Case study: planning to teach a student with Attention Deficit Hyperactive Disorder (ADHD)

Case study: profile of a student with Oppositional Defiant

Disorder (ODD)
Posted on March 3, 2009 by Suzi A
Student competencies and strengths
James is a 14 year-old year 9 student, who has a keen interest in cars, motorbikes, aeroplanes,
and anything else with an engine. James says his favourite school subjects are Wood Technology
and P.E., because they are more hands-on and enjoyable than the more traditional subjects such
as maths and English. He enjoys reading books and magazines when the subject matter interests
him; such as books about cars. He plays soccer and cricket on the weekends, and his mother
believes that playing team sports helps him learn to interact with others in a positive way, and
helps him retain friendships. James is very good at soccer and plays for the local under 16s
division 1 team. James has a younger brother who he gets along with well most of the time.
James father was killed in a car accident when James was six, and he began to develop the
symptoms of ODD a year and a half later, at the age of eight (1).
Student difficulties
Because of his behavioural issues (which are listed below), James has missed a lot of lessons due
to being sent out of lessons and suspended, and is beginning to fall behind in most subjects.
James struggles in maths, because he finds it difficult to grasp some of the concepts he missed
out on learning whilst on a suspension earlier in the year. He hates geography, and his teacher
Mr. Perkins spends most of his lessons in a constant power struggle with James, who likes to
distract other students by annoying them (2), so that he will get sent out of class and not have to
do any work. James has a few good friends that he has known since Primary School, however he
has started hanging around with a group of kids older than him who regularly truant and smoke
cigarettes (3), and this worries his mother. Although James likes to read books in which he is
interested, his reading skills are approximately that of a 12 year old (4); consequently he goes to
special reading classes three times a week. James hates the special classes as he gets taken out of
some regular lessons to attend them, and some kids make fun of him which is affecting his self-
confidence. James sometimes refuses to go to school, and his mother suspects that he may suffer
from some form of mild depression (5), although James refuses to be diagnosed. As a result of
the ODD, James can be argumentative with teachers, especially when they ask him to do a task
which he thinks is too hard, or does not want to do (6). James will regularly annoy other students
during class, lose his temper when he does not get his own way, disobey teachers and his mother,
and worse, will become physically violent toward other students when taunted (7).
Strategies and resources
On one occasion a teacher became so frustrated with James behaviour that she snapped and lost
her temper with him. As a result of James ODD, he became extremely aggressive (8) and
threatened to kill her; the result of the incident being a one-week out of school suspension for
James. Therefore, dealing with James behaviour in the classroom can sometimes be tricky.
Below are some examples of strategies which do and do not work when James has an outburst
while at school (all taken from reference 9).
DO NOT:
Become overtly frustrated, shout at, or lose your temper with James if he has an outburst,
as this will only lead to bigger problems. Instead, remain calm, as eventually James will
calm down too.
Give James too many instructions at once, as this confuses and frustrates him. Clear,
concise, logical steps, preferably written down, will instead help James remain on-task.
Breaking a task down into smaller sections can also be helpful.
Punish James every time he does something wrong. Instead, reinforce his good
behaviours. For example, thank James when he contributes to a class discussion, even if
he accidentally let a swear word slip during his contribution. Punishing him for swearing
highlights the bad behaviour and not the good, not to mention making him feel as though
his contribution was not valued.
DO:
Make sure that James is aware of the classroom rules that all students must adhere to, and
what the consequences are if he breaks these rules. The penalties for breaking classroom
rules must be reasonable.
Multiple punishment options for inappropriate behaviour is one strategy teachers have
successfully utilised with James in the past, as this helps James take responsibility for his
actions. When James chooses his own punishment from a few different options he takes
some direction, and doesnt blame others for his behaviour.
Include James interests in your lesson content as much as you can. This can sometimes
be tricky, but including examples of cars or sports when discussing themes or teaching
new content not only gets James attention, but helps him to understand the examples
given as he is a lot more likely to listen.
Allow James to complete tasks in his own time, as is reasonable. Pacing which is too fast
or too slow will only frustrate him and cause him to begin distracting others.
Try to use hands-on examples and techniques for learning where possible as James
prefers this style of learning, and will benefit from this a lot more than from other styles.
Give lots of warning when moving on to another activity, as James becomes irritated
when he feels as though he has not had enough time to complete a task.
If the above strategies are used appropriately to assist James in maintaining his good behaviour,
and to facilitate his learning, James outbursts are minimised and he is an excellent student to
teach.
CASE STUDY- OPPOSITIONAL DEFIANT DISORDER
M, Age 3, Oppositional Defiant Disorder
Submitted By: Maryellen Soriano
Morris County EduCare,
New Jersey, United States
March 2006
Name: M
Gender: Male
Chronological Age: 3 years, 7 months
Clinical Diagnosis: Oppositional Defiant Disorder
BACKGROUND INFORMATION
M was a full term baby born by cesarean delivery due to abnormal position, which caused the
membrane to break. In addition, the umbilical cord was tangled. M slept very little during his
early years. He always wanted to be rocked and held. His developmental milestones were
accomplished in a normal time frame. His difficult behavior patterns started to concern his mom
when he was asked to leave his second preschool because of his behavior.
M was a strong willed child who easily refused to do anything that was asked of him. His selfcare
skills were still developing. He was not potty trained and would not sleep by himself at night.
He has average intelligence and his behavior was quite purposeful. His hyperactive aspects
surface during oppositional phases. He has refused to pick up toys that hed pull off shelves. He
did not listen and would do what he wanted and when he wanted to.
M was diagnosed with Oppositional Defiant Disorder (ODD). Although oppositional behavior is
often a normal part of development for two to three year olds, M was frequently openly
uncooperative and hostile. His ongoing pattern of defiant and hostile behavior toward authority
seriously interfered with his day-to-day functioning. M had frequent temper tantrums and refused
to comply with adult requests and rules. M was easily annoyed by others and often blamed
others for his mistakes or misbehavior. He made deliberate attempts to annoy or upset others.
M was clearly spiteful and vindictive and often angry and resentful.
M had much difficulty staying focused on activities within the classroom. His short attention span
made him easily distractible, especially by noise. Throughout the day, M would need repetition
and clarification more than other children his age. He most definitely has difficulty establishing
his personal space and physical boundaries. He often runs into others and bumps them roughly.
M was referred to Morris County EduCare & Enrichment Center because of the teachers abilities
to incorporate special needs students into their programs. He was assigned a private aid and
joined the three-year-old class. He is going to begin receiving occupational therapy in July of
2005 to further assist with his sensory integration.
TREATMENT
Treatment methods began with Ms private aid transitioning him into the preschool program by
strictly following his IEP and providing break-away time for M when he needed it. The Listening
Program (TLP) was chosen in order to provide M with some sense of grounding to his
environment. The second goal was to improve attention and aggressive behavior. The purpose
of The Listening Program was to help M maintain auditory attention, communication and social
skills.
The Listening Program was the first treatment started with M since his diagnosis of ODD. The
classroom teacher also made sure to build on the positives, to give him praise and positive
reinforcement when he would show cooperation. The teacher made sure to prioritize the things
she wanted M to do. She set up reasonable, age appropriate limits with consequences that could
be enforced consistently. M began to respond to these positive techniques after participating in
The Listening Program.
PROGRAM IMPLEMENTATION
The Listening Program was easily integrated into Ms day. While the children were in centers, M
and others were given the choice of a listening center. Other children listened to stories on tape
while M used this time to follow his TLP Base Schedule using the Classic Kit. Integrating The
Listening Program this way created a positive experience for M. It enabled him to remain part of
his class group yet work on skills he needed to attend to.
PRE/POST TLP
Before implementation of The Listening Program, the preschool child study team evaluated M.
He was classified as having Oppositional Defiant Disorder. It was recommended for his mother
to attend parenting classes and begin enrollment at EduCare with a private aid.
After CD #2, M began to have less difficulty staying focused. He became less distractible by
noise and much less sensitive to certain sounds of his classroom environment.
By CD #4, M was showing more interest in class work dealing with letters and sounds. He was
becoming better at discriminating sounds. He was improving tremendously with attending to the
work that was expected of his preschool class. He no longer showed sleepiness or tiredness
when listening to the teachers.
By the time M reached CD #7, he showed an improved sense of balance and coordination. He
demonstrated an improved sense of personal space and physical boundaries. This was of great
help for M in making new friends and playing with his peers. M also showed improvements in
rhythm and movement activities. Instead of just jumping around, his movements seemed to be
having purpose.
M still has tendencies to exhibit some hyperactivity but at a minimum. He now is more able to
settle himself down. He has responded extremely well to TLP. M received an evaluation for
occupational therapy and qualified for services before beginning TLP. He was not involved in any
specific activities to improve his motor skills while participating in TLP; however, he has made
great gains in his sense of personal boundaries and fidgeting as well as becoming less clumsy.
He has benefited immensely from The Listening Program.
Listening Checklist
Referring to the Pre and Post Listening Checklist, the following skills went from always to rarely:
Difficulty staying focused, short attention span, easily distractible, over sensitivity to certain
sounds, misinterprets questions or requests.
The following skills went from often to rarely: Difficulty in sound discrimination, confuses similar
sounding words, needs repetition and clarification more than usual, poor short- term memory,
tires easily, and becomes sleepy when listening to speakers.
The following went from sometimes to rarely: Difficulty recalling exact word usage, sings out of
tune, difficulty summarizing a story, difficulty relating isolated facts.
The following difficulties were not noted at all after participating in The Listening Program:
Inadequate sense of personal space and or physical boundaries, fidgeting,
clumsiness, poor sense of rhythm, and timing of movement.
Ms greatest improvements are his self-regulation skills and his ability to settle down
considerably.
SUMMARY OF CHANGES
Perhaps the most evident of all changes that have been observed in M since beginning TLP
came from one parents observations upon leaving one evening. The parent came into the office
and complimented our staff on notable improvements in Ms behavior. She said, Boy, you guys
have certainly done wonders with that boy. That was only after week three. Also, after just
beginning TLP, M started to walk out of the building each night by his mothers side. When he
started in our preschool program, he was known for darting down the hallway and getting running
hard ahead so she could not catch him.
Improvements in Ms ability to attend to Circle Time have also been demonstrated since
participating in TLP. M now can sit with his peers and participate in Circle Time. He also brings
projects home and completes work on letters and numbers.
FOLLOW-UP RECOMMENDATIONS
It is recommended that M continue with TLP on a Base Schedule because he has made so many
nice changes already. Since M is so receptive to TLP and often asks to do listening ears.
Additional listening will take place using the Sensory Integration Kids CD. We will experiment
with open air delivery in the classroom to further promote and support the self-regulation and
grounding M has demonstrated and then move on to headphones.
DISCUSSION
Ms participation in TLP was definitely a rewarding experience for him and his mom. Staff and
other clients recognized notable improvements in his behavior in a relative short amount of time.
He has made gains in listening, attention, and focusing as well. During this time when he was
involved in TLP, M improved in all areas of development including self-help skills. M became
potty-trained. Because of Ms positive involvement in TLP, he will benefit from continued work
with the program to help maintain his gains and assist with continued positive change.
SUMMARY OF PRE AND POST TEST RESULTS
M has only been evaluated by the preschool child study team. Pre and post comparisons are
based on observed behaviors. Hopefully, because M is young and so receptive to The Listening
Program, by the time he enters Kindergarten, he will have become more attentive and less
aggressive.