Behaviour & Other Therapies

1. Specialised AD/HD Coaching

Specialised AD/HD coaching is an important part of the Multimodal Treatment Plan because this type of coach is trained to guide and support people with AD/HD and/or related conditions so that they can understand and overcome the challenges of living with this condition. Children and adolescents with AD/HD can begin to blossom once they start working with a properly trained AD/HD coach. The help that an AD/HD Coach can provide children and adolescents with AD/HD include

  • Creating structures and tools to stay on track
  • Improving organization skills and designing organization systems
  • Providing clarity about specific tasks and managing time
  • Increasing self-awareness and building self-esteem
  • Setting and reaching goals
  • Improving diet, sleep and exercise
  • Improving relationship and communication skills
  • Providing information about AD/HD to the child’s teachers
  • Liaising between the school and the parent in matters concerning AD/HD
  • Identifying areas of weakness and suggesting tutoring as needed, etc.

AD/HD coaching supplements the child’s treatment plan in a very positive way. As the coach usually sees the child at least on a weekly basis, s/he will thus have a realistic opinion on how well the child’s AD/HD symptoms are being controlled, identifying problem areas and suitable interventions and providing invaluable help to both the child and the parent(s).

You will find information about properly trained Specialised AD/HD Coaches on this website under Resources in Belgium.

AD/HD coaching is different to psychotherapy because a coach does not look at the client’s past to find answers for the presenting problem, but focuses instead on the present problem and how the person can move on from there to a more positive and successful future. A child or adolescent can visit a CBT practitioner or other therapist while being coached by an AD/HD coach if this is needed.Top â–²

2. Cognitive Behaviour Therapy (CBT)

CBT combines two very effective forms of psychotherapy, cognitive therapy and behaviour therapy, which for children and adolescents with AD/HD and a comorbid condition, such as Oppositional Defiant Disorder (ODD), Anxiety Disorder and Obsessive Compulsive Disorder (OCD), can bring extraordinary results. It is a very effective therapy for changing destructive behavioural and negative thought patterns.

There are a number of psychologists in Belgium who are also trained in CBT. Some can be accessed through the Community Help Service (CHS), but the waiting lists tend to be long. Most of them also have a private practice and it possible to get appointments quicker by contacting them in this way.

In the few multidisciplinary AD/HD clinics that exist in Belgium, there is usually a Cognitive Behaviour Therapist employed. You will find information about this also under Resources in Belgium.

It is also possible to get information about CBT practitioners from the diagnosing physician.Top â–²

3. Occupational Therapy & Sensory Integrative Therapy

What Is Occupational Therapy?

"Give a man a fish, and you feed him for a day. Teach a man to fish, and you feed him for a lifetime."

This Chinese proverb best describes Occupational Therapy (OCT), which uses meaningful activities to promote functional independence in children with special needs.

Each of the OCT tasks falls into one of these categories: self care, work and leisure. Hence, these are called the Occupational Performance areas. In the case of children, these areas are self care activities, school and play. A child’s occupational performance may be impaired by physical, developmental, sensory, attentional and/or learning challenges.

The goal of the Occupational therapist is to improve the child’s performance of tasks and activities important for successful and independent functioning. The occupational therapist is concerned with ensuring an understanding of, and match between, the child’s skills and abilities and the expectations placed on him/her. Based on a detailed evaluation, the individualized treatment objectives are formulated by the therapist who then carefully selects the treatment techniques derived from the ‘frames of reference’. The frames of reference used in paediatric practice include:

  • Sensory Integration
  • Neurodevelopmental
  • Biomechanical
  • Behavioural
  • Developmental, etc.

The Senses and Sensory Integration (SI):

Our senses give us the information we need to function in the world. Everyone knows the five basic senses: seeing, hearing, tasting, smelling and touching, but there are other senses that are not as familiar, such as:

  • the sense of movement (vestibular)
  • the sense of muscle awareness (proprioception) and
  • tactile sense*

* ability to learn from our environment through our sense of touch, such as knowing how heavy, smooth, rough, big or small an object is just by holding it.

The vestibular, proprioceptive, and tactile senses are the three body-centered sensory systems that provide the sense of oneself in the world. It is important that the sensory information is integrated, processed and well organized in the brain for an effective output or performance.

It is this neurological process of organizing the information we get from our bodies and from the world around us for use in daily life which is called Sensory Integration. Sensory Integration provides a crucial foundation for future more complex learning and behaviour. When the brain is unable to integrate information for use, the result is Sensory Processing Disorder (SPD).

It is estimated that nearly 5% of all children suffer from SPD.

  • Many children with AD/HD also suffer from sensory processing disorder. They either withdraw from, or seek out, sensory stimulation like movement, sound, light and touch. This translates into troublesome behaviours at school and home. (Kristie Koenig, PhD, OTR/L).
  • This is what makes it difficult for a child to filter out nonessential information, background noises or visual distraction and focus on what is essential.
  • The correlation between AD/HD and SPD symptoms is shown by a new national study of children ages 2 to 21 done at the University of Colorado, USA. Parents reported that, of the children who showed symptoms of either AD/HD or SPD, 40% displayed symptoms of both disorders, (Lucy Jane Miller, Ph.D., director of the Sensory Processing Treatment and Research (STAR) Center at the Children’s Hospital in Denver).
  • SPD is estimated to occur within up to 70% of children considered learning disabled.

Therapy:

Therapy addresses the brain’s plasticity and the child’s inner drive. Therapy techniques appeal to the three basic sensory systems offering a wide range of sensorimotor experiences. Activities are tailored to each child's needs and can involve techniques, such as lightly or deeply brushing the skin, moving on swings or working with an exercise ball.

Effectiveness:

  • Ottenbergh (1982) examined 49 published research studies and found that 78.8% of children who received SI treatment demonstrated better performance than children who did not receive treatment. These advantages were found in motor performance, academic achievement and language functioning.
  • Occupational therapy improves AD/HD (www.therapytimes.com 25/05/05)

Temple University researchers, Kristie Koenig, PhD, OTR/L, Moya Kinnealey, PhD, OTR/L and Gail Huecker, Director of OT4Kids, wanted to determine whether AD/HD problem behaviours would decrease if underlying sensory and neurological issues were addressed with occupational therapy. Their study titled "Comparative Outcomes of Children with ADHD: Treatment Versus Delayed Treatment Control Condition." had 88 study participants, all of whom were taking medication for AD/HD. Of the 88 participants, 63 children each underwent 40 one-hour Sensory intervention therapy sessions, while 25 did not. It was found that the behaviour associated with AD/HD was significantly reduced following the intervention.

The research team believes that Sensory intervention affects the plasticity, or adaptability, of the brain to sensory stimulation.

"We found significant improvement in sensory avoiding behaviours, tactile sensitivity and visual auditory sensitivity in the group that received treatment." (Koenig)

"The children were more at ease. They could better attend to a lesson in a noisy classroom, or more comfortably participate in family activities." (Kinnealy)Top â–²

4. Speech & Language Therapy

Speech and language therapy is the most common form of therapy available for children with speech and language disorders, and most international and European schools in Belgium employ a part-time, or have access to a private, Speech & Language therapist or pathologist who works with children with a speech and/or language disorder during the school day.

Speech and language therapists assess, diagnose, and treat children with

a) Speech Disorders, which are characterized as follows:

  • Problems with Articulation, which include difficulties producing sounds in syllables or saying words incorrectly
  • Problems with Fluency,i.e. stuttering, etc.
  • Problems with Resonance, which include problems with pitch, volume, or quality of the voice.
  • Dysphagia/oral feeding disorders, including difficulties with eating and swallowing.

b) Language Disorders, of which there are two types, receptive and expressive:

  • Receptive disorders refer to difficulties understanding or processing language.
  • Expressive disorders include difficulty putting words together, limited vocabulary, or an inability to use language in a socially appropriate way

After thoroughly assessing a child, the Speech & Language therapist does a variety of exercises with the children based on their individual needs. Children with Dyslexia are usually referred to such a therapist while also being tutored by a specialised Dyslexia teacher. In some cases, the Speech & Language therapist acts also as the Dyslexia specialist.

Children with AD/HD very often have a Language Disorder, which is usually identified before the AD/HD symptoms. Such children may be classified as having mild Dyslexia, and if they have the primarily inattentive type AD/HD, they might not be diagnosed or treated for this until much later.

It is important that the true nature of a child’s language difficulties are identified as early as possible and for this to be done properly, a thorough multidisciplinary assessment should be carried out by speech & language, Dyslexia and AD/HD experts.

Speech and Language intervention has been shown to be extremely beneficial to children with a specific Language Disorder. The Speech and Language Therapist should liaise with both parents and teachers, compiling a report of the specific difficulties identified, and giving teachers strategies and resources so that they know what the language goals for a particular child are and how to best to achieve these.

The Speech & Language Therapist works either one-on-one or in small groups with such children, focusing on the following areas:

  • Attention, and listening 
  • Following instructions
  • Understanding instructions and concepts
  • Vocabulary
  • Sentence construction
  • Sequencing/story telling
  • Preliteracy skills

These interventions are also useful for children with AD/HD, but parents should not expect this type of therapy to compensate fully for the symptoms of AD/HD because they do not. When children have a Language Disorder and AD/HD, they do not benefit fully from the interventions done for the Language Disorder until they begin taking an AD/HD medication that is appropriate for their age and degree of disability.Top â–²

5. Social Skills Training

Social Skills Training: AD/HD

Social Skills Training is very beneficial for a child or adolescent with AD/HD to help them be less aggressive and impulsive, manage anger and behave in a more socially acceptable way. This type of social skills training is done by the AD/HD coach and includes the following techniques:

  • Coaching
  • Role-play
  • Practicing ways to resolve conflicts
  • Watching videos/DVDs of good behaviour
  • Learning how to cope with frustration
  • Learning how to listen
  • Learning how to enter new group situations
  • Learning how to give and receive praise

Social Skills Training: Asperger’s Syndrome

While a child or adolescent with Asperger’s Syndrome (AS) would also benefit from this type of intervention, the nature of AS is such that a more basic development of social skills may also be needed to give them techniques to master aspects of social interaction foreign to them, such as:

  • Showing an interest in others
  • Being able to reciprocate
  • Feeling empathy for peers, etc.
  • Understanding abstract language

Social Skills Training: High Functioning Autism

Unlike the child or adolescent with AS, the child with High Functioning Autism does not seek contact with peers and does not suffer when s/he does not have this contact. Social Skills Training for such children is extremely basic and necessary to make day-to-day interaction with other children possible. This is the child who needs everything explained, no matter how basic. These children will invariably need help with all aspects of communication and interaction. They need to learn what comes naturally to other children. For more information about this, please go to www.autismeeurope.beTop â–²

6. Neurofeedback

The goal of neurofeedback is to teach the patient to produce the brain-wave patterns associated with focus, which – if successful - can result in some symptoms of AD/HD, such as impulsivity, distractibility and aggressive behaviour to diminish.

This is done by a carefully controlled treatment during which the child or adolescent is asked to wear a cap lined with electrodes and to sit with eyes closed for several minutes. S/he is then asked to perform a complex cognitive task, such as reading aloud. The results are shown as a colour coded map on a computer screen, indicating areas of the brain where there is too much or too little brain-wave activity. This digital map enables a person’s brain activity to be compared with other brain wave patterns stored in databases and can help develop a treatment plan by delineating sites for the electrodes.

During treatment, the child wears a cap lined with electrodes again while sitting in front of a video screen and is asked to move the characters in a computer or video game (goals vary, depending on the protocol the practitioner uses) by producing short bursts of sustained brain-wave activity in those areas of the brain thought to be under-aroused. The software generating the game monitors and records brain activity.

Loss of focus will cause the game to stop. It plays only when the child exercises that portion of the brain that is deficient in focus.

There have been no double-blind studies done on the effectiveness of this type of treatment. However, it can be used to address specific AD/HD symptoms while the child or adolescent with AD/HD is taking appropriate medication for his/her condition.Top â–²


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