Adhd - A Practical Guide For Schools
Adhd - A Practical Guide For Schools
Adhd - A Practical Guide For Schools
A PRACTICAL GUIDE
FOR
SCHOOLS
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Acknowledgements
We would like to express our thanks and appreciation to those who responded
to consultations in the preparation of this booklet, including teachers,
classroom assistants, health professionals, NIADD (The Northern Ireland
ADHD Family Support Group), parents and young people.
The information contained in this booklet has been gathered from a wide range
of published sources which are not individually referenced. We also wish to
acknowledge the expertise of a large number of practitioners who have helped
to inform and refine the management strategies which have been included.
Authors note
In line with current practice, in this booklet the individual child will be referred
to using they and their in order to avoid gender-specific references.
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Principal authors
Gayle Nixon
Roz Richardson
Copies of this booklet may be obtained from your local Education and
Library Board. Copies can also be downloaded from the ELB web sites
(See Useful Contacts - Appendix 6).
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Contents
SECTIONS
PAGE
1
Introduction
Section 3: Appendices
Appendix
Appendix
Appendix
Appendix
Appendix
Appendix
1:
2:
3:
4:
5:
6:
Diagnostic criteria
Observation schedules
Education plans
Useful websites
Behaviour programmes, charts & diaries
Useful contacts
2
3
3
4
4
4
5
6
9
10
11
13
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17
20
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26
27
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31
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36
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Introduction
At one time or another, most children show weak concentration, become
overactive, or act without thinking. There are some children, however, who
show particular and exceptional difficulties with inattention, hyperactivity and
impulsivity, which have an effect on their learning and behaviour and which
they themselves seem unable to control. These difficulties do not appear to be
explained by usual influences such as computer games, too much TV, poor
management or diet.
These children have a condition known as Attention Deficit Hyperactivity
Disorder (ADHD - sometimes referred to as ADD).
The purpose of this booklet is to provide school staff with information about
ADHD and how children with the condition can be helped in school. A booklet,
Your child with ADHD: A practical guide, has also been produced that is
aimed primarily at parents and carers. Copies of both booklets can be
obtained as previously described.
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Types of ADHD
Children with ADHD are all individuals and no two are the same. However,
they may be divided into three broad groups according to their behavioural
presentation:
1.
2.
3.
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Its so hard to
concentrate, teachers
dont understand this.
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When we understand the types of difficulties children with ADHD have to cope
with, we can imagine how tough school life can be for them.
Children with ADHD have difficulty: Screening out unwanted stimuli
Everything screams for the attention of the child with ADHD: the hunger pangs
in their stomach, the noise of the distant lawn mower, thoughts about the
football match, the pencil dropped by the child behind them. The teachers
voice is only a small distraction! Imagine yourself sitting in an important
lecture trying to concentrate on the speakers voice while two of your favourite
films are showing at full volume in the conference room, your mobile is ringing,
your friend is waving through the window and the person next to you keeps
chatting to you. This might help you to imagine how the distractions of a
normal classroom affect the child with ADHD.
Monitoring and regulating their own behaviour
Children with ADHD are poor self-monitors. They often require high levels of
feedback to let them know what they are doing right and wrong. When these
children hear, Stop that! they may not actually know to which behaviour the
teacher is referring.
Inhibiting inappropriate verbal and physical responses
Its not that the child did not know it was a bad idea to throw the paper
aeroplane; its just that they knew it after they threw it! The mechanisms that
allow us to think before we speak or act are affected in ADHD.
Knowing how much concentration is needed for a task
We know that it requires greater effort to read an academic journal than it does
to read a magazine and we allocate mental effort accordingly. This is difficult
for the child with ADHD.
Sustaining attention for prolonged periods
Children with ADHD may start an activity with great enthusiasm but they find
this difficult to sustain.
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Medical intervention
For significant numbers of children, psychostimulant medication has been
shown to be highly effective in the management of ADHD. It is widely
recognised, however, that supporting the child at home and in school is also
extremely important. Strategies to support the child with ADHD will be
addressed later in the booklet.
Although, as educationalists, we are not directly involved with medication, we
can play a key role in monitoring its effectiveness. It is therefore important that
we have a basic understanding of the medication involved.
Children with ADHD are often prescribed psychostimulant medication (e.g.
Ritalin & Dexedrine). These are not sedatives, they are actually stimulants
that help the child to concentrate and settle to task so the child may seem
calmer when they take them. They have an immediate, observable effect
within half an hour or so, and wear off in around four hours so the child may
need a number of doses a day. This medication is now also available in a
slow-release form so some children may only need to take their tablet once a
day. If medication is required during the school day, your schools own
procedures for the administration of medication should be followed.
Some side effects are possible and it is therefore important for both schools
and parents to monitor the childs behaviour, mood, eating and sleeping
patterns and pass this information to the prescribing consultant. This will
assist the consultant in devising a medication schedule (timing and dosage)
appropriate to the child. Not all children with ADHD respond to medication,
however, research suggests that it is the single most effective form of
treatment for many when it is carefully monitored.
Some children with ADHD have been reported to respond well to vitamin and
food supplements (including fish oils and essential fatty acids). Research is
ongoing in this area.
It is important to remember that children with ADHD have complex difficulties
and medication will not solve all of them. Perhaps it is useful to think of the
medication as providing us with a window of opportunity in which to work with
children to help them change their behaviour, and develop their self-esteem,
social skills and peer relationships.
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Setting targets
To set effective targets, we should focus less on the childs difficulties and
more on the things we would like the child to be able to achieve. Targets
should always be achievable and something the child could manage with
appropriate support. Think in terms of exact and measurable outcomes. This
ensures regular success and positive outcomes for pupils, teachers and
parents.
e.g. By the end of March, John will work independently
for 5 mins once a day, 3 days per week.
John will work independently
Devising strategies
You will already have a large repertoire of management strategies that you
adapt to the needs of the children you teach. Hopefully there will be a few
strategies within the booklet that you can add to this. It is important to note the
strategies you have tried on the education plan so you can identify which are
useful / beneficial for the child. See Appendix 3 for some examples of
education plans.
Sometimes children with specific difficulties may be eligible for special
examination arrangements at secondary level. Guidelines are published each
year detailing criteria and procedures. If you are working with a child who may
benefit from special arrangements, it would be worth discussing this with the
SENCo and/or examinations officer in your school.
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Strategies
The following strategies are not particularly new or radical. They are all things
that you will find in place in many schools. They will be useful for lots of
children, not only those with ADHD. In order to support these children, it is
essential to put structures and supports in place to help them cope with the
demands of school life. The principles behind the following strategies are
applicable to children with ADHD regardless of their age. The practical
application, however, will vary according to the age and ability of the child so
youll need to adapt them to your particular situation.
It is important to note that these strategies are not meant to replace the normal
disciplinary procedures in your school. If a child with ADHD misbehaves,
sanctions may need to be imposed to help them understand that their
behaviour was unacceptable. Dont, however, expect todays sanction to
moderate the childs behaviour tomorrow. The sanction simply shows right
from wrong. If you want to see the behaviour change you will need to
implement some supportive strategies.
The strategies target many of the difficult behaviours associated with ADHD.
We must implement them sensitively and supportively remembering that life
can be tough for children with ADHD and the behaviours are not deliberate.
Living with ADHD without appropriate support can affect childrens self-esteem,
relationships with others, academic progress and can lead to low self-worth,
anxiety and even feelings of hopelessness.
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Favourites
These are the strategies that have been tried and tested by a number of
teachers and have been found to be particularly useful.
Headphones / screen
Children with ADHD have difficulty screening out external stimuli so that they
can concentrate on the task in hand. As a concentration aid, try allowing them
to listen to music on headphones while engaged in a piece of settled work.
The music screens extraneous auditory stimuli and helps the child to
concentrate on their work. This would, of course, need to be handled
sensitively in a classroom situation. In order to avoid stigmatising the child
with ADHD it may be necessary to allow other children to use headphones too.
If you decide to play music aloud to the whole class group, give the child with
ADHD headphones, because without the screening effect of the headphones,
the music will simply be a further distraction.
Placing a screen around the childs desk, like a study carrel, will reduce
external visual stimuli for the child. This would, obviously, only be appropriate
for certain tasks/lessons and would again require extremely careful handling.
Clearly interacting with peers is important for social development so screens
should be used sparingly and in a way that doesnt stigmatise the child.
In the secondary setting these strategies will not be practical in all subject
areas but might work well, for example, when concentrated pieces of
independent work are required.
Traffic lights
This simple visual system is used in many primary classrooms as a way of
managing noise level. A poster of traffic lights is displayed in the classroom
with a moveable arrow. The teacher sets the arrow at an appropriate noise
level for the task in hand i.e. red = silence, amber = whispering, and
green = free talking. This can be a useful support for a child with ADHD
because it provides a visual reminder of a verbal instruction. Using as many
modalities as possible to communicate expectations to the child and providing
regular, positive reminders will maximize the likelihood of compliance. For
older children, the visual reminder can take the form of written instructions on
the blackboard or key words displayed on the walls.
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Attention training
This can be labour-intensive but is often very successful and so worth the
effort. First, time how long the child can sustain attention on a routine task e.g.
copying down homework. This might only be 3-4 minutes (or even 20
seconds!), but whatever it is, mark it onto an attractive chart. Show the child
how long they concentrated for. The next day ask the child to try to beat their
time. Make this fun. Say ready, steady, go and let them see the timer.
Kitchen timers that show the time ticking away are great. Failing that, just use
a stopwatch. Each day repeat the procedure, marking the childs new time
onto the chart. Make lots of fuss as you see the child improve.
Improvements in this area will be difficult for the child and will require lots of
effort. Be sure to acknowledge this and dont make unrealistic demands.
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A stress toy is useful to give to a child with ADHD when you are talking to the
whole class and require quiet attention. Playing with a stress toy appears to
help the child to concentrate. It also keeps their hands busy so that they dont
fidget with pencils and rulers. Even a piece of blu-tac could do the same job.
You just want to give the child something to fiddle with that wont make a
sound if it is dropped and wont injure someone if it is thrown across the
classroom!!
ICT
Computers are a wonderful resource for children with ADHD. They provide
non-judgmental, immediate feedback in an exciting multi-sensory way every
single time - much better than human beings! Incorporate as much computerassisted instruction into your timetable for these children as possible. It could
also be used as a reward on a behaviour programme. Remember, because
the computer is so rewarding for the child with ADHD, getting them to move on
to the next activity can be difficult. It is helpful therefore to use a timer so that
the child is aware how long they can spend on the computer and when their
time is up.
Circle Time
Children with ADHD often lack understanding of social rules, and can have
difficulties forming and sustaining friendships. For this reason, Circle Time can
provide an excellent forum for them and other children to develop the skills of
turn-taking, listening, empathy, and making good decisions. Circle Time topics
can be chosen with the particular needs of the ADHD child in mind.
Circle Time is often successfully implemented during Personal & Social
Education or form class / tutor group in secondary school.
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Positive reinforcement
Provide frequent, immediate and consistent feedback about acceptable
and unacceptable behaviour. This helps children monitor and regulate
their behaviour.
Praise positive achievements and behaviour and be specific (e.g. You
were kind to your friends in the playground today instead of Good boy,
well done).
Where possible, ignore minor inappropriate behaviour and actively
reinforce desired classroom behaviours with positive teacher attention
(e.g. acknowledge the positive behaviour of a nearby pupil).
Use careful reprimands for misbehaviour, ensuring you criticize the
misbehaviour not the child (e.g. Hitting others is wrong instead of You
are very naughty).
Avoid imposing negative consequences on the whole class based on
one childs behaviour.
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Ensure that pupils know what happens when the rules are kept or broken.
Be seen to do exactly as you say you will do. Do not make false threats
or promises.
Establish a daily classroom routine and schedule and ensure that it is
known, understood and practiced. This is particularly important at
transition times.
Classroom layout
If possible, seating in the classroom should be flexible, with several
tables for group work in addition to rows or individual desks for
independent work.
It is important for the teacher to be able to move freely about the room
and have access to all students.
Giving instructions
When you give instructions to the class, get their quiet attention first.
Shouting over a noisy class doesnt work.
Use lots of eye contact when speaking to the class.
Give short sequences of instructions in the order you want them to be
carried out. If necessary, give instructions one at a time.
As an additional reminder, follow up oral instructions with written or
pictorial instructions that the children can consult if required.
Before commencing a task check that pupils know what to do.
During tasks, make frequent checks to ensure that pupils are following
instructions correctly.
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Teaching aids (visual and audio) should relate directly to the material to
be learned in order to keep distractions to a minimum.
Include a variety of activities during each lesson and vary the pace
where possible.
State what the class is expected to learn during the lesson. Outline key
concepts, vocabulary etc.
Describe how pupils are expected to behave during the lesson
(e.g. be clear about when pupil movement is permitted and when it is
discouraged).
Identify all materials that pupils will need during the lesson and make
sure that they are easily accessible.
Tell pupils how to obtain help during the lesson (e.g. refer to a specific
page in their textbook, raise their hand and wait for teacher attention etc).
Encourage concentration and on-task behaviour by providing short
breaks in which pupils can engage in physical activity.
Allow adequate time for lesson review / recap.
Worksheets
Use large, dark black print on buff-coloured paper.
Keep page format simple avoiding visual clutter (i.e. pictures that are
not directly related to the task).
Avoid handwritten worksheets.
Provide only one or two activities per page and give simple, clear
instructions. Four worksheets containing five questions each is
preferable to a single worksheet of twenty questions.
Divide the page into sections and devise a system to cover sections
when they are not being used.
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Easily distracted
Seat the pupil in the front third of the class, as close to the teacher as
possible without being punitive or permanently isolating from other pupils.
This will enable the teacher to monitor and reinforce on-task behaviour.
Seat the pupil away from distracting influences (windows, doors, library
corner) to minimize visual and auditory distractions.
It can be useful to have two seats in the classroom for the child with
ADHD - one away from distractions for periods of concentrated work, and
the other within a group to promote social contact.
Place the pupil between well-behaved, positive role models. This will
provide opportunities for cooperative working and will enable the pupil to
learn from their peers.
Remove all objects not required for a task from the pupils desk.
Listening to soft music through headphones is a useful concentration aid
as it blocks out other auditory distractions (see Favourites section).
Use desk dividers / study carrels to reduce visual distractions (see
Favourites section).
The use of physical proximity helps prevent wandering attention and also
alerts the pupil if they are off-task. The adult should stand next to the
pupil when giving instructions / presenting a lesson.
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Untidy / disorganized
Assist the pupil with personal organization. This can be done by colourcoding books and folders, providing lists of books and materials needed
for each day/class, providing print-outs of homework and course-work
requirements (including submission dates), and enlisting help from home
where possible.
Arrange for peer support. Find an organized friend who is willing to help
out. If possible, find something that the child with ADHD can help them
with in return so that there is some equality.
Reward tidiness through classroom rituals. Set aside special times to tidy
folders etc. and times of amnesty when long-forgotten work can be
handed in and organized.
Be willing to repeat expectations each time you set a piece of work.
Instructions summarized on the board are helpful too.
Keep worksheet format simple.
Keep materials needed to hand. Walking across the classroom to get
something provides too many opportunities for distraction!
Develop a clear system for keeping track of completed and uncompleted
work.
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Fidgets / squirms
Break tasks into small steps.
Allow alternative seating. Allow the pupil to straddle their chair horsebackstyle, with the back of the chair against the pupils desk. It is more
difficult to swing or tip a chair in this position.
Allow alternative movement where possible. Allow the pupil to stand at
times when working and provide opportunities for seat breaks (e.g.
running errands or handing out books).
Consider using Brain Gym or giving the child a stress toy (see
Favourites section).
Peer problems
Utilise Circle Time, role-play and drama to teach concepts of
communication, participation and cooperation.
Arrange joint activities in class with likely friends. Encourage inclusion of
the child in friendship groups by structuring some of their play activities.
Use cooperative learning activities. These tasks require all members of
the group to fulfil their role to ensure group success. This method is
often found to increase co-operation and cohesion within the group.
Reward appropriate social behaviour (involve parents and lunchtime
supervisors). Again this is just catching the child being good. When they
behave well with peers, notice it, draw their attention to it and praise
their efforts.
Assign the pupil responsibility in the presence of their peer group. If the
other children see that the child with ADHD is highly valued by the
teacher it will increase their standing in the peer group.
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Behaviour programmes
Behaviour programmes are useful for many children who find it hard to comply
with the expectations of school, because they:
Help the child to focus on specific targets
Shift the emphasis from bad to good behaviour
Impact positively on behaviour in class, self-esteem & peer relations
N.B. It is important not to confuse behaviour programmes with education
plans. The behaviour programme is one possible strategy to support the child
in achieving the behavioural targets on their education plan.
There are many ways to set up a programme; this is just a suggestion.
Firstly, think carefully about the behaviour the child is currently displaying
and the behaviours that you wish they were displaying! Consider the age
and ability of the child before deciding how many targets to work on. For
relatively able children, from late Key Stage 1 right through to secondary
age, it is often good to work with 3 targets.
1.
2.
3.
Display these targets prominently near the pupils desk and on the programme
chart or diary. If possible involve the pupil in drawing up the targets so that
they feel some sense of ownership of them (while keeping the above principles
at the back of your mind!).
Divide the day into manageable chunks of time and encourage the pupil,
for each period of time, to achieve their targets. At the end of each period
(e.g. half hour) record on the childs chart which targets they have
achieved. Clearly this is easier in secondary school because the day is
already divided into classes.
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So, in conclusion...
We hope this booklet has given you some insight into Attention Deficit
Hyperactivity Disorder (ADHD) and how it can be managed within the school
context. Understanding the world from the point of view of a child with ADHD
allows us to empathise more fully and provide appropriate support. The
strategies mentioned are useful, however, very often children feel more
positively about school and achieve greater success simply because they feel
their teachers understand them and are on their side.
Remember...
ADHD is a genuine and complex disorder.
Life can be extremely tough for children and young people with ADHD.
The strategies used to help these children will benefit all pupils.
School staff are in a powerful position to make changes that will have a
positive impact on lives of pupils with ADHD.
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Either 1 or 2
Six (or more) of the following symptoms of inattention have persisted for
at least six months to a degree that is maladaptive and inconsistent with
developmental level:
INATTENTION
a)
b)
c)
d)
e)
f)
g)
h)
i)
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HYPERACTIVITY
a)
b)
c)
d)
e)
f)
IMPULSIVITY
g)
h)
i)
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29
6
7
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IQ of above 50
Note:
30
31
TIME
DATE
SETTING
(i.e. place, people present, activity
and childs mood state)
S.T.A.R.E
TRIGGER
NAME:
ACTION
RESULT
EXPECTATION
BEHAVIOUR TO BE OBSERVED:
Behaviour
Date:
Consequences
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Antecedent
Name:
ABC Record
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Class
Child
General aims
Target
Strategies
Success Criteria
Responsibilities
Review date:
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Mr Patient
Class
Eoin Brown
P6
28.10.03
General aims
To improve Eoins concentration, relationships in class and self esteem
Target
1. Eoin will attend to a task within his ability for 10 minutes at a time
without prompting
2. Eoin will engage in unstructured play with peers at break-time without
negative incident
Strategies
- Attention training
- Circle time
- Behaviour programme with targets relating to above
Success criteria
1. One 10 minutes session of concentrated work per day
2. Less than 3 negative incidents per week
Responsibilities
Teacher - run circle time and behaviour programme
SENCo - attention training (twice a week)
Review date:
15 December 2003
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Miss Browne
Darren McNamee
Class
P2
1.9.03
General aims
Ongoing academic progress at his own level and improved
peer relationships
Target
1. Darren will be able to read the first 10/100 key words and identify 15
letters and sounds (a, e,i,o,u,s,x,t,p,m,r,d,n,c &z)
2. Darren will play cooperatively with peers during structured play with
minimal adult support
Strategies
- Small group literacy support (daily)
- Behaviour programme (cube box challenge - target = kind to friends)
- Cooperative learning tasks
Success criteria
Read 10 words on 3 separate occasions without prompting
Read 15 letters on 3 separate occasions without prompting
1/2 hour successful play 3 mornings out of 5
Responsibilities
Literacy support - SENCo
Play support - Teacher and Classroom assistant
Support behaviour and revise words / letters - parents
Monitoring & assessment arrangements
Cube box monitored daily by teacher and classroom assistant
Literacy progress assessed weekly by SENCo
Review date:
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Useful websites
www.attention.com
www.helpforadd.com
www.adders.org
www.cdipage.com
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Try to catch the pupil being good (even when its difficult!) so that
success can be achieved early on.
2.
3.
If the pupil has a successful day, he should be given a small reward, such
as being allowed to go on a message or collect in the books. Initially if
the pupil achieves 5 points out of a possible 10, that should be rewarded
as a successful day. As behaviour improves they could aim to achieve
more.
4.
The sheets could be punched and kept together in a ring binder that goes
home on a Friday.
5.
If three out of five days have been successes in any week, the parents
may like to give a reward at home.
6.
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If ****** has not achieved a smiley face at the end of an activity, leave the
square blank rather than including anything negative.
Rewards
****** should be rewarded every time she achieves a smiley face on her
behaviour sheet.
If possible, reward should gain ****** appropriate attention and make her feel
special (e.g. leading the line, setting the dinner table etc).
At the end of each successful day, ****** should also be rewarded at home.
****** should not receive any special treats on days when she has failed to
meet her target of smiley faces.
To sustain interest in the programme it may be necessary to change the
rewards from time to time.
Time out
Time out is based on principle of removing the child from all sources of
reinforcement for a brief period.
When a particularly unacceptable behaviour occurs and ****** has
not responded to warnings given, calmly and unemotionally say,
You cannot stay with the class if you hit, etc, you need to go to the
quiet room.
****** should remain supervised in the quiet room for a short period
of time (e.g. 3 minutes). This time only begins when she is sitting
quietly. A timer rather than a clock or watch should be used. The
adult should not talk to ****** during this time or make eye contact.
If ****** is doing something inappropriate at the end of this time,
wait for her to stop, allow a few seconds to pass and tell her,
You can join the class now ******.
If she refuses to join the class again, ignore her until she does.
Do not hold a grudge when ****** comes out of the Quiet Room,
but wait for her to display any appropriate behaviour and praise
her for it.
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If time out has been used for non-compliance, once the 3 minutes are up, you
should repeat the original command.
Teacher:
******:
Okay.
Teacher:
If ****** refuses to carry out the command then the entire sequence should be
repeated.
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43
Week Beginning:
8:17 pm
Class:
25/5/04
Name:
Target Diary
44
45
Pupil
Date:
Signed:
8:17 pm
Pupil
25/5/04
Year Head
Teacher
1
2
3
4
5
6
7
8
9
Other
Signed
Other
Signed
T1 T2 T3 COMMENT
Day
Initials
Day
T1 T2 T3 COMMENT
Day
Day
Initials
46
47
1
2
3
4
5
6
7
8
9
Other
Signed
Other
Signed
T1 T2 T3 COMMENT
Day
Initials
Day
T1 T2 T3 COMMENT
Day
Day
Initials
Friday
Thursday
Wednesday
10
20
30
40
50
60
70
80
Week 1
Week 2
Week 3
Week 4
Week 5
8:17 pm
90
100
110
25/5/04
Tuesday
Monday
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49
My name is
Today is
21/6/04
11:52 am
Page 53
My name is
Today is
50
51
Break
Hometime
Lunch
Lunch
Break
3
Lunch
Todays
Total
15
I said...
Comment
Checked by parent
My teacher said...
8:17 pm
Break
I will be nice to
my friends
25/5/04
Morning
My name is
Today is
25/5/04
8:17 pm
Page 55
52
25/5/04
8:17 pm
Page 56
53
A PRACTICAL GUIDE
FOR
SCHOOLS