Sub-Theme 5: Attention and Hyperactivity

Lebo is a playful young boy (TPI1:L1). He is still immature (TPI1:L1) and finds everything very amusing (TPI1:L1-2). Towards the end of the second year of intervention, Mrs T noticed that Lebo’s coping mechanism was to try and be funny, make the class laugh with ‘funny’ acting (TPI2:L13-14). There was evidence of Lebo’s difficulties focussing and with hyperactivity. Mrs T mentioned that Lebo had concentration problems (TI1:L27) and he could not sit still (TI1:L27). The psychologist said that he had difficulty sitting still (PR:L10) and

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fidgeted a great deal (PR:L10). This was further reinforced by Lebo’s father mentioning that he was “fidgetive” (sic) and had “fidgetive” tendencies (PI2:L89). Both Lebo’s mother and father mentioned that he could not sit still (PI2:L89; PI1:L92-93). When discussing Lebo’s schooling prior to joining ABC Primary School, his father mentioned that the teachers used to say that Lebo was boisterous (PI2:L95-96) and Lebo’s father believed that he was just too energetic for them (PI2:L95-96). His father also mentioned that he was labelled as troublesome (PI2:L101), and that he was dismissed as a troublesome boy (PI2:L101). The psychologist also mentioned that Lebo was very distractible during his assessment (PR:L7). Lebo had trouble focusing during the psychological assessment (PR:L7). This was reinforced by Mrs T who remarked that that Lebo found it a challenge to focus (TPI1:L2-3). In Mrs T’s report for Lebo in Term 3 of Year One, Mrs T reported that he often needed reminders to stay focused (T3R1:L7-8). This was again stated in the end of the year report where Mrs T said it was difficult for Lebo to remain focused for extended periods of time (T4R1:L10-11). He was often impulsive and did things without thinking (T4R1:L11). However, on Lebo’s Term 1 report of the second year of intervention, there was an improvement. Mrs T mentioned that Lebo was usually focused, but occasionally needed reminders to stay on task (T1R2:L10-11).

Lebo was easily distracted (PI2:L332, PI2:L323, TPI1:L3, T1R1:L1) and had to be reminded of what he needed to do. “You have to remind him ‘what did I say you must go and do?’” (PI2:L323). It could be said that Lebo needed constant monitoring (TPI1:L3-4, T1R1:L1). He would randomly just sit and laugh at nothing and could not explain it (TI1:L43-44). He did not give anyone a chance to talk (TI1:L45-46) and he would not keep quiet until he has said what he wanted to say (TI1:L46).

Mrs T said: “And you can see with, if I ask something, and we move on, and he needs to say something, he will not be focused, he will not be listening to me. I can see, he wants to say what he wants to say and finish (PI2:L326-328). If he wants to say something, then he wants to say it” (PI2:L333-334).

However, when Lebo did speak out in class, he would just start talking and then just go off topic and speak about different things (TI1:L73). Lebo had this constant energy (TI1:L63), where the educator mentioned that he was all over (TI1:L51) and this was reinforced by Lebo’s father mentioning that Lebo was “very busy, all the time busy” (PI2:L111) and that he was

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always, always in a hurry (PI2:L139). Mrs T mentioned that Lebo was always laughing and could just jump up, randomly, just scream something and then wanted to walk out (TI1:L57- 58). Mrs T also mentioned that he was always loud (TI1:L73). It was evident that Lebo could not sit still for long (TI1:L63) and sitting for long periods was still an issue for Lebo (TI1:L63, TI1:L67, PI1:L92-93). Lebo still had the habit of randomly just laughing (TI1:L71) and was “always asking, always talking, always asking things” (TI1:L70-71). The psychologist mentioned that Lebo had poor concentration (PR:L75) and he struggled to persevere (PR:L74). At the end of Term 1 of Year One, Mrs T mentioned that Lebo was slowly settling down and was understanding the formal routines better (T1R1:L9-10). However, in Term 3 of Year One, Mrs T noted that Lebo still experienced some difficulty adjusting to the expectations of the classroom (T3R1:L9-10). Mrs T mentioned that Lebo needed constant supervision and direct support to begin assignments and to say on task (T2R1:L1-3, T2R1:L8). At the end of Term 2 of Year One, Mrs T mentioned that Lebo was “very impulsive and acts without thinking and this affects his accuracy” (T2R1:L5-6). Lebo often required encouragement to listen attentively during group work, according to his Term 3 Year One report (T3R1:L1-2). On Lebo’s Term 3 Year Two report, Mrs T mentioned that “he seemed more calm and focused” (T3R2:l9-10).

To help reduce Lebo’s fidgeting, Mrs T created the fidget stick and the fidget band (Figure 4.103.) (OBS108). The fidget stick was an ice cream stick with beads along the one side that Lebo could move up and down with his left hand while working or writing with his right hand. While the sticks seemed to reduce Lebo’s fidgeting, the fidget band appeared to work better. The band was tied around the legs of Lebo’s chair and Lebo would voluntarily place his feet behind the band or in between it, allowing Lebo to work with both hands while constantly moving his legs.

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Children who were born premature are at a higher risk of having ADHD (Bhutta, Cleves, & Casey, 2002). Very preterm babies are at risk of experiencing attention problems and have an increased risk for ADHD (Johnson, 2007). Attention-deficit/hyperactivity disorder is a condition that preterm infants may experience (Anderson & Doyle, 2003). A child born preterm increases the risk of the child having ADHD (Lindström, Lindblad, & Hjern, 2011). A study revealed that the gestational age of an infant, and each gestational week that passes, significantly impacts the neurodevelopment of the child and increases the risk for ADHD (Sucksdorff, et al., 2015). This study also found ADHD is at an increased risk of occurring if there is poor foetal growth (Sucksdorff, et al., 2015). Children who are born preterm and those who were small for gestational age (SGA) are at increased risk of experiencing ADHD or the symptoms of ADHD (Hack, et al., 2004; Hille, et al., 2001; Strang-Karlsson, et al., 2008; Wolke, Samara, Bracewell, & Marlow, 2008). A study revealed that lower birth weight may contribute to an increased risk of ADHD and its symptoms, rather than prematurity or lower gestational age (Heinonen, et al., 2010). Very low birth weight (VLBW) infants may experience psychiatric symptoms and are at an increased risk especially of ADHD (Botting, Powls, Cooke, & Marlow, 2006). Preterm birth and low birth weight (LBW) have been determined to be risk factors for certain psychiatric disorders including ADHD (Johnson & Marlow, 2011). However, “VLBW and very preterm (VPT) births appears to be associated with a greater risk for symptoms of inattention than hyperactivity/impulsivity” (Johnson & Marlow, 2011, p. 14R).

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In summary, the table below demonstrates the resources used to assist Lebo within the domain of cognitive development.

Table 4.10. Resources to assist Lebo within the cognitive development domain

Colour and shape support activities

 2-piece shape puzzle  2-piece shape puzzle  2D shapes

 Book of colours  Bottle top spiders  Bottle top worms  Colour crayons

 Coloured shape buttons  Earbuds and straws  Felt ice cream sticks  Flower and peg activity  Ice cream sticks shape puzzle  Velcro and ice cream stick shapes

Handwriting and writing support activities

 Finger space template  Handwriting cards

 Lowercase handwriting card  Salt

 Sentence sticks  Shaving cream

 Uppercase handwriting card  White board

Maths support activities

 2-piece Maths puzzle  4-piece maths puzzle

 Addition and subtraction cards  Bottle tops

 Build and add more cards  Build up and take away cards  Clear and green eggs

 Clear and white spoons  Dice

 Froot loops

 Ice cream sticks and pegs (counting)

 Ice cream sticks and pegs (missing numbers)

 Ice cream sticks and loom bands  Jelly tots

 Magnets and paperclips

 Maths ice cream sticks (more / less)

 Maths pegs activity  Maths scrabble  Maths worms  Maths writing cards  Metal locks and keys  Money

 Pegs and cards  Plastic bears  Plastic blocks  Playing cards  Pool noodles  Roll and Add

154 Phonics,

reading and spelling

 ‘Car park” reading  ‘Fly swatter’ reading  ‘Spray bottle’ reading  2-piece alphabet puzzle  Balloons

 Beans  Bottle tops  Bubbles

 Doll shaped ice cream sticks  Egg blends

 English peg activity  Foam letters

 Ice cream stick alphabet puzzle  McDonalds sight words

 Party blowers  Peg board  Pendulums  Phonic cards

 Phonic spoons  Phonics / letter cards  Plastic blocks

 Roll and Read  Salt

 Sentence strips  Shaving cream  Sight word booklets  Slider blends  Snakes and ladders  Tic-tac-toe reading  Toilet roll blends  Unifix blocks  Whisper phone  Whistles  Wooden beads  Word turner blends Attention and

Hyperactivity  Fidget bands  Fidget sticks

In conclusion, all the participants in this study affected the case of Lebo. The psychologist formed the basis of the case study as she provided the official diagnosis and some of the difficulties that he may face and faced previously in the classroom environment. Mrs T used the psychologist report to formulate the IEP for Lebo and the interventions that were used to assist him. This included support in the form of small ability groups, individual support and support as member of a small team of mixed ability. Due to the small classroom size of only 18 learners, Mrs T was able to successfully implement curriculum differentiation. Mrs T assisted these learners in multiple ways and in different contexts, in the classroom and with the use of the garden.

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It is evident that Lebo benefits greatly from the use of concrete activities. This method of teaching forms part of the progression that he has made throughout the period that he has been in the LSEN class. Lebo was able to progress from ability group 1 to ability group 4 in Maths and from ability group 1 to ability group 4in English. This progression occurred over a period of two years. Mrs T also expected the parents of Lebo to be involved with his learning, calling parent and teacher interviews at regular intervals. The parental involvement also contributed to Lebo’s progress as the concepts covered in class were reinforced and revised at home.

4.9.CHAPTER SUMMARY

It is evident throughout this chapter that Mrs T provides support and creative methods to assist Lebo and all his peers with any difficulties that they may have. In the LSEN class, learning occurred in multiple environments, such as the classroom and in the garden and each child received different forms of support, individually, in a small group and as a member of a team. Through this level of support, Lebo was able to progress in the period of two years within this class. This progression was influenced by factors such as small class size, differentiation and the level of support.

Mrs T uses a variety of resources, many that she has created herself, in addition to the multiple commenced by implementing different groups in her class, differentiating children into ability groups in the class and mixed ability groups outside of it. Mrs T created four different assessments and adapting her teaching materials for these groups. This differentiation in the classroom allowed for the learners to learn to the best of their ability, regardless of their difficulties. Many of the resources used in the classroom were not only used to assist the learners within that specific domain of development, but they also assist with other development domains. For example, a resource that assisted in the domain of motor and physical development, may have also assisted in the cognitive domain. The resources that Mrs T created, and the curriculum which was individualised, differentiated and adapted, assisted Mrs T to meet the child’s unique learning needs.

Chapter 4 commenced with explanation of each domain of functioning according to the DSM5 (APA, 2013). The DSM5 frames the domains of functioning as practical, social and conceptual. However, these three domains were then adapted for the study into five: motor and physical, communication, social and emotional, adaptive and cognitive. Within the cognitive domain. It

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was further subdivided into colors and shapes; handwriting and creative writing; mathematics; phonics, reading and spelling; and attention and hyperactivity. Lebo’s difficulties within each domain were discussed, with evidence provided by raw data and thick rich description, and photos of the assistance and support that Lebo received from Mrs T. These methods were supported and reinforced by a critical review of the literature.

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