Supporting children with DCD and ADHD

in small group teaching sessions

Amanda Kirby

Amanda Kirby 2012

2Do-IT Solutions Ltd copyright (December

2011)

One size DOES NOT fit all

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Starting point

Important principles

– Dyslexia often overlaps with ADHD and DCD (35-40%)

– Children often have dyscalculia as well

– Lower self esteem is often present

– Increased risk of anxiety and depression

– Greater risk of being bullied

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Dyscovery Centre copyright 2010

Dyslexia + Speech and Language

Speech and language difficulties are linked to poorer literacy skills (Snowling et al, 2000)

Followed up children with SLI at 8 and 15 years-greater reading difficulties- worse with age!

Better outcome if had expressive language difficulties only

Dyscovery Centre copyright 2010

SLI + Dyspraxia

Early years with SLI… 60% had associated DCD (Missiuna and Gaines,2007)

(Kavanagh, 1994; Barkley, 1990; Cantwell & Scatterfield, 1978; Lambert & Sandoval, 1980)

ADHD + Dyslexia

25%-

40%3-6%3-6%

Early manifestation of delayed language & inattention

Overlap is not a new problem

• Rutter et al (1975) in their landmark Isle of Wight Study, found that 40% of pupils with anti-social behaviours had severe reading problems

• Wilson and Evans (1980) and Epstein (1985) in their research for the Schools Council, found that learning difficulties and behaviour problems were strongly associated.

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ADHD

Dyscalculia

DCDASD

Dyslexia

Children don’t do tasks in isolation

• A child trying to read a book and write notes

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Prefrontal cortex

The Dyscovery Centre copyright 2011 Amanda Kirby

BUT learning is undertaken in a

dynamic system

The Child

Outcomes

Environment in which Manner of

Activity occurs presentationAmanda Kirby 2012

DiagnosisTeacher

Child

Input needed to make a diagnosis

Parent

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Recognise the signs

Be alert to the presence of difficulties

Needs to be seen in more than one setting

Need information from parents, school ( where possible) and tutor sessions

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Common motor associated

issues

Posture

Sitting on the chair

Planning

Work

Spatially

Fine motor

writing

Scissors, rulers

Gross motor

Common motor associated issues

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Common ADHD related associated difficulties

ADHD

Fidgety Impulsive

Answering out of turn

Poor planning

Starting off

Planning out work

Time management

Time concepts short term

Longer term planning

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Screening of children for DCD and ADHD

• Screening tools for DCD • DCDQ• Early years movement checklist • Movement ABC checklistTests• BOT-Brief (new)• DASH• ADC (16-25 years)

• Screening tools for ADHD • E.g. Conners screening tests• SNAP1V• SDQ (http://www.sdqinfo.org/)• ADHD-RS

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Early years movement checklist

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Screening tools can help to map out

• Areas of child’s difficulties

• BUT

• Also consider their strengths

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Strengths

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Outcome

environment

task

individual

There are different ways of looking at how we do different things

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Once you recognise the pattern of difficulties :

• Set up the Environment

• Adapt Tasks

• Work on Skills

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Setting up the sessions

• Have you a goal?• How do you measure progress?• What happens if this is not

happening?• What areas does the child need

support or adjustments in?• Think about the mix of children• How long can they all focus on a

task?• How can you break the session into

parts?

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Environment & presentation

Space

Think of the peer group mix

Discuss strengths between them

Start with easy tasks

Praise effort & participation

Belief that child can achieve task

Have you a reward system in place?

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M.A.T.C.H. the activity to the child

Modify the task

Alter your expectations

Teach strategies

Change the environment

Help by understanding

M.A.T.C.H. strategies available from CanChild website http://www.canchild.ca/

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The child’s goal

Do you ask the child what they would most like to improve?

How do they feel about the different tasks they need to do in school?

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Teaching the child

• Task specific approaches

• Cognitive Motor approaches

Goal

Plan

Do

Check

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What is a goal?

• A behavioural statement of what the child is expected to complete or perform

• A criterion that states how the behaviour will be measured

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How successful is training if it is not embedded in every day

life/school?

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What are appropriate goals for the session?

• Goals that have meaning for the child and family

• Goals that are achievable

• Goals that fall within the specific role of the professional working with the child

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Most effective approaches

• Linked into every day functioning.. What can they do at home?

• Practising enough (3-5 times per week)

• Practising appropriately

• Providing carry over/transferability

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Task-orientated

TaskPractice

Variety

Fun

Motivation

Positive experiences

Self-esteemGraded approach

Child and parent led

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Goal setting

Parent

ChildTeacher

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Start with the environment

Have you the kit you require?– Timer

– Fidget toys

– White board

– Angle board

– Adapted scissors

– Adapted rulers

– Pencils and pens

– ICT – keyboard,laptop

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Reducing the stress levels

For the child– Let the child know the format of the

lesson

– Time to settle down

– Review last week/session

– How will this fit into next week/session

– Write it down for the whole group

– Check understanding

– Clear beginning to the lesson

– Clear time frames for each part

– Pattern to each session

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Does the child know what to expect each session?

Use a calendar to anticipate reinforce language concepts, literacy skills

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Make sure all equipment is there and accessible for all

• Does the child have space at the table?

• Mark out their area with tape?

• Give ALL the children access to a range of different pens etc.

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Use a visual timetable

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We all learn differently

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…How does the child learn best

Using our senses to learn

Seeing

Hearing

Doing

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Common issues

Posture Planning Fine motor Gross motor

Posture and BalanceCommon issues

Posture Planning Fine motor Gross motor

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Balancing on the chair

• Correct table height

• Feet on the ground

• ? Wobble cushion or seating wedge

• If the child is leaning over , there may be a reason

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Seating and posture, table height

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Check vision

Improving posture

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Supporting the child

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Sebel chairs and desks

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Changing the angle

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Changing the environment

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Turned away from others for some tasks

Headphones if concentrating on a task –choose their own music

Book at correct heightBook holder

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Have a choice of tools

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Look at the pencil grip

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Adapt it where possible

Check language of placement

• In order to write:

– Up

– Down

– Top

– Bottom

– Left

– Right

– across

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Does the child know their abc and position?

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Check pre writing skills

• http://preschoollearners.com/Prewriting.php

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http://www.senteacher.org/Worksheet/17/Handwriting.xhtml

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Create fun opportunities to practise pre-writing shapes

• Sand tray shapes

• Shaving foam and stick

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Finger painting

Finger puppets

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Hand strength

•Posting •Threading•Peg games

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Minimise or avoid writing

Apples are ................

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KIDSPIRATION

WWW.IKONMAP.COM

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Use alternatives

Lower case keyboard

Dana NeoAmanda Kirby 2012

Literacy softwareFirst Keys

Clicker

Wordbar

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Mathematics

– Language of maths

– Visualisation of maths

– Learning times tables

– Recording in class

– Using tools

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Rulers

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Scissors

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Staying on task

• Break up session

• Use a timer

• Check understanding

• Refocus if drift

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Create a plan

• Think of other ways to get ideas down

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Show examples of what you expect

• Worked examples from others

• Model how to do the task

• Check understanding

• Break the task into parts

• Get another child to model

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Time reminders

Use timers to set the time for a task

Inattention/fiddling

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Movement breaks

• North

• South

• East

• West

• Child has to hold onto chair and move the direction of the command

• Change commands- right , left, forward, backwards

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Breathing techniques

• Focusing on their breathing

• In for 3 and out for 2

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Listening to punctuation

• Full stop- freeze

• Capital letter-make the shape of the capital letter

• Exclamation mark-reach tall then crouch down

• Question mark- shrug shoulders

• Comma- freeze and then mark on the spot

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Movement breaks

• Running on the spot

• Shoulder shrugs

• Hand presses

• Playing the piano

• Stretch and walk

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Reward system

• Card for each session with targets set

• Incentives- let the child decide what s/he working for short term

• Scale rewards- if get 50%.../75%....

• Larger reward over a period of time

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And Literacy based

difficulties• Suitable reading materials

Rising Stars

Barrington Stoke

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M.A.T.C.H. example

Difficulty keeping up with handwriting, slow, incomplete work, crucial information missed, unable to listen and take notes simultaneously, complains of hand being tired

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M.A.T.C.H. strategies

Reduce amount of writing required

Ensure all written output is necessary – ask yourself “What skill is this demonstrating to me?”

Minimise time spent copying non-essentials (e.g. date, title)

Allow rough and final drafts on computer

Photocopy notes from class and teach child how to pick out key meanings while peers are copying from board

Allow more time to complete work

If encouraging speed, accept a less accurate product (and vice versa)

Let child use technology

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Why has this child difficulties with handwriting

• Difficulty with copying from the board?

• Difficulty writing at speed?

• Difficulty with visual perception?

• Difficulty with spelling ?

• Difficulty with hearing?

• Problem of instability of the arm away from the body?

• Wrong tools for the task?

• Is the child always going to have difficulties?

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Handwriting

• Has the child pre writing skills?

• Can the child sit still?

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Handwriting Myths

1. Using a pencil grip isn’t always the answer

2. Practising writing over and over again won’t always improve the skills

3. Handwriting is not essential for life

4. Joining dot to dot letter shapes is not writing

5. Not all children are ready to write at 6 years of age

6. Giving a child more time may not improve the problem

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Handwriting

Observe pupil writing

Pencil grip, sitting position, letter formation

Look at handwriting

Letter size, spacing, on the line

Discuss with pupil

Do they want writing to be different, does their hand ache

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Pencil grips

Dynamic tripod

Lateral quadropod

Dynamic

quadropod

Lateral tripod

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Sitting positionBottom back in chair, table at elbow height, feet on floor, non-writing

hand on paper. Sloping desk may help.

Letter formation, start & finish, size, shapeTeach in letter groups c a d g o q, b h n p m r, w x z k, e

s f, i t l, u y j

Letter joins – need to be taught 4 basic joinsai, ou ab, ol

SpeedTrade off between speed and legibility, different writing

for different tasks, exam techniques

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Moving and planning

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Fine motorCommon issues

Posture Planning Fine motor Gross motor

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Assessment of fine motor skills

Assessments of manual dexterity

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Accuracy

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Accuracy

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Manual

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Tool usage

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Writing control

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Writing positions

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Finger position

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Case 1

• John is 9 years old

• Reading age of 7 years

• Spelling age of 5 years

• He has very poor writing. He cant keep the words on the line

• He fidgets and leans across the other children

• He loses focus when set tasks on his own very quickly

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Case 2

• Janet is 15 years of age

• Her reading is age appropriate but her writing is difficult to read, and she is very slow getting her work down onto paper.

• She gets some pain on writing when has she has to write for long.

• She makes spelling errors and has difficulty planning out her work.

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Case 3

• Sam is 6 years old. He is chatty and wants to answer all the questions all the time in the group.

• He avoids writing all together whenever possible and finds it hard to sit still for long.

• He cannot colour in very well.

• He has some great ideas and tells you some stories that are inventive .

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Think about 24 hours

• Quick bits of advice can make a big difference

• E.g www.boxofideas.org

• Remember small things can make a BIG difference

• DCD, ADHD and Dyslexia often overlap

• Expect this rather than being surprised and consider it within your teaching

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Advice to home

• Same place

• Same time

• All equipment ready

• Home- school diary

• Create a plan

• Use an essay planner

• Parent buddy

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TASKS NEW SCHOOL

ENVIRONMENTINDIVIDUAL

The Dyscovery Centre copyright 2011 Amanda Kirby

Thank you

Any questions

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Hand Strength exercises

• Activities that involve tearing paper, especially stronger paper like sugar paper are good. The paper can be used to make papier mache. Balloons of different shapes can be used to plaster the papier mache on to. It can then be painted and made into animals or other things. Make collages and textured pictures.

• Using a single hole punch (purchased from WH Smith) can help the child to punch along the outside of a shape to make his own lacing card. If you use strong paper they can then lace the card when they have finished punching.

• Encourage the child to play with play dough. As strength increases, move to plasticine and clay – rolling, squeezing, and smashing. Play games like – making food for dinner or animal shapes or letter shapes (whatever interests the child). Hide pennies in the dough and roll into a ball. Encourage the child to pull the dough apart to find the pennies. Roll out the dough into thick sausages and squeeze the fingers to make dinosaurs

Hand strength

• Squeezing soft balls or stress balls.

• Games played with clothes pegs are good for developing strength. Think of different ways of opening and closing the clothes pegs – thumb and index, thumb and little finger. Play a game where you pretend to hang washing on the line or clip the pegs on to an animals tail (piece of cloth). Place them around the edge of a shoebox and roll a dice. Take off the pegs according to the number of the dice.

Activities to improve stability of the thumb joints

• Make a circle between thumb and index finger, with just finger tips touching, try to prevent this circle being broken when you with your index finger hooked through the circle tries to break it.

• As for above, make a circle, but this time have a piece of card/paper/ruler (something thin) between the fingertips. Squeeze fingers hard to try and keep it there whilst someone else tries to pull it away.

• With palm facing upwards, flex thumb across palm. Place a thin book etc. between thumb and palm. Try and keep this in place whilst someone tries to pull it away.

Dexterity and coordination

• Threading activities – Thread all sorts of things – buttons, beads, hula hoops, macaroni, polo mints, straws cut into pieces.

• Lacing games – Vary the size of the lace used. Where lacing is difficult, start with a thin wooden dowel with a large bead fixed securely on the end to stop objects falling off. As the child progresses move to net curtain wire or nylon cord. Move then to thick laces with a long plastic end, then to thinner laces with a shorter end.

• Use of finger puppets – Make up a story where the puppets have to talk to one another.

• Finger painting – Experiment using fingers, knuckles, sides of hands, heels of palms etc

• Place a pile of play coins on the table. See how many the child can pick up using one hand only without dropping those already in the hand. Challenge them to see if they can collect more than you. Alternatively, how fast can they post coins into a money box. Practise using both hands. This is also a good game to promote numeracy skills.

• Build with Lego or Duplo as much as possible. Sit alongside while they make something to play with and encourage them to pull pieces apart and put them together. Use construction materials and games of all kinds, as this type of play activity is excellent for developing dexterity, coordination and concentration.

• Use jigsaw puzzles, either inset trays or interlocking puzzles, whichever is age appropriate for the child; these are excellent for developing dexterity. Sit with your child and be there if they get stuck and give them just as much help as they need to be successful.

Try some of the following:

• Standing feet apart, roll the ball in a figure of eight round the feet using different parts of the hands – backs, fingers, palms, etc. – first in one direction then the other.

• Sitting – legs bent, feet on the floor. Roll the ball gently under the knees from one hand to the other.

• Now try rolling the ball under the knees and then round the feet – first in one direction, then the other.

• Now try rolling the ball under the knees, round the feet, then round the back – in both directions.

• Sitting – legs astride. Hold the ball near the ground in both hands – open the hands to release the ball. Try to get both hands back to the original position as the ball bounces up.

Fine Motor skills

ACTIVITY EQUIPMENT SKILLS BREAKDOWN

Empty the Jars

Practise unscrewing

and screwing the

lids of different

types of jars and

containers. Put

objects inside to

make the game

more interesting.

Screw top jars

Container

Fine motor skills

Self-help skills

Eye/hand co-ordination

Stencilling

Use one hand to

support the shape

and the other to

draw around it.

Alternatively, fix

stencil with a small

amount of blu tack,

place a piece of

paper over the top

and with chubby

crayons,

manipulated

lengthways, crayon

over the top to

reveal a magic

picture.

Stencils

Paper

Pencils

Crayons

Blu tack

Eye/hand co-ordination

Fine motor skills

Pencil grip

Pencil control

Letter/number shape

concepts

‘Tiddly Winks’

Again this skill

requires a pincer grip

in addition to those

identified above.

Coloured

counters

Saucer

Eye/hand co-

ordination

Turn taking

Grading of

movement

Problem solving/

use of strategy.