INTERVENTION WITH HYPERACTIVE CHILDREN A Case Study Approach

INTERVENTION WITH HYPERACTIVE CHILDREN A Case Study Approach

Marvin J. Fine, Ph.D. School Psychology Training Program University of Kansas Lawrence, Kansas

MTP:!iUMITED International Medical Publishers

Published in the UK and Europe by MTP Press Limited Falcon House Lancaster, England

Published in the US by SPECTRUM PUBLICATIONS, INC. 175-20 Wexford Terrace Jamaica, N.Y. 11432

Copyright © 1980 Spectrum Publications, Inc. Softcover reprint of the hardcover 1st edition 1980

All rights reserved. No part of this book may be reproduced in any form, by photostat, microform, retrieval system, or any other means without prior written permission of the copyright holder or his licensee.

ISBN-13: 978-94-011-6286-9 e-ISBN-13: 978-94-011-6284-5 DOl: 10.1007/978-94-011-6284-5

Acknowledgment

Appreciation is expressed to the many contributors to this book. They all share a genuine concern for the hyperactive child and are making their respective contributions to assisting this child and his family.

I have benefited from the stimulation and support of my colleagues. In particular, John Poggio and Neil Salkind, through their own research with hyperactivity, have demonstrated a high standard of scholarship. They have both been readily available to discuss issues and to share ideas.

Jacalyn Wright assisted me greatly in the editing of manuscripts, as did Penni Holt and Roger Maitland. Peggy Miller and Gayle Robb were kind and patient with me as they typed and retyped the manuscript.

The result of the efforts and contributions of these individuals is a book that should be of great value to persons working with hyperactive children.

M.J.F.

JOAN E. BACKMAN Department of Psychology Carleton University Ottawa, Ontario

JOy PATRICIA BURKE, Ed.D. Human Development and Psychological

Services University of North Carolina­

Chapel Hill Chapel Hill, North Carolina

STEPHEN T. DBMERS, Ed.D. School Psychology Program University of Kentucky Lexington, Kentucky

NORMA ESTRADA, Ph.D. Psychology Department Everett Gladman Hospital Oakland, California

H. BRUCE FERGUSON, Ph.D. Department of Psychology Carleton University Ottawa, Ontario

Contributors

A. J. FINCH, Ph.D. Department of Psychology Virginia Treatment Center for Children Medical College of Virginia Virginia Commonwealth University Richmond, Virginia

MARVIN J. FINE, Ph.D. Department of Educational

Psychology and Research University of Kansas Lawrence, Kansas

LINDA HALL JACKSON, M.D. Child Psychiatry The Menninger Foundation Topeka, Kansas

PHILIP C. KENDALL, Ph.D. Department of Psychology University of Minnesota Minneapolis, Minnesota

KATHERINE GLENN KENT, M.S. Family Therapy Training Program The Menninger Foundation Topeka, Kansas

MIMI LUPIN, M.A. Self Management Tapes Houston, Texas

lEAN MAYO, M.S. Feingold Association of the U.S.A. Houston, Texas

CHRISTOPHER R. MILAR, Ph.D. Division for Disorders of Development

and Learning University of North Carolina­

Chapel Hill Chapel Hill, North Carolina

MARY MIRA, Ph.D. Children's Rehabilitation Unit University of Kansas Medical Center Kansas City, Kansas

EUNICE NELSON, M.Ed. Department of Educational Psychology Wichita State University Wichita, Kansas

A. LEE PARKS, Ph.D. Department of Special Education University of Idaho Moscow, Idaho

NANCY L. PETERSON, Ph.D. Department of Special Education University of Kansas Lawrence, Kansas

JOHN P. POGGIO, Ph.D. Department of Educational

Psychology and Research University of Kansas Lawrence, Kansas

JEAN L. PYFER, P.E.D. Department of Health, Physical

Education and Recreation University of Kansas Lawrence, Kansas

HERBERT l. RIETH, Ed.D. Department of Special Education Indiana State University Bloomington, Indiana

NEIL l. SALKIND, Ph.D. Department of Educational

Psychology and Research University of Kansas Lawrence, Kansas

R. L. SHERBENOU, Ph.D. Department of Special Education Purdue University Lafayette, Indiana

BARBARA l. THOMPSON, M.A. Department of Education Baker University Baldwin, Kansas

RONALD TRITES, Ph.D. Department of Psychiatry and Psychology University of Ottawa Neuropsychology Laboratory Royal Ottawa Hospital Ottawa, Ontario

HELEN TRYPHONUS, M.Sc. Department of Health and Welfare Health Protection Branch Ottawa, Ontario

FRED H. W ALLBROWN, Ph.D. Department of Counseling and

Personnel Services Kent State University Kent, Ohio

VIVIEN J. WORSTER, M.A. Indiana Department of Public

Instruction Division of Innovative Education Indianapolis, Indiana

Preface

Hyperactivity has historically been a major concern of parents and teachers. Over the years, the term has come to mean many things to different persons. For some, the term is synonymous with "brain damage," and the prescribed course of treatment is medical. For others, the term is a catch­all, covering almost any behaviors that are found to be obtrusive or disrup­tive by the child's caretakers. In recent years, there has been a great outcry by some over the use and abuse of the term as a justification for controlling the child. Others have expressed great concern over the excessive, inappro­priate, or poorly monitored use of drug therapy with regard to hyperactivity.

The current interest in hyperactive children is reflected in several major books (Cantwell, 1975; Feingold, 1975; Fine, 1977; Ross and Ross, 1976; Wender, 1973; Safer and Allen, 1976; Stewart and Olds, 1973). The num­ber of published papers and symposia over the last several years is also voluminous.

The main questions posed by practitioners revolve around intervention with the hyperactive child. The growing literature on intervention has identified a variety of approaches with demonstrated utility; including drug therapy, behavior modification, biofeedback, sensory-motor training, cog­nitive training, environmental manipulations, and family therapy.

The major text sources cited include recommendations and descriptions of intervention approaches with the hyperactive child. But most fall short of extensive case-study material that details the thinking behind the inter-

vention and the specific steps that were actually followed. For the school psychologist, counselor, learning consultant, and teacher looking for specific direction, there is a void of good resources. Blanco's text on program pre­scriptions (Blanco, 1972) is a model of one kind of a "how-to-do-it" approach; while this approach has demonstrable value, the reader is required to have an already functional frame of reference into which specific and unelaborated suggestions can fit. In contrast, the booklet by Conner (1974) presents an extensive detailing of classroom procedures; the activities dis­cussed, however, seem to be more of a novel, attention-getting nature to be used with an entire class of students, rather than specific children whose hyperactivity may interfere with extensive and cooperative group involvement.

This book of case studies is intended to meet the needs of persons work­ing with hyperactive children who are interested in learning about specific intervention approaches. The book should serve as a source book of con­cepts and procedures on intervention, with enough detailing of rationale and intervention to expand the practitioner's repertoire of strategies for intervention. It emphasizes intervention in educational as well as home settings, and as such, places emphasis on the kinds of interventions that non-medical persons can affect. The book should also be of great value to physicians who may be seeking alternatives or supplements to a pharma­ceutical approach. Accordingly, drug studies per se were omitted, although drug treatment is discussed.

The orientation of the chapters is first to present an initial introduction to literature on hyperactivity; touching on the historical issues, treatment efficacy studies, and the current scene; with regard to concepts of etiology, developmental course, and intervention. This is followed by several chapters concerned with specific intervention themes. For example, there are chapters that give detailed case studies on intervention via behavioral strategies, sensory-motor training, biofeedback and relaxation procedures, psycho­therapeutic approaches, and classroom curriculum modifications. The use­fulness of the book as a sourcebook is enhanced by the organization of the case studies. Each case study is presented in the following framework: 1. Current Problem, 2. Background Information, 3. Intervention, and 4. Con­clusions. This framework should provide the reader with ample information to correlate the case study child with the children he is concerned about. Each chapter has an orienting introduction, with key references cited.

The measurement of hyperactivity is important if we are to determine whether changes have occurred as a result of an intervention. The chapter

by Salkind and Poggio represents a compendium and critical analysis of instruments for assessing hyperactivity. The last chapter of the book sum­marizes some important considerations in diagnosis and intervention; the need to view the child holistically, the importance of a comprehensive and differential diagnosis, and collaborative planning by the involved persons are stressed.

References

BUNCO, R. F. Prescriptions for Children with Learning and Adjustment Problems. Springfield, lit: Charles C Thomas, 1972.

CANTWELL, D. P. (Ed.) The Hyperactive Child. New York: Spectrum Publications, 1975.

CONNER, J. P. Classroom Activities for Helping Hyperactive Children. New York: Center For Applied Research in Education, 1974.

FINE, M. J. (Ed.) Principles and Techniques of Intervention with Hyperactive Chil­dren. Springfield, Ill.: Charles C Thomas, 1977.

FEINGOLD, B. F. Why Your Child is Hyperactive. New York: Random-House, 1975. Ross, D. M. and Ross, S. A. Hyperactivity: Research, Theory, and Action. New

York: John Wiley, 1976. SAFER, D. J. and ALLEN, R. P. Hyperactive Children: Diagnosis and Management.

Baltimore, Md.: University Park Press, 1975. SCHRAG, P. and DIVOKY, D. The Myth of the Hyperactive Child. New York: Pantheon

Books, 1975. STEWART, M. A. and OLDS, S. W. Raising a Hyperactive Child. New York: Harper &

Row, 1973. WENDER, P. W. The Hyperactive Child: A Handbook for Parents. New York: Crown

Publishers, 1973.

Contents

Preface ................................................................................ ix

Part I Introduction

1. The Hyperactive Child ...... ................. ...... ............ ........... .... 3

Part II Case Studies

2. Behavioral Approaches to Hyperactivity............................ 23 Case Study #1. The Use of School and Home Manage­ment Programs to Diminish the Inappropriate Behavior Emitted by an Eight- Year-Old Hyperactive Student

Herbert J. Rieth ................................................ .......... 26

Case Study #2. The Use of Activity and Token Reinforces to Increase the Reading Achievement and Appropriate Social Behavior of a Seven-Year-Old Hyperactive Student

Herbert J. Rieth .......................................................... 33

Case Study #3. Cognitive-Behavior Modification in a Case of Impulsivity jOveractivity

Philip C. Kendall and A. J. Finch, Jr. ........................ 42

Case Study #4. The Use of Self-Management to Improve Reading Skills in a Hyperactive Child

A. Lee Parks and R. L. Sherbenou ............................ 54

Case Study #5. Effects of Parent Training on Behavioral Tempo in a Preschool-Aged Boy

Mary Mira and Chris Milar ........................................ 59

Case Study #6. Contingency Contracting With a Hyper­active Boy and His Parents

Joan E. Backman, H. Bruce Ferguson, and Ronald L. Trites ........ ..... ... ............... .................... ..... 65

3. Autogenic Training: Learning Body Control.................... 73 Case Study #7. The Effects of Biofeedback Training on and Eight-Year-Old Boy

Vivien J. Worster ........................................................ 75

Case Study #8. The Use of Biofeedback Training on a Nine-Year-Old Child

Vivien J. Worster ........................................................ 77

Case Study #9. Relaxation Therapy With a Hyperactive Six-Year-Old Child

Mimi Lupin ................................................................ 80

Case Study #10. The Eclectic Use of Biofeedback, Be­havior Therapy and Therapeutic Counseling by a Male / Female Team in Effectively Treating Hyperkinesis

Norma Estrada ............................................................ 85

4. Psychoeducational Intervention......... .......... ..... ........ ..... ....... 91

Case Study #11. Psychoeducational Programming With a Hyperactive Child

Eunice Nelson .............................................................. 93

Case Study #12. Use of a Structured Classroom Approach With a Multisensory Instructional Strategy

Fred H. Wallbrown .................................................... 103

5. Perceptual-Motor Training .................................................. 117

Case Study #13. Perceptual-Motor Training With a Five­Year-Old Boy

Jean Pypher ................................................................ 118

Case Study #14. Perceptual-Motor Training With a Six­Year-Old Girl

Jean Pypher ................................................................ 135

6. Ecological Considerations .................................................... 149

Case Study #15. An Ecological Perspective of Hyper­activity in a Preschool Child With Developmental Delay

Barbara J. Thompson and Nancy L. Peterson ............ 152

Case Study #16. Teacher Consultation as an Intervention With a Hyperactive Second-Grade Boy

Stephen DeMers and Joy P. Burke ............................ 163

7. Psychotherapeutic Intervention .. ........ ................... ............. 173

Case Study #17. A Therapeutic, Multi-Faceted Interven-tion Program With a Preschool Hyperactive Boy

Linda H. Jackson ........................................................ 175

Case Study #18. Structural Family Therapy With the Family of a Hyperactive Child

Katherine G. Kent ...................................................... 182

8. Diet Management ................................................................ 191

Case Study #19. Diet Management With an Eleven-Year Old Boy

Jeanne Mayo .............................................................. 193

Case Study #20. Diet Management With a Seven-Year­Old Boy

Jeanne Mayo .............................................................. 198

Case Study #21. Treatment of Hyperactivity in a Child With Allergies to Foods

Ronald L. Trites, Helen Tryphonas, and Bruce Ferguson .......................................................... 204

Part III Measurement, Diagnosis, and Intervention

9. A Review and Appraisal of Instruments Assessing Hyper­activity in Children

John P. Poggio and Neil J. Sa/kind ............................ 213

10. Diagnosis and Intervention: A Summing Up ...................... 233

Index .................................................................................. 241