The symptoms of ADHD are typically noted before the child enters school (i.e., before age 7) (APA, 2000). Furthermore, children who are identified with ADHD before entering school typically have more severe symptoms and are often identified with ADHD-PHI or ADHD-C. Many of these children present significant challenges for their parents and preschool teachers and are at a high risk for developing academic difficulties and oppositional and defiant behaviors (DuPaul & Stoner, 2003). This makes it especially important to intervene early to address current behavior difficulties as well as to prevent or reduce the severity of academic skill deficits, aggression, opposition, and defiance (DuPaul & Stoner, 2003).
One strategy that has been proven effective in addressing the needs of young children with ADHD is the use of parent-mediated interventions (DuPaul & Stoner, 2003). DuPaul and Stoner note that parent-mediated interventions that have proven effective include
- Use of brief, direct commands
- Positive parent attention to appropriate child behavior
- Implementation of contingency management strategies in which children earn token reinforcers (e.g., poker chips) for compliance with parent directives
- Use of response cost and time-out from positive reinforcement strategies to reduce noncompliant and aggressive behavior
If early intervention efforts are to succeed, it is important that home-school partnerships with families be developed. These partnerships are largely based on gaining trust of the family; addressing the diverse needs, backgrounds, and experiences of the family; and offering a range of usable, flexible services that address the changing needs of the family (Salend & Rohena, 2003). These partnerships also offer parents and teachers the opportunity to share information about the child, monitor the effectiveness of medications that may be administered, coordinate assignments, and develop behavior modification plans (Bos, Nahmias, & Urban, 1999).
Barkley (2000) has recommended the use of home-based reward programs as part of home-school partnerships in addressing the needs of students with ADHD. One such program is the behavior report card. The behavior report card consists of a structured form that the teacher completes daily as an evaluation of the student's behavior in targeted areas, such as class participation, performance of classwork, and following class rules. The parents then use this report card to give or take away rewards, depending on the child's behavior. Report cards are initially sent home daily; but as the child's behavior improves, the report cards are sent home less frequently.
In the case of young children with extreme hyperactive and impulsive behavior, it is likely that even with intensive interventions and close cooperation between home and school, the behaviors will continue to interfere with the child's development. Under these circumstances, medication will often be prescribed to control the child's behavior. When this occurs, it is especially important that teachers and families work together closely to monitor the effects of medication on the child's behavior and continue to use effective interventions to ensure the child's academic and social progress.
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