Supporting children with DCD and ADHD in small group teaching sessions Amanda Kirby
Amanda Kirby 2012
One size DOES NOT fit all
Amanda Kirby 2012 Do-IT Solutions Ltd copyright (December 2011)
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Starting point Important principles – Dyslexia often overlaps with ADHD and DCD (3540%) – 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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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 yearsgreater 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)
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ADHD + Dyslexia
3-6%
25% 40%
3-6%
Early manifestation of delayed language & inattention (Kavanagh, 1994; Barkley, 1990; Cantwell & Scatterfield, 1978; Lambert & Sandoval, 1980)
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.
ADHD
Dyslexia
Dyscalculia
ASD
DCD
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Children don’t do tasks in isolation • A child trying to read a book and write notes
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Prefrontal cortex
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BUT learning is undertaken in a dynamic system The Child
Outcomes
Environment in which of Activity occurs
Manner Amanda Kirby 2012
presentation
Input needed to make a diagnosis
Teacher
Diagnosis
Child
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Parent
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 Common motor associated issues
Posture
Sitting on the chair
Planning
Fine motor
Work
writing
Spatially
Scissors, rulers
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Gross motor
Common ADHD related associated difficulties ADHD
Fidgety
Impulsive
Poor planning
Answering out of turn
Time management
Starting off
Time concepts short term
Planning out work
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 checklist Tests • 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 Amanda Kirby 2012
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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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There are different ways of looking at how we do different things individual task
environment
Outcome Amanda Kirby 2012
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? Amanda Kirby 2012
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? Amanda Kirby 2012
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/ Amanda Kirby 2012
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
Check
Plan
Do Amanda Kirby 2012
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 Amanda Kirby 2012
Task-orientated
Task Fun
Practice
Motivation
Variety
Self-esteem
Graded approach
Child and parent led
Positive experiences
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Goal setting
Parent
Teacher
Child Amanda Kirby 2012
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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 Amanda Kirby 2012
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 Amanda Kirby 2012
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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learn ‌How does theWe childall learn best
differently
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Using our senses to learn
Doing
Hearing Seeing
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Common issues Posture
Planning
Fine motor
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Gross motor
Common issues
Posture
Planning
Fine motor
Gross motor
Posture and Balance
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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
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Improving posture
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Supporting the child
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Sebel chairs and desks Amanda Kirby 2012
Changing the angle
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Changing the environment
Headphones if concentrating on a task – choose their own music
Turned away from others for some tasks
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Book at correct height Book 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
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Check language of placement • In order to write: – Up – Down – Top – Bottom – Left – Right – across Amanda Kirby 2012
Does the child know their abc and position?
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Check pre writing skills
• http://preschoollearne rs.com/Prewriting.php
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http://www.senteacher.org/Worksheet/17/Ha ndwriting.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 puppets
Finger painting
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Hand strength
•Posting •Threading •Peg games Amanda Kirby 2012
Minimise or avoid writing
Apples are ................ Amanda Kirby 2012
WWW.IKONMAP.COM
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KIDSPIRATION
Use alternatives
Lower case keyboard
Dana Neo
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First Keys
Literacy software Clicker
Wordbar Amanda Kirby 2012
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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Use timers to set the time for a task
Time reminders
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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 Amanda Kirby 2012
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 Amanda Kirby 2012
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 Amanda Kirby 2012
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 Amanda Kirby 2012
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? Amanda Kirby 2012
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 Amanda Kirby 2012
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Pencil grips Dynamic Dynamic tripod
Lateral tripod
Lateral quadropod Amanda Kirby 2012
quadropod
Sitting position Bottom back in chair, table at elbow height, feet on floor, non-writing hand on paper. Sloping desk may help.
Letter formation, start & finish, size, shape Teach 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 joins ai, ou ab, ol
Speed Trade off between speed and legibility, different writing for different tasks, exam techniques
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Moving and planning
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Common issues
Posture
Planning
Fine motor
Gross motor
Fine motor
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Assessments of manual dexterity
Assessment of fine motor skills
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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 Amanda Kirby 2012
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. Amanda Kirby 2012
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 . Amanda Kirby 2012
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 Amanda Kirby 2012
Advice to home • • • • • • •
Same place Same time All equipment ready Home- school diary Create a plan Use an essay planner Parent buddy Amanda Kirby 2012
TASKS
NEW SCHOOL ENVIRONMENT
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INDIVIDUAL
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
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.
EQUIPMENT
Screw top jars Container
SKILLS BREAKDOWN
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’ Coloured Again this skill counters requires a pincer grip Saucer in addition to those identified above.
Eye/hand
co-
ordination Turn taking Grading of movement Problem solving/ use of strategy.