
Baltimore, Md.: University Park Press, 1975. SCHRAG, P. and DIVOKY, D. The Myth of the Hyperactive Child. New York: Pantheon
Books, 1975. STEWART, M. A. and OLDS, S. W. Raising a Hyperactive Child. New York: Harper &
Row, 1973. WENDER, P. W. The Hyperactive Child: A Handbook for Parents. New York: Crown
Publishers, 1973.
Contents
Preface ................................................................................ ix
Part I Introduction
1. The Hyperactive Child ...... ................. ...... ............ ........... .... 3
Part II Case Studies
2. Behavioral Approaches to Hyperactivity............................ 23 Case Study #1. The Use of School and Home Management Programs to Diminish the Inappropriate Behavior Emitted by an Eight- Year-Old Hyperactive Student
Herbert J. Rieth ................................................ .......... 26
Case Study #2. The Use of Activity and Token Reinforces to Increase the Reading Achievement and Appropriate Social Behavior of a Seven-Year-Old Hyperactive Student
Herbert J. Rieth .......................................................... 33
Case Study #3. Cognitive-Behavior Modification in a Case of Impulsivity jOveractivity
Philip C. Kendall and A. J. Finch, Jr. ........................ 42
Case Study #4. The Use of Self-Management to Improve Reading Skills in a Hyperactive Child
A. Lee Parks and R. L. Sherbenou ............................ 54
Case Study #5. Effects of Parent Training on Behavioral Tempo in a Preschool-Aged Boy
Mary Mira and Chris Milar ........................................ 59
Case Study #6. Contingency Contracting With a Hyperactive Boy and His Parents
Joan E. Backman, H. Bruce Ferguson, and Ronald L. Trites ........ ..... ... ............... .................... ..... 65
3. Autogenic Training: Learning Body Control.................... 73 Case Study #7. The Effects of Biofeedback Training on and Eight-Year-Old Boy
Vivien J. Worster ........................................................ 75
Case Study #8. The Use of Biofeedback Training on a Nine-Year-Old Child
Vivien J. Worster ........................................................ 77
Case Study #9. Relaxation Therapy With a Hyperactive Six-Year-Old Child
Mimi Lupin ................................................................ 80
Case Study #10. The Eclectic Use of Biofeedback, Behavior Therapy and Therapeutic Counseling by a Male / Female Team in Effectively Treating Hyperkinesis
Norma Estrada ............................................................ 85
4. Psychoeducational Intervention......... .......... ..... ........ ..... ....... 91
Case Study #11. Psychoeducational Programming With a Hyperactive Child
Eunice Nelson .............................................................. 93
Case Study #12. Use of a Structured Classroom Approach With a Multisensory Instructional Strategy
Fred H. Wallbrown .................................................... 103
5. Perceptual-Motor Training .................................................. 117
Case Study #13. Perceptual-Motor Training With a FiveYear-Old Boy
Jean Pypher ................................................................ 118
Case Study #14. Perceptual-Motor Training With a SixYear-Old Girl
Jean Pypher ................................................................ 135
6. Ecological Considerations .................................................... 149
Case Study #15. An Ecological Perspective of Hyperactivity in a Preschool Child With Developmental Delay
Barbara J. Thompson and Nancy L. Peterson ............ 152
Case Study #16. Teacher Consultation as an Intervention With a Hyperactive Second-Grade Boy
Stephen DeMers and Joy P. Burke ............................ 163
7. Psychotherapeutic Intervention .. ........ ................... ............. 173
Case Study #17. A Therapeutic, Multi-Faceted Interven-tion Program With a Preschool Hyperactive Boy
Linda H. Jackson ........................................................ 175
Case Study #18. Structural Family Therapy With the Family of a Hyperactive Child
Katherine G. Kent ...................................................... 182
8. Diet Management ................................................................ 191
Case Study #19. Diet Management With an Eleven-Year Old Boy
Jeanne Mayo .............................................................. 193
Case Study #20. Diet Management With a Seven-YearOld Boy
Jeanne Mayo .............................................................. 198
Case Study #21. Treatment of Hyperactivity in a Child With Allergies to Foods
Ronald L. Trites, Helen Tryphonas, and Bruce Ferguson .......................................................... 204
Part III Measurement, Diagnosis, and Intervention
9. A Review and Appraisal of Instruments Assessing Hyperactivity in Children
John P. Poggio and Neil J. Sa/kind ............................ 213
10. Diagnosis and Intervention: A Summing Up ...................... 233
Index .................................................................................. 241