Ask Amanda: Oppositional Defiance Disorder

In August we talked about aggression. I shared The Dreaded Power Struggle on http://kindergarten-teachers.ning.com/, a social networking site of which I am a member. A fellow member responded, saying that she had experienced a “Can you do this?”-“I’m not doing it!!” power struggle in her classroom.

Her student has oppositional defiant disorder, and she has a great system in place to help deal with the child’s difficulty following instructions. Here is her story… and her question:

“In math, the class was on the carpet for the lesson and she [the student] was lying across the floor. They [the other students] all went back to their seats for independent work, but my student sprawled across the carpet face down and refused to get up.

“So I left her a few minutes, came back over asked if she knew what she should be doing. She replies, yelling, ‘Yes and I'm not doing it!’

“I gave two options, to get up and do it at the table now, or do it during her free choice centre time. Eventually she came ... over … to my reading table at the end of the group I was working with.

“…. I started a contract this week focusing on two little goals: 1) keeping her shoes and socks on during morning meeting (she gets a sticker) and during math lesson (she gets another sticker). Goal 2) is a little more difficult but is to sit in her square on the carpet for morning meeting (sticker) and for math lesson (sticker).

“So she's working just on those two goals right now. I view it as baby steps and hopefully progress in the long run. Her parents are very supportive and have no idea what to do either. She was adopted at age 1 and of course most of what she does is learned behaviour. Thoughts?”


Firstly, I just want to encourage and commend this teacher to say that she is doing a great job. Baby steps, calmness, patience and lots of rewards (rather than focusing too much on the negative behaviour) are the essential tools in helping this child want to change their behaviour. And behaviour is likely to only change long term if the child’s wants it to change.

The behaviour contract is also important – it clearly outlines exactly what is expected, no room for misunderstandings or negotiation. This again reduces the opportunity for power struggles.

The use of tangible, immediate rewards means that she can see the connection between a specific behaviour (eg. sitting on her carpet square for morning group time) and the reward. This is very important for all children with different abilities because it gives them specific guidance about what is desirable behaviour without a “lesson” or “discussion” being involved.

The identifying of very specific behaviour attached to the reward also means that you can reward her for that behaviour even if she is displaying some other undesirable behaviours. This is an important starting point as it helps the child “get off on the right foot” so to speak. That is, it helps build their self-esteem and self-worth which can lead to more positive behaviour.

One of the most disheartening things for a child struggling with the social and behavioural demands of school is the withdrawal of a reward. For example, if you have a points system where you get 10pts for appropriate behaviour, 10pts off for inappropriate, many children with behavioural difficulties will constantly end up in the red.

For that child, it really isn’t worth trying if they expect to fail.

This also applies to the possibility that the child is struggling with Math. For example, they may feel that every time they do Math they are likely to get it wrong, or they are simply struggling to understand your directions. This may mean that they use defiant or inappropriate behaviours to avoid this possibility of failure. It may be that you need to reasses what tasks you give your child in Maths, and how you ask them to complete it (eg. cutting up a pizza to learn fractions rather than drawing lines and answering questions on paper).

The other thing I just wanted to mention is the idea of learnt vs instinctive behaviour. Learnt behaviour = behaviour children observe and mimic. Instinctive to me means that they are acting based on their own feelings.

Children who are adopted or who are in Foster care may experience a range of emotional challenges that may not be faced by children living in their birth families. Issues of loss, grief and difficulties with attachment may arise. The emotional effect of these issues may result in children (whether adopted or not) acting out, being defiant, rejecting friendships, not responding in the same way as their peers to adult attention, impulsiveness and low resilience and/or self-esteem.

However, I must stress that all children respond differently to adoption and separation, and that behavioural and emotional effects can be mitigated by the actions of parents, teachers and others supporting the family and child. But there are others who can speak with greater authority on this topic than me.

The following sites have some interesting information about how adoption or separation/divorce may affect children and what you might be able to do to prevent this.
http://family.findlaw.com/adoption/adoptive-parenting/adoptee-grief.html
http://family.findlaw.com/adoption/adoptive-parenting/adoptee-early-development.html
http://www.catholiccare.org/files/files/FS/post%20separation/Effects%20of%20Separation%20on%20Children.pdf

This site has a list of other websites where you can find information and counselling relevant to adoption:
http://www.community.gov.au/Internet/MFMC/Community.nsf/pages/section?opendocument&Section=Adoption

So if a child has these extra challenges, then it is even more important that we focus on expecting small improvements, rather than sweeping behaviour change. That we use calmness, patience and lots of rewards and positive interaction.

Our children are precious. All of them.

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Helping children follow your directions

Golden rule:
Give your instructions in different formats in an environment that is as quiet as possible, and reward them for their efforts.

A quiet environment
Some things to think about at home if your child is having problems hearing or focusing their attention on your instructions:

- Turn off the TV before you start talking
- Don’t try and yell over the washing machine, dishwasher or mower – or yelling kids. Turn the appliances off, and wait until your child is quiet before giving instructions.
- A room that is carpeted and has curtains will help cut down background noise
(My Dr, 2005; Neven, Anderson and Godber, 2002)

Some things to think about in the classroom if your student is having problems hearing or focusing their attention on your instructions:
- Negotiate and enforce rules about sitting quietly while the teacher is talking. Enforce the rules through praise and having a visual list of the rules on the wall (AFCEC, nd).
- Have a signal (eg. flicking the light switch for high school, clapping a rhythm which the students then have to copy in primary school) that indicates you are about to speak. Don’t try and yell them to attention (CDI, 2008).
- Wait until you have their attention before giving instructions.
- Use a noise-o-meter to keep children aware of what noise level is appropriate.
- Be aware of how any appliances, floor coverings and other features of the room may increase or decrease background noise.

Different ways of giving instructions:

Verbal
“Okay, kids, collect your Maths books, sit down at your desk and start work on page 6.”

Modelling
As you talk, demonstrate each step.

Visual
This can be hung on the board, or put on the child’s desk.
Written
Give this to the child so they can tick off each step as they complete it.
(Adapted from http://www.do2learn.com/organizationtools/classroom/educationalresources.htm)
Motivation and rewards

"If you do your work, then you can have a sticker." This is a “bribe”.

"Remember that when you finish this you will be able to put a star on your I've Finished chart." This is a negotiated reward that is a natural consequence of task completion.

But maybe we’ll talk more about this another time.

References:

Alabama Federation Council for Exceptional Children. (nd). Rules for Structuring the Classroom. Retrieved 25th May, 2009 from: http://www.afcec.org/tipsforteachers/tips_b2.html

Child Development Institute. (2008). Suggested Classroom Interventions ForChildren With ADD & Learning Disabilities. Retrived 25th May, 2009 from: http://www.childdevelopmentinfo.com/learning/teacher.shtml#Suggested

MyDr. (2005). Hearing Impairment and School Children. Retrieved 25th May from: http://www.mydr.com.au/kids-teens-health/hearing-impairment-and-schoolchildren

Neven, R.S., Anderson, V. and Godber, T. (2002). Rethinking ADHD. Allen and Unwin: Crows Nest.

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Doing what you are told

One day, in a state of complete exhaustion, I got up to complete my final routine before crawling into bed. In my head I planned to do as follows:
Put cheese in fridge
Put rice crackers in cupboard
Clean teeth
Crawl into bed

As I discovered when I next was looking for my favourite snack, what I actually did was:
Put cheese and rice crackers in fridge
Clean teeth
Crawl into bed

This is an example of cognitive planning going wrong… and an illustration of how executive function can be affected by fatigue. Children whose executive functioning has been affected by factors such as fatigue, anxiety, ADHD or other factors/disorders may find it hard to carry out a sequence of steps even if they do remember the main points of what they have been told.

Doing what you are told

To follow instructions we need to be able to identify the important items, plan and organise the information so we can follow-through with the instructions. Then, finally, we need to be able to concentrate and monitor our actions (ie. I should have realised that the rice crackers really didn’t belong in the fridge). All this is managed by something we call executive functioning (Hagemann, Hay and Levy, 2002).

Executive Function (Hagemann, Hay and Levy, 2002):

Executive function is part of the working memory system. It is a cognitive function that helps us helps us decide what to remember, and what to discard. It helps us put the information in the right order. And it helps us stay on track.

So if a teacher says, “Well, kids, now it’s time to pack up. I want you to put your pencils in your pencil-tin, your books in your tote tray and then come and sit on the floor ready to have a story.”

A student whose “executive function” is working well might have a thought process that goes something like this… “pencils away, book in tote, sit on the mat”. They will then do this in the required order, and be sitting quietly at the front of the room ready for the teacher.

A student whose executive functioning is not operating in the same way, you may find they carry their books and pencils with them to the mat, or they get out their tote tray and put it on their desk. Alternately, they could get distracted half way through and need multiple reminders to get back on track because they aren’t monitoring their own behaviour.

For other children it may just be that they take much longer to work through the process, having to work hard at remembering each step.

Executive functioning is identified as one of the key functions that is affected in children with attention deficit disorders like ADD and ADHD. This means that the children often act impulsively, without thinking about the instructions or consequences of their actions. It also contributes to the fact that they prioritise what’s going on outside the window rather than listening to the instructions you are giving (which, of course, links back to the difficulties with paying attention).

So this is just one more thing to consider when we give instructions….

Next time I am going to post a letter from a parent who has a child with ADD. It provides some great insight. If you want to contribute a similar letter, please email it to me at amandag7@optusnet.com.au

I hope this blog is helpful to you. If it is, make sure you vote on the poll on the left. I also look forward to your questions and suggestions for future topics.

If you want to find out more about me and what I am up to, you might want to visit www.learn2bebuddies.com.au


References

Hagemann, E., Hay, D.A., and Levy, F. (2002). Cognitive Aspects and Learning. In S. Sandberg (Ed), Hyperactivity and Attention Disorders of Childhood, p214-241. Cambridge University Press: Cambridge.

You might also want to visit:
http://www.ldinfo.com/executive_functioning.htm
http://www.ncld.org/content/view/1200/480
http://www.ldonline.org/article/Executive_Function_Fact_Sheet

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Why aren’t you listening? Disobedient or Distracted?

Picture copyright Daniel East - from "Dave is Brave" www.learn2bebuddies.com.au

“I’ve told him what to do a dozen times, but it goes in one ear and out the other!”

Have you ever heard that said? Well, it might be very near the truth.

But, despite what you might feel, a “good kick up the backside” is not the solution. We need to understand why our words have not stuck with the child.

What is involved in doing what you are told?

When you are told to do something you have to be able to hear, listen, interpret, remember and act on the instructions. If you have difficulties doing any one of these things you can seem “disobedient”.

In this post I want to talk about hearing.

Hearing

I won’t give you a biology lesson on hearing here. You might want to visit the Mayo Clinic if you are interested in how the ear works. For now, I just want to point out some reasons why a child might not be able to hear you.

Conductive hearing loss (ASHA, 2009; Australian Hearing, 2009; Moore, 1997)

Children who have recurring ear infections such as Otitis media, or even a build up of wax in the ear will find it hard to hear clearly. For others the bone and cartilage structure may interfere with the movement of sound through the ear to the nervous system that processes the sounds.

Children with Down Syndrome are shown to be at increased risk of ear infections and conductive hearing loss because of their susceptibility to infections and the smaller ear canal (Moss, nd).

Indigenous Australians have also been shown to be at increased risk of conductive hearing loss (Coates et al).

For some children, the treatment might be through antibiotics or grommets (MyDr, 2008). For others, hearing aids may be used.

Sensorineural hearing loss (ASHA, 2009; Australian Hearing, 2009; Moore, 1997):

This is when the cochlea or the nerves that carry sound to the brain might be affected. The levels of hearing loss may differ, but generally sensorineural loss cannot be fully addressed even if the child is using hearing aids. For children whose cochlea is damaged, cochlea implants can be used. For others, communication will be through the use of sign language.


The levels of hearing loss are described as mild, moderate, severe and profound. If you want to know what a child might hear depending on the level of hearing loss they have been diagnosed with, visit ASHA and the Medical College of Wisconsin (they have a great picture that is easy to understand). The Warren Centre also has a good diagram of what sounds equate to different decibel levels (as seen in the ASHA description).

Disobedience or Distraction?

If a child has an ear infection such as Otitis Media they will struggle to hear you call their name in a noisy room or if their back is turned to you. So if they don’t respond, it is that they haven’t been able to pick out your voice from all the other noises going on around them.

If a child has a hearing aid or a cochlea implant, it doesn’t mean that they have perfect hearing. They will struggle to hear you in noisy rooms, or if there is something or someone making a noise closer to them than you.

You also need to remember that children with hearing impairments may have smaller vocabularies and may struggle with understanding how sentences are put together. This is because their learning of language is interrupted by what they can and can’t hear. This may mean they find it hard to pick out the important bits in your instruction.

For example, if you say "Julie, can you put your book away in your book tray, please?" the child
may know you have mentioned a book and a tray, but not make the connection between the two. So the child may be confused about what exactly you want them to do with the two objects.

Next Time

In the next post I will talk about the difference between listening and hearing. Later I will also talk about some strategies and things to think about when giving instructions to a child who has a hearing impairment.

References
Australian Hearing (2008) Types of Hearing Loss. Retrieved 10th May, 2009 from: http://www.hearing.com.au/types-of-hearing-loss

American Speech-Language-Hearing Association. (2009). Type, Degree and Configuration of Hearing Loss. Retrieved 10th May, 2009 from: http://www.asha.org/public/hearing/disorders/types.htm

Coates, H.L., Morris, P.S., Leach. A.J., and Couzos, S. (2002). Otitis media in Aboriginal children: tackling a major health problem. Medical Journal of Australia 177 (4): 177-178 Retrieved from: http://www.mja.com.au/public/issues/177_04_190802/coa10271_fm.html

Mayo Clinic (2009). How do we Hear? Retrieved 10th May, 2009 from: http://www.mayoclinic.org/hearing-disorders/how.html

Moore, B.C.J. (1997). An Introduction to the Psychology of Hearing. SanDiego: Academic Press.

Moss, K. (nd). Hearing and Vision Loss Associated with Down Syndrome. Retrieved 10th May, 2009 from: http://www.deafblind.com/downmoss.html

My Dr (2008). Otitis Media in Children. Retrieved 10th May, 2009 from: http://www.mydr.com.au/kids-teens-health/otitis-media-in-children

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