A REPORTOF A SCIIOOL I'SYCIIOLO(i Y INTERr-;SI Ill''\"1'TIIE WESTERN AVA!.ON ROI\·IAN l'1\T IlOl.l C SClIOOI.IJOARl).
INCLUDINGA REPORTOFARESI:ARCII STl IDYTITLED.
SPECIALEDUCATION TEi\C'IIERS"BEIJ IT SxnourSTl MIII.i\NT
MEDICATIONIN TIlETREATMENT OF A·ITENT ION·D I TICIT/IIY I'I~RI\{T[Vl·!·YDISOR1)1~1~
PaulaCundyJacobs
AreportsubmittedIIItheSchoolof(iradumc Studiesin pa rtinlfulfltlmcmor the
rcqulrcmcuts for thedq~reeIll"
Mustcr olEducution.
FacultynfFducution Memorial University ofNewfoundland
August1996
sr,John's Newfoundland
1+1
Nationa1Lobrary 01Canada8lbliolhequenaliOnale d"Conado AcquiS~1ORSand Direction.des~cquSilionset BibhograJhCsevces Branch dessevces bibl"lOQraphiques
!~.,~ E ~
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ISBN 0-612·17606·1
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ABSTRACT
This rep ortdescribes a nine-weekinternsh ip programmeattheWestern Avalon Ruman CatholicSchoolHoardin Avondale.Thegeneralgoals.objec tives andtheactivitiescarried outto accomplish these goals, as wellas the effectiveness andlimita tionsof'the internshiparc describedinthe first two chaptersofthis re po rt.Detailsoftheresearchprojecttitled,"SpecialEd ucationTeach ers'Beliefs AboutStimulantMedicationInTheTreatment
or
Aucntion-Defici t/ll ypcmctivity Disorder(ADlID)," arc describedinthe third chapter.ACKNOWLEDGEMENTS
I1lI1lgrateful to have hadDr. Julia O'Sullivan(111d Dr. William Kennedy asmyinternship supervisors.
To Dr.JuliaO'Sullivanwho helped mewiththeresearchproject.lor challengingmyideas.offeringconstructivefeedback goes my deepestgrutitndc andrespect.Thankyou forprovidingexcellentsupervisionilltheprepamlillllor this internship report. Your adviceproved alwaystobehighly valuable.
To Dr.William KennedyI wouldlike to thankyou Ii-Iryour helpful comments.directionand supportthroughouttheinternship.
To GerryWhite [wouldliketo Ihnnk youfor your vufuablcassistance,111<1 adviceinanalyzingthe statisticaldata.
ToJerry Blackmore.my internshipfield supervisor. Iwould likettl express gratitudefor your tremendousamountof supportandguidance. Thankyoufor listeningtomy ideas andprovidingme with directionwhenneeded. Your guidance and supportwill always be rememberedand appreciated.
Ialsowouldliketoextend thanks toIhc WesternAvalonRomanCmlmlic SchoolBoard foractingasmy placementsiteandgrantingme perl11i.ssi flll tn conductresearch intheirdistrict,
iii
TAUI.E OFCONTENTS ABSTRAcr
ACKN(,W I.l; I)(il;MI;N TS
LISTOFTAHr.J:S . CIIAPTERI INTIW])IJCr! ON
Rationale fortheInternship . Fbclntcmship Scuing
Supervision .
InternshipGonls&Specific Obje ct ives CIIAI'T EHII.
rrn:
INTERNSHIP: ADESCRIPTIO NOFACTIV ITIES lmroduction .lmcrnshipGoalslindActivities. Consultation
Psychologicaland Psychocduct uionalAssessment ReportWriting.
lutcrvcntio n•
ProgramPlanningandEvaluation. Continuing ProfessionalDevelopment., Research
iii vii
14
24 25 28 29 31
Conclusion .t ~
CHAPTERIII .':;
HIERESEARCU PROJECT .l:i
SU11l111;lry. .1:i
Int roduction . .Hl
WhatIs Aucntion- Dcfic it/llypcmctivityDisorder'!. .'\h HowPrevale ntIsAttention-Deficit/HyperactivityDisnrdcr? .1K WhatCauses Attcmicn-Dc fielt/l lypcructivity Diso rder" W lIow Common IsThe Usc
or
StimulantMeiJicatin nToTreat Ancnticn-Dcflcit' l typcractivit yDisorder? ·W What ArcTheBcncflciul EffectsorStimularn McdicHtillll'! 4.1 WhatAreTheNegative Side-Effec tsOfStim ula ntMcdicutiou? 44 WhatArc TheLimitatio nsor
Stimulants As ATrcauncmFur Attention-Dc ficit/l'lypcructivityDisorder?. 46 What Is The Teacher'sRoleInThe TreatmentOfAttention-Deficit/HyperactivityDisorder'!. 47
PurposeoftheResearch 50
Method. 51
Sample.. 51
Oucstlonnalrc.. 51
Procedure. 53
Results . 54
Discussion RHERENCES
FOOTNOTES. APPENDICES.
70
J8 .... .... . . .. . .88 89 AppendixA.:NamesandLocutions
or
The SchoolsAtTheWestern Avalon Roman Catholic SchoolBoardfor Which The EducationalPsychologistIs Respo nsible. . 90
Appendix B:Tests Examined. 92
AppendixC:Tests Administered... ... ... .. .. . .. ... . . .... 95
AppendixD: Reading List 98
AppendixE:Bclmvloral RatingCard&Progress Chart. 104 Appendix F: Letter
or
ConsentForTheSuperintendent.. 109 AppendixG:Letteror
Consent ForThePrincipal. . . . .112 Appendix II: Letter OfConsent For Thc SpecialEducation Teachers. ...115 Appendixl: Questionnaire:Attcntion-Deficit/Hyperactivi tyDisorder&Stimulant Medicati on. . ....118
Appendix1:Follow-upLctter forThe SpecialEducation Teachers. 124
vi
LISTOF TA B L ES
Table1: Number of Respondents.Mean Response.nudStalld,m lDe\"ia\;on for ItemsMeasuring Beliefs About the Natureof
Attention-Deficit/HyperactivityDisorder . .56 Table2: NumberofRespondents.MelinResponse. :111dStandardDeviation
forItems Measuring Beliefs About theEffectiveness
ar ;Limitations ofStimulantMcdlcnrion 59
Table3: Number of Respondents. MeanResponse.andStandard Deviation forItems MeasuringBeliefs AbouttheTrueljcncficinl
andNegativeEffects orStimulant Medication. . 63 Table4: NumberorRespondents. Mean Response.(lil t!SmndurdDcvhuion
forItems MeasuringBeliefsAboUItheFalseBencticia\
lindNegativeEffectsofStimulant Medication . .(,(1
vii
CIIAI'TERI INTRODUCT ION
Rationalefor theInternship
Aspartof therequirementslo r aMaster'sDegreein Education Psychology,
«udcmsmay chousetoeither completea thesis,paper folio. project. or do an interns hipwhichincludesa minorresearchcompo nent.The internshipoption requires a miuhnumtit'eight consecutiveweeksof placemen tinasetting appropriateto a studcutseventualcmploymentinterest.
Theintern, havingteamedmuch about her strengthsand skills as a potential schoolpsychologist during herprncricumexperienceatthewesternAvalonRoman CntholicSchoolHoard.wished10furtherdevelop competencies inconsultation and assessment and otherareas whichschoolpsychologistsarc expected to perform.The internshipwouldprovideextensiveon-the-jobtrainingto allow the intern10acquire, pmcticcand developthesenecessaryskills. Inaddition. thispracticalexperience wouldallowtheinternto gainfurtherknowledge of some: ofthe clinicalsyndromes and disorderschildrenexperienceandtobecome moreaware of the typesof interve ntionstrategiesusedtotreat such conditions.
Giventheintern's interests.alongwiththe desireto receivefeedbackfromand seekconsultatio nwithotherprofessionalsindevelopingtheseskills,theintern ship nptionis consideredtobethemost appropriatefor accomplishingthesegoals.
Th..:lnt..:mshirS..:uinl;
Theintern's interestliesin workingwith studenlsIrnm diITl'T\."I11ugc gn>ullSil l theprimary,elementary. andsecond ary levels,arlf.ishewislll..'t.II\1exper iencetheduties ofaschoolpsychologi stinurural scuing. Fl'fthesefl'll'lI.lllSlin: westernAvalon RomanCatholic SchoolBoardatAvondalewaschosenasihcsettingfortheint..:mship.
Thewestern Avalon RomanCatholicSchool BHindisresponsiblefortwenty- sevenschoo lsintheWesternAvalonRegion. Atthe lime ortheinlernship.the Sehnul Boardconsist ed of15full timeprofessionalstanmembersundIIsupp ortstall Althoughthe Edu catio nalPsychologist.JerryIuuckm orc.isstationedalRonculli CentralHighSchoolin Avondale.heisrc sponsj blcfor14SdKlolswith in theWest...ru AvalonRomanCatholicSchool Board. astudcn t JII'p ulmionof apJlnlxil11 lucly]:!UI).
Sec AppendixA fortheschoolsilltheWest ern AvalonRoman Cntho lieSchuollk lilrtl for whic h theEducationalPsy cholo gist,JerryBlackmon:. isrcsponsihle.
Supervision
JerryBlackmoreprovidedtheinternwith on-sill.'supervisionfor the nine-week Internship. Theinternmetwith thesuper visordaily10discussre ferralcases.
experie nces, andothe rconce rnsthat arose during theinternship.
Regularmeetingswerealso heldwiththeintern'!>university supervisors.Dr.
Julia O'Sullivanand Dr,WilliamKennedy.Regularmeeting!>wereheld with Ilr.Julia O'Sullivanto discusstheresea rchproject . Dr. WilliamKennedyvisitedRnllc alli
CentralHigh Schoolin Avondaleto discuss theintern'sprogress inthesetting and to talk aboutanyconcernsthatthe intern mayhavebeen experiencing. Both Dr.Julia O'Sullivannnd Dr. William Kennedy provided theintern with valuablesupportand guidmlcethroughout the internship.
Internshi pGoalsand SpecificObjectives
According to the NewfoundlandandLabradorDepartment of Education (19I)2a).school psychologists arc expected toprovide a range ofdirectandindirect services to theirclientswhich requireinvolvement with theentireeducationalsystem.
Thepurpose ofthese servicesis to promote mental healthand facilitate learning.
Althoughthe following services are listedseparately,these activit ies complementone another and therefore arcmostaccuratelyviewed asbeing integratedandcoordinated rather than discreteservices:
A.Consultation
B.Psychological&Psychocd ucationnl Assessment C.Interventions
D.Supervision E. Research
F.ProgramPlnnning andEvaluation G.C\mtinuing ProfessionalDevelopment
In devising. goals for the internship. theseservices werekcptin mind. Aftcr
being supervisedanddirectedbyboth the internshipfieldsupervisorandthe Illliwrsity internship programsupervisors.the J"nlluwing gnalsand specific Ilhjceliwswere decidedupon.Theinternshipgoals:llldspcclflctll~ieeti\'l'swerecategllri/l'dunder gene ralheadingsas indicatedbelow.
~onsultution
Goal1:To further developskills inconsultation.
SpecificObjectives:
A. To attend meetingswiththeschoolpsychologistlindobserveconsutnuiou.
B. To establishgood working relationship withparents.the selmlllpcrsouucland outside personne lof the clients whohave been referred for psychologicalservices, C. To consult and collaboratewithschoolpersonnel.parentsmidlitheroutside personnel regardingmentalhealth,behavioralandeducationalconcernsas required.
PsychologicalandPsyehocducationlllAssessment
Goal 2: To furtherdevelopand enhance skillsin tileareaIll'formnl assesslIlent techniques.
SpecificObjec tives:
A. To becomefamiliarw;l.hthe psychometric properties ofdifferent standardized instruments.
B, To administervariousstandardizedinstruments til assess areas
or
pcrsunlll.sm;illiadjustment, intclligcncc-scbolastlcaptitude,adaptive behavior, language and cummu nic utionskills.acndcrnic achiev ementand sensory andperceptual- motor functionin g.
C. Tolearnmoreaboutthe interpretationsandrccormncndationsthatarisefrom
.~talldardizcdassessmentsthrough discussionswith school psychologists,readingsand
research.
(hurl3: Tilfurtherdevelopandenhance skillsinthearea ofinformal assessment techniques,
Specific Objcctivcs:
A. Todevelopandenhanceobservationskills neededforassessmentpractices.
n.
To furthe rdevelopinterviewingskills.I~ epll rtWriting
(lual 4:Ttl develop skillsann obtainexperience inthestyleof writingusedin repllrtsofpsycbocducationalassessments.
Spl.'CilieObjectives:
A. To cxnrnincpsychocducational reportsontilcattheSchoolBoard.
II. 'I'llpracticereportwritingskills.
IntervcntiOIl
011,11S:Toprovide directandindirectinterventions to facilitatethe functioningof
individuals.
SpecificObjectives:
A. To speci fygoals. objective s. strategies. cvnhurtion criteria.li,\ll\l\\'-Il jldates amI responsibilities;\1order10ensurethatdata{Illprogressarc CIlI\cclcd anddisclissedin casesofintcrvclition.
B. Toprovidelnscrvlccsforeducato rs/parentsonprevcntion/iutcrvcutionmavrs asrequired.
ProgramPlonni"!!andEvaluntion
Goal6: To assistin developingand implementing programsunderthesupervision{If theschoolpsychologist.
SpecificObjective:
A. Toparticipateinindividu a lprogrnmplanningreams.
ContinuingProCessional Develo pment
Goo17:To actively panlcfpatcandengagein activities designed10continue.cnhnucc.
and upgradeprofessional trainingandskillsto ensure 4ualityservice.
Speciflc Objccrives:
A. To exploreanumber ofassessmentrnutcriula,journals. honks and other referencesourcestodevelopskillsand knowledgeinareas ofinterest.
B. To expand knowledgeofthenatureofa varietyof clinicalsyndromesand
disorderschildrenexperienceand10becomeaware ofthe diagnosticmethodsusedto idcnrifythcsc dlsordcrs.
C. TndevelopHloo se-leaffile ofdiagnosticandremedialstrategiesforquick referencewhileoutinthefield.
U. To participatein1I1linscrviccifthe opportunityarises.
Research
Goul 8:Tocomplete a projectwhich wouldmeettheresearchrequirementfor the completionof the internshipandwhichwouldberelevantanduseful10thedistrict personnel lit thewestern AvalonRoman CatholicSchool Board.
Allcrconsultntionwith the fieldsupervisorandtheuniversity supervisors,the iutcm decided10undertakearesearch projectwhich had the followingpurpose:to examine thebeliefsofthespecialeducation teachers at theWesternAvalon Roman CarbolicSchool Board about theuscofstimulantmedicationin thetreatmentof Aucntion-Dcflcit/llypcructivityDisorder (ADHD).
CIIAPTERII
THEINTERNSIIIIl:A DESCRIPTIONOFACTIVITIES Introduction
The internshipat the WesternAvalonRoman CatholicSchoollkumltookplace from Apri l 16. 1996 toJune 18. 1996 ,for a periodof nine week s.The purposeof'this chapteristo provideadescriptionorthe activities in whichtheintern partlciparc din order to accomplishtheinternshipgoalsnud specific ubjL"t:livesliSoutlinedin churler one. The conclud ingsection ofthis chapterwillfocus(111how those experiences he lped fulfillthe statedobjectives.
InternshipGoalsandActivitie s Consultation
GoalI:To furtherdevelop skillsinconsultation.
Specific Objectives:
A. To attend meetings withthe schoolpsychologistundobserve consuluuion.
B. To establishgoodworkingrelationshipwithrarelll~.thesehoulpc rs onuc! lind outsidepersonnelofthe clientswhohavebeenreferredlorpsychological services.
C. To consultand collaboratewithschool personne l,parentsandotheroutside personnelregardingmentalhealth.behaviora land educational concerns as required.
Activitiesperformed toaccom plish th isgO<lIwere:
t. Thcintern attended twomeetingswith[hefieldsupervisorIn observethe consultationprocess.On oneoccasio n,theinternuccompaniedherfieldsupervisorIu
meet witha to-year-oldmale and his parentsat the ir home. This male had been convictedof'ussauhingIIguidancecounselloratthe school hehad previo uslyattended.
lIe was also convicted ofa breakandentry whichhad occurred atthesameschool.
liehadservedtime atboth the Youth CorrectionalCentreinWhitbo urnc andthe penitentiar yin 31.John' s.The purpose
or
themeetingwas to determine thestuden t's sincerityinwantingto continuehis educationandto discusswhat placementoptions wercuvaihrblctohim.Because of thesruceni'segc,hishistory with violenceand poor angercontrol.itwasdecide dthathis readmissiontothesameschool would likely producebehaviorssimilartothatwhichhadled10problems withthe lawandwhich had produced greatfrustration for him. Whenitwas suggestedthatahome study prognuuorenrolment innn Adu ltBasic EducationProgrammight be possible nltcmurivcs. the student became extre mely upset, startedswea ringandle nthe house in arage.Subsequently.bothparentsagreedthatan adultenvironm entwouldbemore suitableforaddressinghisneed ssince the ruleswouldbe moreflexibleandhe would havegrcntcr responsibilityforhisownlearning. Theparen ts weregivensome information regarding application forms. fees,undcounsellingservicesavailable atthe institutio n.011anotheroccasion .lhe intern observedher field supervisorconsult withII guidancecounsellorurLavalHigh SchoolinPlacent ia regarding a Level II female student\\1110was experiencingextremelest anxiety. Theanxietymanifes teditse lfby obsessivebehaviorsuch asspendingextraord inary amounts oftimestudy ingwithout
10 allowinglimetoenga geinotheractiviti e s.Her obsessive behavio rwasstm tillb! Itl interferewitheveryday normalfunctioning .Durin gthepustyenrtheslmlelll ancmptccl suicidetwice andwas udmlttcdtoucJaneway ChildHealthCentre.Althoughthe guida ncecounsellorhadbeencounselling the stude ntonlinon-goiugbnslsIi,lrthe past year, he feltthai he had rotmadeany substantialUlIlO\l11lof progresswithhcl pinl,!It.
allevia tethe student'sanxiety and her ob sessionwithstudy ingmul marks.
During this meetingtheguidancecounscflorInfor medtheFie ldsnpc rvi;;llr 01"
what typesof interve n tionstra te g ies had beenpu t in plac eoverthe pastyear. In addition,duringthisconsulta tionsession the guida nce coun sellor.thefichlsupervisor andthe internexploredwhatinterventionoplionswere nvnilnblc.IIwu~decidedtluu thestudentwo uldbeexempted fro mull finalexams lhis year. Also.the smdcntwould receive11leiter rather thananumericalgradeonellfuture rests thisyenr.This was done to help the studentto avoid obsessing onmarks.Theresultingplanor actionwns believedtobeibcmostappropriatelitthepresentlimesincethestudent would be facing extreme anxiety with final examsapproaching inJune.Theguidancecoullscllur wasencouraged to keepthefieldsupervisorinformedof the sllll/cnt's pmgress.
2. Inorde rto gainabetterundcrstundiugorsomeufthe important issuesInvolved in consoinnion,theinte rnreviewedChapter24ofAsse.ssmenlufChildrenhySailler (1992 ) pp.763- 799.Inparticular.theethicalslandardstil'psychulngisl.Swerestudied carefu llyandconsultation techn iques forworkingwithparents and tcnchcrs were revie wed.Such readingsprovidedthe intern withagrunterupprcciuthmul"the
11 re sponsibilities associatedwiththeprofessionalroleof{Ischoolpsychologist.
3. Onoccasio nsthroughout theinternshi p the internconsultedandcollaborated withschoolpersonnelinihcfollowing schools:St.Joscph'sEtcmemary.Ha rbour Main;
Iio lyCross Elementary,Holy rood;St.Edward'sElementary,Brigus;Ron cahi Ce ntral IlighSchoo l, Avondale;1\11Hallow ' s Elementary.North Rive r; Dun n eMcmo rinl Prin1llfY.Riverhead ; l"ulimaAll Gra de.SI. Bride's;and BishopO'Neill.Brigus.
Severalme etings withteache rs.both individually andinsmallgroups,wereheld\0 discussstud entswho had beenreferre d fromtheirclasses,Theintern discussedwith theschooludministrutorsthe recommen dationsthatweresuggestedforvari ousstudents reluting to academic:111 ([behav ioralinterventi o ns,
4. Theinternparticipat edinthreecase conferenceseachof whichinvolved tea chers,ndmieistmtors,guidancecou nsellor s.educational psycholog ist s, spee ch- langulige pa thologists,parentsandoth eroutside personnelsuch as a socialworkers fro mthe.luncwayChild HealthCentre. Forexample.the internaccompan iedherfield supervisorto aUend two caseconferencesatHoly CrossElementary,Holyr ood.Here thelicld sup ervisorand thein ternmetwiththe principal,thegu idancecounsellor,the Grade 2reacher.theinstruction alresourceteach er.the coordinatorof specia lservices,
IIsocial workerfrom theJaneway,and theparentstodiscussthe assessmentfindings Ill'his reportasfhcy related tothechild' s eligib ilityforspecialservicesunder Cri te ria Cof(heChallengingNc~'dsdocumen tationprocess.
Uur ingthismeeting the assessment findings and recommenda tionswere
12 presente d. The consultationprocessinvolvedmorethan justu recitationtil'theTl' SUI1S or a readingofthere port. The entire processrequired much sensitivityandall understandingoffhcfeelings. needs, and desiresof theparents.Th...assessmentresults wereexplained inund erstandabletermsinorder 10 help the l"ITen!srccugnizc the natureof the problemand(0accept the irnplicatlcnsIll'the limJings. Throughout the meetin g the parentswerecncourag. d to askquestions regardingthespecificdiagn\\sis and todiscussany concerns they may have had aboutthe futuredrcci uf Criteria L' classification on thechild'sprogrammingandplacement.Inpnniculur.fhep.lrcnl s WCfI:
concernednbouttheamount orintegrationintheregularclassroom their child woukl receive. Itbecame apparent to the inte rnrhutil is essentialthat theparentsview themsel ves aspartofthe teamprocess since theyplay allimportantroleincarrying1Il1' the recommend ations.
Anothercase conference inwhichtheintcrnparticipatedwashell!atRonculli Centra lHighSchool inAvondale. Thepurposeofthismeeting wastil discussa Grade 9 studentwho had been referredafterbeing suspendedfrom school forthreatening teacher s and beingextremelydisruptiveduringclasstime.Individualspresent atthis meetingincludedthevice-princ ipal.theguid ancecounsellor.lhe mstr uetionalresource teacher. jhc school psychologist.asocial worker fromthe Janeway undILfosterparent.
Thisstudenthad a historyofviolen1and abusivebehaviorand had beenreferredtorhc Jane wayChild Ilcallh Centre attcrhe hadthreatened tilcommit suicide. The school team wished to discussallavailable options todeterminethe mostappropr1nle
13 placementtoaccommodatehis needs sincethe school learn fellitdid not have the resources tocffccrivclyaddressthem .The social workeragreedtoinvesti g ate the alte r nativeplacementsand todiscusshe r finding s atIIlater da le.
5. Cons ultat ions withthe speech- languagepatholog istatthe Avalo n North IntegratedSchool Bo a rd wereheld 10 discusspossible assessmen tapproachesand recommendationsfor a Grode3 studentwhowasreferred for an evaluationof a reading disability,After thepresentati on and discussionofthe assessment resul ts obta inedby the speech-la nguagepathologist andthe intern.itwas decide dthat the speec h-language patho logistwo utd udmini stcr theWoodco c k- Johnso nProficie ncy BatteryforLanguage- Revis ed in order to explorethestudent's phonolo g ic al awarenesssincemanystudents who experience rendin g difficu ltieshave problem sin this area.
Thein ternulsoconsultedwijhaneducatio nal psychol ogistat the AvalonNorth Integrated School Board who hadprev iou sly wo r kedwith this child.Becausethe parents wishedtohave theirchildassessedforScoto picSensitivitySyndromeandthe inter nhadrec eiv ed110tmlnlng inthisarea .the educa tionalpsychcloglstatthe Avalon Nort hIntegratedSchoolBoard agreed to complete th e assessment Wilh thepermissio n of'theparents,the resultscrtheachievem ent lindintelligence testswereforevarde dto theeducationalpsycho lo gist ut the Avalo nNorthIntegrated SchoolBoard 6. Theinternconsultedwiththefieldsuperviso randtheguida ncecounsellorat Ronc ulliCentra l lligh School inAvondale 10 discussexperiencesand re ferral caseson 1\dailyoasis. The advice and support providedbythefield supervisor andthe
'"
guidancecounsellor atRoncnlfCcmml HighSchoolwusa vital componentofthe internshipprogram lind was round10he importanttothe intern's overalldevelopment.
Theint e rn also attendedmonthly meetingswiththeeducationalpsychoh1gisls at the Avalon NorthIntegrated SchoolBoard. During.nnel11cc ti l1j;thedingllostic methodsandinstrumentsused 10di:lj!110SCAllcnlion·])dicilfl lypc ractlvityDisorder were discussed . Discussion at anothermeetingfocused nilthe cuucntionnl psychologistsrolein the determinationorastudent'seligibility tilTreceivingrcsllurccs allocated bythe Departmentof Educationunder Criteria C.
PsychologicalandPsychocducationalAssc!\.~1l1Ct1t
Goal2: To funherdevelopand enhnnceskills in the urcntil'formnlassessment techniques.
SpecificObjectives:
A. To becomefami liar withthepsychometric propertiesofdifferent stnndunlizcd instruments.
B. Toadministervariousstandardizedinstrumentstoassessareasof pcrsonul-sociul adjustment,intelligence-scholastic aptitude.adaptivehclmviuur, hmguuIJc anti comm unication skills,academic achievement and sensoryumlpcrccptual-motur functioning.
C. To learn more about the interpretationsand recommendationsthatarise frnm standardizedassessments throughdiscussionswith schoolpsychlllngisis.readingsand
15 research.
The activitiesperformed to meetthe goalof further developi ngand enhancing skills inthearea of forma lassessmenttechniques were:
I. The internstudied thepsychometricpro pertie s of differe ntstandardized instruments. The fieldsupervisor revie wed with the intern allpertinent materials.
techniques,and proced uresreq uiredfor properadmin istra tio nof a test instrumen t. A completelist oftestsexamined is presented in AppendixB.
2.Theinternobserved her Jieldsuperviso radminis ter.score andinterpreta number ofdiffe rent sta ndardizedinstrume ntssuchas theTest of Auditory-Pe rceptual Skills(TAl'S ),The RavenSta ndardProgressive Matrices, AdaptiveBehaviour Scale (ABS-SE),Co nner's Parent RatingScale(Cr RS ).Conne r'sTeacherRatingScate (CTRS)andDisruptive Behaviou r RatingScale(OBRS).
3. Wh e nthefieldsupervisorassigneda student foranassessment,hediscussed with the intern which instruments were required to bead ministe red andwhy the inform ationprovidedwo uld be necessaryorusefulfor tha tstudent.
Beforethe admi nistrationof anyassessmentinstrume nttheinterntriedto establishrapp o r twiththestuden t.For thosestudentswhofelt apprehensi veaboutthe testingsituation.the inte rntried 10 provide reassurance andsupportby explain ingthe purpose ofthetesting . Somet imes reluctant stude ntsneededto be encouragedto respondto aquestion.The student'seffort rathertha n theresults of their effort were prais...-d.
J(,
The internadministered.scoredand interpretedthercsu lls ll(s lanJ,lrdizcd tests.
Alist of the testsused andthe number of asse ssmentscompleted with these instrumentsisincludedinAppendixC. Throughouttheinterns hip.theinterndiscussed with thefieldsupervisor the resultsobtainedfromvariousassessment insuumcntsund howthe resultscouldbeinterpreted andincorporatedwithinawritten report.
4. Theinterncompleted extensivereading sabout theintcrprcuuionsnud recommendationsthatarise from variousstandardizedassessments.Examples orsuch readingwere:
Truch, S. (1993).TheWISe·1lIcompanion: Aguidetninlcrorclutiu nand educational intervention. Austin.Texas:PRO-ED. Inc.
Whitworth, J.R.•&Sutton,D.L.(1978).WISC·Rcomplieutiun:WhatludnIImv that you knowthescore. Novato,California: Academic Therapy Publicutlons.
Goal3: To furtherdevelop andenhance~killsintheureanlinformnlassessment techniques.
SpecificObjective:
A. Todevelop and enhanceobservation skills needed forassessment pr actices.
Activitiesperformedtoacco mplishthis objec tive were :
The internread Chapter17
or
Assessmcntof Childrenby Sattler(11)92 )PI'.472·530in order to gaina better understanding of the nbscrvatlonaltechniquesused toassess behavior.
2. Throughouttheinternship period the interncompletedseve ral behaviorul observationsin the fol1owingschools: Holy Cross Elementary,Ilolyrood:St.EtlwanJ's
17 Elementary,Brigus; RoncultiCcntrulHigh School,Avondale; AllHallow'sElememnry, North River;ami DunneMemoria l Primary,Riverh ea d.Onnine differentoccasions the intern observedthe behaviorof seven different studentswhohad been referredto educationalpsychologistfor assessment Fo urofthesestudentswere referredbecause of problems associated withinattentiveness, distroctibilityand theinability10sustain ancmion.
Bclmvillwl observations WL-rC invaluable in diagnosing Attention- [)clicillI-lypcractivityDiso rder.Accordingtothe!Jiagnosticand Statistical Man ualor MentalDisorders (4th cd.),theessentialfeatureofAltent ion-Delic itlHyperactivity Disord eris a persistentpattern ofinatten tio nand/o r hyperactivity-impulsivitythatis morefr equent andsevere thantypically obse rved inindivid ua ls atacomparablelevel of development. The classroomobservationsprovided the internwith asys te matic recordofboththe stude nt's beha v ior andthe behaviorsofothers. Thishelpedto determine whethe rornotthe ch ild'sbeha v iorwas substantiallydifferentfrom the I1chaviorsof othe rs. Bcccuscit is veryun usual forindividualstodisplaythc same level
or
dysfunctionin nilsettingsor within the sa m esettin g atalltimes.theintern completedobserva tions duringdifferentscheduledactivitiesandwith differentteachers in order 10dete r minewhe ther or notthebehaviorpatternwas consistent.In onecase .the interncompleteda behavioralobservationon a GradeIstudent in whichtheclassroomenvironmentwas so disorganizedandchaoticthat itWlIS virtuallyimpossib letoobserve andisolate the behavioralproblemof the child.During
thelesson manychildrenwere chatting whentheyweresupposeIIIhe listeningtothe teacher. Severalstudents got out of theirscots withoutpermission.Theteacher continuedto teach,fa ilingtoslapthe distractions.Beforecompleting theaSS\.'SSl1lcn!
onthis particularchild.theintentprovidedtheteacher with someguidancere~anli ng classroomdiscipline.
Behavioral observationsgavethe interntheopportunityto comparethechild's behaviorinthetestsituationand thebehaviorinmore naturalisticsituationssuchliS
in the classroom. Furthermore.classroomobservationsallowedthe hneru toverify the accuracy of parentalandteacherreportsregardingthe child'sbehavior. Insllmc instancesthe teacher'sperceptionoftheproblembehaviorwasquite differentfromthe parent'sperception.lastof n11,behavioralobservationswereespeciallyhelpfulwhen theintern wasrequired toassess a developmentallydelayedGrade6studentwhocouhl notbeevaluatedea silyby othermeans.
3. To determineintcrobscrvcrreliabilityfor thebehavioralobscrvnrions. tbcintern andthefield superviso rrecordedobservations whilesimultaneouslyandindependently observing aGrade Istudentat DunneMemorial Primary.Riverheaduntwo different occasions. Thisactivitywas beneficialinthatitprovided the internwith the opportunityto compare herfindings with thoseufanotherexperiencedobserver.
SpecificObjective:
B.To furtherdevelopinterviewing skills.
19 Toachieve this objective thefollowingactivitieswerecarriedoutby theintern:
Readingson assessmentof behaviorbyinterviewmethods werereadbythe intern.lin exam pleuf suchreadings was:Chapter 16of Assessmentof Childre nby SlllllcT(]I}()2 )pp.4011-471.
2. The internobservedher fieldsupervisor conductpre-assessment interviews with pare ntsof children referred 10theschool psychologist. Theintern learnedfromthese sessions how11pre-assessmentinterviewis conductedand what types of information nrcrequiredIII fullyestablishthechild'shistory.Relevantexperiencewithsimilar cases also seemed quiteimponunt in helpingthe fieldsupervisorarriveat thetypeof questioningIhatmightdicitmeaningful informatio n.
3. Theinterncompletedseven pre-assessmentinterviews with parents/guardians Ill'stude ntswho were referred lorpsychceducctionnlassessment.The pre-assessment interviewallowedtheinte rnto: assesstheparents/guardians perceptionsof the chi ld's problem: obtaina case history;ide ntify problem areasand relatedantecedent and consequen t events:idcnti fy reinforc ingeventsforboth childandparents;assess purcnt'smotivation andreso urcesfo rchange: obtaininformedconsent;and discuss assessmentproceduresand follow-up contacts(Sattler. 1992),
The Semi-Structured tnrcrvtcw withParents from Sattler(1992)wasused inull llowcvcr.theinternhad torem ain flexible withher questionsin thatthe parents wouldprovide ndditionalinfo rmationthat requ iredfurtherprobing.Whendiscus sing till'parcm'sparenting skills.the interncmphnslzcd their constructiveend hel pful
zo
approachesratherthan less effective approaches.ThishelpedIIIgniuthcir cooperation.
4. The Semi-Structured Interview with Teachers fromxonlcr (1992)wasuscdtu gather information about thereferred student. Initialinterviews withtill' teachers provided the internwiththe opportunity to: examinethetcachcrxperception
or
the problem:clarify(my misunderstandingsandumbigutlllsresponsesOilthereferral document;explorewhat has been doneto alleviatetheproblem:examinehowother children andreachersreacttothereferred child:lind,explorehow thereferredchild performsacademically.Duringthe internshipperiod. theintern became more confidentlind the interviewsappeared tonowmore smoothly.Theinternbccurncless preoccupiedwith thetypes of questions 10 ask andwas able10listen more caref ullyto thehucrvicwcc's verbalresponses and tointerpretnonverbal communications more effectively.IIIsome
CDSCS.the intern noted discrepantcommunications illthutthe interviewee'sverbal responsesand nonverbal behavior were incongruent.For instance,duringone intcrview theintern noticedthatwhilethe teacher triedto portraythalshewasrelaxedhy thc choice of words shcusedto describedthe problem situation,thedefensiveroue or her voice andherflushed skin did notconvey the samemessage.Thelrncm remained objectiveandlistenedto herfrustrations.The teacher'sfeelings of' inudcquucy in dealing withthe student'sproblem behaviorhcc urncapparentthrnuglmut {hehucrvicw.
Byemphasizingthe teacher's strengthsin helping rcmcdiutctheproblem behavior, the teacherbecame moreatcase andwillingto contributeto theprocess.
21 Reflectionupon this interviewhelpedthe internrealize how importantitisto avuitl powcr struggles between teachers and parents.Suchpowersrrnggles willonly interferewith the commun icationprocess. The internalsobecam e awa re ofthe importanceofeffectivelisteni ngandsummarizing skills.Sensitiv ity10thereactions or theintervieweealsoemergedasanotherimportantskill of a psychologi st.
Aftereach interviewtheintern mel the fieldsupervisor to discuss details of interestandconcernwhich had arisenduring theinterview. In some casestheIield supervisorprovidedtheintern with furtherinsightinto the natureofthe problemwhich leadIn furtherprobing in laterinterview s.
5. AISt.Edward'sElementaryin Brigus,theintern preparedand conducteda diugnosticmathematical intcrvie won aGrade 5student who was ex periencing difficulty withher basicaddition and multiplicationfacts and algo rithms.During the initia l interview the intern explored the student' sco nceptua l and procedural understanding of place value,addition,subtraction, multiplication. and divisionat the concrete .pictorialandsymboliclevels. The mathematicaldiagnosticintervi ewwas usefulinidcntifyingwhat mathconcepts ateach level had been mastcred.Thishelped ttldeterminewlnunewskills needed tobetaught.Becausestudents tend 10 understand :1muthconceptbetterwhcn teaching progressesfrom theconcrete to the abstract.the internwished todetermine thestudent's understandingat each level so thatappropriate iurcrvcruicnsuggestionscouldbeprovided.
6. Theinternobservedher fieldsupervisorconductpest-assessmentinterviews
with parentsandteachers. On one occasionthefieldsupervisorpresentedthe assessment findingsundrcconunc ndmions tothe pare ntofaGrudc 2:srudcmwhohad beenreferredbecauseshewasexperiencing rendingdifflcuhics. Theasscemcmresults were explainedthoroughlyandtheparentWl1Sprovidedwithexphutmiousforthe conclusionsandrecommendations.The intern noticed rhnt lhe field supervisor was directand honest withthe parent and that he avoidedtccbnkul jargon. The pmcnls wcre encouraged to llsk questionsabout the assessmentresults nud rcconuucnd.uicus.
7. Post-assessment interv iewswerc cnndectcdwithparcntsund teachersof'chihlrcn whohad beenassessed earlierbythe intern to discussl1SSCSSll1cnl results and remediation. In the easeof a studentwho was dillgnosed with Auc ntlon- Deficit/HyperactivityDisorder.the intern metwiththeparents.the principulandthe teacherseparatelyto explain the findingsin the report before meeting with them1111 togetherasa programplanningteam.1\11members were encouragedttlaskqucstiuns abouttheassessment process,thediagnosis. andthe basisup onwhich theconclusions and the suggestedrecommendationsweremade.
Theseindividualpost-assessmentmeetingsproved ttl be beneficia lilllhatthe parents andthe school team couldexpress theirconcerns freelywithoutbeinginhihhcd.
Inaddition,itprovided the team withthetime to thinkabouttherccornmcndutiuns before meetingasngroup\0discuss the specificsofUteimplemenllllillnofthe behavioralmanagementprogram.
On anotheroccasion the internmetwiththeGrade 5teacher ut St.Edwurd's
23 Elementary in Brigus\0discuss theassessmentfi ndingsandspecificrecommendations for ustudent whowasreferredbecause of difflcuhlcswith mathematics. There was aSUhS1<l lll ilildiscrepancy betweenher level of achievementinmathematics and that whichwouldbeexpected based onthecsthn atcdovcrnllintellectualabilityIlSmeasured bytheWechslerIntelligenceScale(WISe·IIl). This indicateda need foracademic remediation in mathematicalskills.
The teacherW<lSgiven activitiestohelprcmcdiatc thestudent's difficulties.For example.basedon the diagnosticinterv iew thestudent had learnedthe operational proc edureofmultiplicationundndditlo nwithout reallyunde rstand ing the unde rlying concepts. Forthisreason shesometimesconfused thealgorithms. Theteacherwas providedwith specific remedialactivities tohelp facilitate thestudent's connection between theaddition and multiplicationalgorithms andthemeaning of numbers[i.c.
place value). Inaddition, duringthediagnostic interviewitwasevident thatthe student haddifficultiesill theautomatic recallofheradditionandmultiplication facts.
Theteacher was given some suggestio ns toprovide the studentwithpracticeto overl earnthe math conceptsso thatthe studentwould beabletorecall and uscthem nutommicully. Inordertoprovid e specific interventionsto remedinte mathematical difficutties, itis essential to complete11thorou gh assessmentto identifytheproblem
Goal 4:To developskillsand obtain experienceinthe stylellfwrili ng.used inreports ofpsychccducarionatassessments.
Theactivitiesperformedto meetthis goalwere:
Severalpsychocducntlonalreports011Iile >IItheWestern I\val\111 Ronuni CatholicSchoolBoard were examinedbytheintern,
2. The reportwriting chapter ofSattlers (11)92) Assessment
or
Children(pp.12 ;·
726) was reviewed.The intern usedthe reportoutline assuggested hy Saltier(lI)l):!l when writing thepsychoeducationnl reports.
Theintern wrotcsevenreports Cor10childrenshe hadassessed lluringthe internship.Psychccducational reportswere written assoonaspossibleutter the evaluation had been completed 10 ensurethatimportant detailswerenutfcrgoucn.
Assessmentfindingsthat werenotconsidereda valid ora reliableindicator01' the child'sabilityor hehav iorwere notinterpretedor reported.Furexample,the imcm omitted results obtained onTheRavenStandardProgressive Matrices lilr a (irndcI student becausethe child appearedbored withthetesting situationandhe started guessing answersrandomly. Referencesto the child's bchuvior during the administrationofthisinstrumentwereincludedinthe report(ISfurther confinnution ofthe observationsreported bythe classroomteacher. It wasevidentfrom this experience thal inthe intern'sfuture practiceshewouldincorporate allobservational data sincesuch data offersuseful knowledge .
2S Consultationswith the field supervisorwere heldto discuss assessmentfindings amiintervention strategies.Thefieldsupervisor provided the intern withfeed back throughout the wr iting proc.:ss sothatnecessary revisionscouldbe made.To writea report thatcommunicates the assessmentFindingsclearly and concisely requiresmuch thought,effor tlind consideration.
ImcrvcllIion
(inal 5:Tilprovide directand indirect interventions\0facilitatethe function ingof individuals.
SpecificObjectives:
A. Ttl specifygoals,objectives,strategies.evaluationcriteria,follow-up dates and respons ibilities in order10ensurethat data onprogress arc collected anddiscussed in casesofintervention.
H. Toprovide lnscrviccsfor educators/parentsonprevcmion rlntcrvcnrion matters us required.
The activitiesperformed to meet this goalwere:
",ncrcompleting athoro ughassessmentwhichincludedseveralclassroom uhscrvations. discussions with parents andteachers. and the results from a number of differentbehavioral rating scalcs.fhcinternconcluded thatthe behaviorof'twost udents assessed during the internshipwas consis tentwiththe diagnosis of Attention- Ildid tJl lypcmetivil)' Disorder.Based on thisdiagnosis. the intern de veloped goalsand
~6 objectivesof individualized prognuusfor thesechildren. Also. cvuhunioncriteria.
follow-updales andresponsibilities wereoutlinedinorderto ensurettuudntn\111
progress were collected anddiscussed.For example.theinternoutlinedthelillluwillg three goalsfor a GradeI studentwho wasdingnosedasIHIVing Attention- Deficit/Hyperactivity Disorder:
1. Toimprovesocializationskills.
2.Fo developcopingskills to enablehim\1\lItlcnulImlstayon tasks Ior 11l11gcr periodsof timein theclassroom setting.
3.To reduce disruptive and innpproprinteheha\'inrshy consistently implementingconsequencesdesignedfor srcciflcbchavinrs.
To accomplishgoalI ofthe program, the guidance counsellor wasgivena number ofdiITercntsocialskill training nettvincs
nom
Mannix (199] ) tohelphnpruvc thestudent'ssocialskills.Inorderto accomplish goals2uudJthe intern providedthe teacher witha behaviormanagement planwhich included behavioral raling cardsuml progress charts,See AppendixEfor an exampletil'ahchuvturalrulingcardund:1 sampleprogress chart.The behavioral rating card isatoulwhichcunheuseful inprogramming behaviorchange inan individual. Itcanhemodifiedsuthatthe child nuryreceive feedbackacrossdifferent situations.behaviors. andindividuals.
Theintern foundthai the progress chartservedseveral useful purposes inthe behaviorchangeprocess.Itprovided an ongoingrecord{Ifthe targethchuvinr and il
27 invol ved the child in themeasurementof progress .Italsoencouragedparentstolook positivelyut the child'sbehaviorsand summarizedthecomponentsofthe program.
The nceumulutionof stars.checks or pointsprovidedareadilyavailablevisu al representatio nofwhut was occurring. Seeingprogressinmeasurableterms often servedtoreinforce appropriate behaviors of both parentsandchildren.
Initiully.theclassroomteacher appeared hesitantto implementtheprogramin thatshebelieveditwouldhe10 0time consuming. Inthis situat iontheinternlistened 10her concernsand stressedthe importanceof implementingsucha program.Arter conddcrmgthe assetsandlimitatio nsofthe classroomselting lindthe teacher' s concernsregardingthe interventionstrategy,the intern made some modificationsto the bchuvlorulprogram.Allmembersorthe program planningteam seemed pleasedwith the resultingplan oraction.
2. The internprovidedreachers andparentswithbooks. pamphle tsandvideos regardingAucrnion-Dcficit/l lypcractivit y Disorder andPervasiveDevelo pmental Disorde rsu that theymightgaina betterunderstanding of thecharacteristicsof these disorders.
J. lnfonmuion onremediation techniquesandstrategies wereread,co pied as pcnuiucd lind orgunizcd intoilloose-leaffile for quickreference whileoutin the field.
lhcnuu crinl\\~JSorganizedinto suchcategoriesas:
Rcmlil.J::remediationactivities Spellingremediationactivities
Written language remediationactivities Mnthcm.uicnl rc mcdintion ucrivitics
Generaltechniquesforteachingthelcuming disabledchild Techniques lorhelping theAucntion Deficit child Behaviourmanagementtechniques
Parental suggestionsfor childmanagement pwhlellls Classroom discipline strategies
Socialskillactivities
Strategiesforparentsandprofessionalsfordenlirl!l.withAutismundPervnsive DevelopmentalDisorder
Suggestionsforstudentswith nuditcryrvcrbalmcmorydeficits Death/depression(Helpingchildrencope)
Crisis interventiontechniques
Readingsin AppendixDcontains some of theinfunu.uiou thatIVnsrend mill copiedforfuture reference.
ProgramPlanningand Fvahmtion
Goal6: Toassist in developingandimplementingprogramsunderthesupervision of the school psychologist.
SpecificObjective:
A. Toparticipatein individualprogramplanningteams.
29 Activities performedto meet thisgoal were:
The intern studiedpre viousIndividual Educationa l Progra ms andCha lleng ing Needs DocumentationReports (CriteriaC)onfile attheWestern AvalonRoman CatholicSchoolHoard.
2. The intern assisted in the preparationofa reportfor ChallengingNeeds Documentation underCriteria C fora Grade 6studentwhowas referreddue tohis inability\0cope withthemodifiedacademiccurriculum.The intern realizedthat as pari of the multidisciplinary (cam inherrole asaschoolpsychologistshewillbe required toplayun lmnortantpariin thedetermination oftheappropriate allocation of ed ucationa lresourcesforstudents withexceptionalneeds.
C0l11inuim.: ProfessionalDevelopment
Goal 7;Toactivelyparticipate and engagein activities designed10 continue. enhance, andupgrndeprofessionaltraining andskills toensure qualityservice.
SpecificObjectives:
A. To exploreanumber of assessment materials, journals.booksandother referencesources10develop skills andknowledgeinareas of interest.
n. To expandknowledgeof thcnat ure of a varietyofclinicalsyndro mesand disorders childrenexperience andto becomeawareofthe diagnosticmethodsusedto identifythesedisorders.
C. To develop a louse-leaflile ofdiagnosticandremedial strategiesforquick
.10 reference while out inihe field.
D. To participa teinaninscrviccto enhanceandupgmdcprofessionalskillsin identifyingreadingproblemsiftheopportunityarises.
The activitiesperformedto achieve thisgnalwere:
The internreviewed many journals. booksandother reference sourcesIn developskillsand knowledge in the following arcusofinterest: Ancnnon- Deficit/HyperactivityDisorder.ConductDisorder.Oppositional Dcfunu Disorder.
Behavioral Disorders,SocialSkills Deficits.RClldinl,' Disahilities.Muthcmatics Disabilities.Genera l Learni ng Disabilities,CrisisPrcvention/lntcr vcution. Chi ldAhuse, Autism/ Pervasive Dcvelopmenmt Disorderand BrainInj ury.Sec ApflClIdix11I'MII completelist of readings examined. Thesereadings providedtheintern with opportunityto expandhcrpresentknowledge of the nature of clinical syndromesand disorderschildrenoften experience. Also,itallowed the internIu becomemore familiarwiththe diagnostic criteriausedto identifythese disor derslindco nditions.
2. Informaldiscussionswere heldbetween theintern,thefieldsupervisorandthe educationalpsychologistsat theAvalonNorth Integrated School nnnrd concerningthe assessment, diagnosis,andremediationof ReadingDisabilities, ScotopicSensitivity Syndrome.AttentionDeficit Disorders,Pervasive DevelopmentalDisorder,Ol11duet Disorder,andOppositionalDefiantDisorder.
31 Rc.'>Curch
GoalH:To examinespecialeducationteachers'beliefsaboutstimulant medicationin thetreatment of Attention-Deficit/ Hyperactiv ityDisorde r(ADHD).
The activitiesperfor med to accomplishthisgoalwere:
Theinterndesigned nndadministeredIIquestionnairein orderto collect demographicdata relating 10theparticipants andinformationabouttheir beliefs regarding this pharmaceuticalintervention.
2. Literature dealing with the follow ing issues related to Attention - Deficit/Hyperactivity Disorder(Am ID)wasreviewed:what is ADHD; howprevalent isADI-ID;the causesofADUD;theusc ofstimulant medication asIItreatmentfor
"DJ-ID;the beneficialand negativeeffects of stimulantmedicati on;and theteacher's roleinthetreatm ent ofI\DHD.
3. Regularmeetingswith Dr.JuliaO' Sulliv an,university superviso r,were heldto discusstheresearch proje ct.
4. Data collectedfromtheresearchsubjec tswas analyzedanddiscussedinthis repo rt.
Details ofthe resea rchcompone nt of theinternshipare presented inthethird chapter of thisreport.
32 Conclusion
The nine-weekinternshipattheWestern Avalon Roman CatholicSchoolBourd proved to beahighlyvaluableexperience. Theintern hadthe uppurtunityIn experienceand comparetherole of n schoolpsychologist in a rurulsettingtothutof an urban setting. Basedonthe intern'sexperiences at theAvalon Consolidated IntegratedSchoolBoardin SI. John's,the school psychologist' srole inurural selling seems tobe muchmorediverse inthatthere islessopportunity10specialize inlII1area of interest or an agegroup.Beingresponsiblefor students over alarllcgctl~mphical location.theintern realizedthatto utilize lime cfflclcntly andeffectivelyone musl developgood time management and organizationalskills.
The internaccomplished mostofthegoals she wishedIIIachievedmingthe internshipperiod.The intern becameactivelyinvolvedina varietyofactivitieswhich helpeddevelopandenhancehercompetenciesin consultation,formalnndinformal assessment, and report writing.Also, thispractical experience allowed theintern tn gain further knowledge ofsomeof the clinica1syndromes and disordersthatchildren often experience.Thc intcrnbecamemore familiar with thediagnosticmethods used to identifythesechildre nandthe types ofintervention strategiesused totrentsuch conditions. The research projectcompletedatthe Western AvalonRomanCuthulic SchoolBoardwas especiallyhelpful in makingtheintern more knowledgeable of the assessment techniques,the diagnos ticcriteria and specificinterventionstrategies used totreatAttention-Deficit/HyperactivityDisorder. Similarly.byparticipatingin ease
JJ conferences,re v iewing and~ssistingin the preparationofreportsforChalleng ing Needs ducumcntauon underCriteria C.theinternis11I0reinformedof the process involved in identifyingchildrenwithexceptionalneeds and the resources availableto addressthem.
Althoughthe internwishedto participateinaninscrvlccto enhanceand upgrade professionalskillsin identifyingreadingproblems. thiswasnotpossible.However.the internwas ablelureviewseveraljourunlsandbookswhichallowedher 10 acquire furtherknowledgeinthis ureaas wellasotherareasofinterest. Informaldiscussions wilhthelick!supervisoramithe educationalpsychologists<Itthe AvalonNorth lntcgnucdSchoolBuurdwerealsovery informativeinthatresourceswere shared and discussed. Simi!nrly. although theinte rnW,ISunabletoinscrvicc educators011 prevention and interventionmatters relatedtolearning disabilities.theinternread.
collectedandorganizedmaterials onprevention andinterventionstrategiesforlearning disabilitiesundothertopics of interestso thntit isavailableforfuture reference.
l'hcinternshipperiod provided theintern withtheopportunitytowork with stndcmsofdifferent agegroups HItheprimary.elementary.andsecondary levels.
f\·1any\11"thereferred studentswere ofthe primaryand elementary level with fewer studentsatthejunior andseniorhighlevel. Theintern hadtwoyearsteaching experiencentthcjuniorandseniorhighlevel.thereforethe internfeltthattheincreased exposureto theyounger age groupswas beneficial.Theinternbecamemore familiar withthe shorterattention spansand activitylevels ofyounge rchildrenwhich enabled
herto developmore eot..ctiveassessment techniques.Inndditiou,theli,cttlunmore primaryand elementarystudents werebeing referredIIItheschoolps)·ehtl lu~istfor academicand behavioraldifficultieswasviewedI1llsitivclyill
uuu
ituppcnrs tluu childrenarc beingidentified atyoungerages.This is importantsince intervention techniques appear10be more effectivewhentheproblem ureaisidentifiedand rcmc dia tcdatanenrlyage.A wide rangeof caseswere consideredduringthecourse of theinternship.The interngaineda substantial nmoum ofexperience working with :1I1ddevd Cllling interventionstrategies for childrenwith problems nssocintcdwithinuucnriwncss. distractibility.andtheinability tosustainuucntlon. Similarly.theinternhndthe opportunity to assessandprovide teachers'Intipurcntswith specifie imervcmiul\
activities forchildren who were experiencingacademicdifflculucs in readillg.wriling.
and mathematics.
In conclusion.the internshipoptionproved toIll.: extre melyworthwhile experienceand playedan importantpan mthcintern's overalldevelo pmentas afuture schoolpsychologist.
CHAPTERIII
rru:
RESEARCII PROJECT: SI'ECIALEDUCATiON TEAC HERS'RELIEFS ABOIJTSTIMUI.ANTMEDICATION IN THE TREATMENT OF Ar rENTION- J)EFICIT/IIYPERACTIVITYDISORDER (A01-ID).Summary
'l'hcpurpose ofthisresea rch projcctwastoexamin ethebel iefsofthe special educationteachersatthe Western Avalon Roman Catholic School Board abouttheusc or stimulant medication inthetreatment of Auemion-Dcficit/llypcractivlry Disorder (AOIJ[)). Inparticular. their beliefsabom: (I)the adequacyoftheir university educationand pmfessional developmenttraining abouttheuse of stimulant medication totreat ADIID:(2) the natureof ADl-ID;(3) theeffectivenessandlimita tionsof stirnulammedicationinIhe treatment of ""'.111-1 0;and (4) the true[i.c.•establishcd)and false(i.c.inotcstabllsltcdl cffccts of'sdrnulantmedicationwereexplored.Twenty-three teacherscompleteda J6-ilemquestionnairedesignedtomeasuretheirbeliefs.Findings indicatedthat most ofthespecialeducationteachersbelieved that they hadnot received udcq uutctrainingabouttheuscof stimulantmedicationin thetreatment ofADI-ID.
MUSIteachers bcficvcd thurADI-IDisamedicalcondition and thatmany childrenlire diagnosedwith thisdisorder whodonothaveit.Those beliefs arcconsistentwith current research. Theteachers didnotdiscriminate betweenthe true vers usfalse effectsIII'stimulantmedicationand,althoughthey believed thatthis treatment is llssnciatl'dwithnegative side-effects.they didnot recognize what most ofthose side-
36 effects are. The implicntious of thesefindings forthe educationllfchildrenwith ADIIDare discussed. Rcxonuncndarions fur iuscrvicctrainingtil increasethesespccinl educationteachers'understanding inthisureaareoutlined.
lutnuluction
Thissectionisorganized as follows. First. Attention-Dclicilll lypcractivity Disorder (ADI-ID)is defined andprevalencestatisticsme present..-d.Theil. researchon thecausesofAttention-Deficu/llypcractivity Disorder(ADI[IJ)is sUlIllllariz..'tL Next.
theusc of stimulant mcxlicutioninthe trcutmcntof AUl.'ntion. Dclicitll lypcmdiv ilY Disorder (ADIID),andthe bcncflclalandnegativeeffectstlfthoselllcdicatiullsnrc discussed.Also.the limitationsofsnmulam medicationas1Itreatmentfur Attention- De flch/HypcractivityDisorder(ADHD)medescribed.Fin:llly. the tellchcr' s rillein the treatment ofAttention-Dcficlt/HypcmctivityDisorder (ADI]]))isoutlined.fnlltlwedhy the purposeof thepresentresearch project.
WillI!Is Altcntion-Delicit/I'YQCr:lclivjly Disorder"
AUcntion-Delicit/l-lypcractivity Disorderthcrcnncr referred10 as AUIlf) is defincdas a persistentpaucrnof inattenti onand/orhypcructivc-impulsivchchavlnrthat ismorefrequent and severe thanis typicallyobservedinindividualsatu comparable levelof'dcvelopmcnt (American Psychiatr ic Assnciulion, 1994,.Accurdingtothc1C)I)4 AmericanPsychiatric AssociationDiapnnstic:mdStlltislica[M'Ulllal
or
Menl:tl37 Pi!'iunlcrs..FourthEdition.(DSM.IV).adia gnosisofAm IDrequiresthai: (a) sym plllmsrntritbepn.-scnl before age7:(b)there:mustbedeareviden cethatlhe symptomssignificarlllyInterferewithsocial.academicoroccupatio nal developmentand functioning; eel thesymptomsmustbeprcscnt inIWOormore settings{e.g.•atschool andalhorne]and generally.they worsen insituationsthai req ui resusta ined allention or thatlackintrinsicappealornovelty;and(d)symptomsarenotprimarilydue to a psychotic(e.g..Schizophrenia)oranother mentaldisorder(c.g.•Mood Disorder.
Anxiety Dis order,DissociativeDisorder.ora PersonalityDiso rder).
111the[)S M· [V.18characteristics ofina ttention.hypcmctlvityandimpulsivity arcdescribed,andtobe diag nosedwithADHDa childmustexhibi t atleastsixof these characteristics .For exa mple. manychildrenwiththis disorder do notseemto listenwhenspoke ntodirectl y andoftenappearasiftheir mindis some where else.
Manyoften failto pay alieniionto derails, makecarelessmistakesin schoolwork.have difficultyconccnrrnting ontask s.andoftenfailtocompletetasks. Thesech ildren often experiencedifficult iesinorg enizingtasksoract ivities.tend toavoidor haveastrong dislike furactivitiesthatrequiresustainedmentaleffortsuchasschoolworkor homework,and losethingsnl'CCSS3ryfortasks oractivitie s suchasbooks.pencils.
tools.etc.Childrenwiththisdisorder maybedistractedbyirreleva nt stim u liand may frequentlyinterruptongoingtaskstoattendtotrivial noisesor eventstha tareusually igno redby others(e.g.• a background conversation).Thesedifficultiesareevident in academic.social••tndoccupational contexts (A mericanPsychiatric Associat ion.1994 ).
If h)'pcn:tclivilytsprcscru. itmaybcmanif..'liI ..-dhy!illlc'l..1in..-ss. r.1i1ingromnain seatedwhen expected10do so.excessiverunning.ordlml'li n~lll"f'\.·arinl!IIIhe"dr iven by a motor" ortailingexcessively.These children\\;11often illuri\lut answ ersIdi. r..•
questions have beencomptcrcd. TheymarhawlIiOic uhrmm ilingthe irtumin activitiesandmayinterruptorintrudeonothers (e.g.. bunintl1 al'\ II1\'C1'N1IMIl 1ur game),
HowPrevalentb Attent ion-Dcfk it/ilyncrilctivityDisllrsh;r"
Theprevalenceof ADHOistypicallycsthuut..'d10bebetween.lh.S a;.Ill'all school-ag echi1~rcn(AmericanPsychiatricA!l...;o d atiun.IC)1J.l).tlowe vcr,dCflCll..ling on howthedisordcris defin...rd. prevalcn cestarisucs range (film<1%til1::!'JI.llfthe schoo l-agepopulation(Frick&Lahey_1991). Accllrt.ling\0 'Illestimat eIlythe Nationallnsti tuteofMentalHcalth(Ila ncock.19( 6). onesndcm in"''V\.'f)'da.'\SRKIIlI is affected byit Males arc510 10tim es morclikely10he dia grm...-dtha nf"'IIlilles (Glow,1980;Ilclborcw.Berry.&Elkins.1984 1,
ADHDisbcingdiagnosedwithincn..::asingfrequency inchiklrcnudolcecnts.
andadults[Shaywitz& Shaywitz..1991).tlnwcvcr .conside rablede b ateremainsabout thereliability andvetidity oftheconstructitselr.ubomthelIiilgllllsticenter!ufiN'Ihis disord er,and aboutitsdiagnosisin individualchildren. Furexample.uucntion disorderscanbe difficult to distinguishfromlearning disahililicx,emotiunal pmhlcms, badbehavior. poorparenting, overlystre-ssfulenvironment...;.demandingSCIIlKlls.
39 lazi nessandlack of motivation (Copeland ,1991).There isgrowingconc ern inthe men tal hea lt h communitythurfora verietyofsocial.educationa l,fa m ilial and psy chologica l reasons, the diagnosisisbeing increasing applied tochild ren whose behavior linddevelopmentdonotwarra ntit(Hancock.19 96}.
WhatCnuscs At\clltion·nclicitll lyrcract ivityDisorder'?
Dccudcsofrc sc nrch have failed to identifyDspecificcause. or groupof causes.
Ill'ADlm .However,researchhasruled outcertainvaria blesasprim ary andsufficien t causes.These include:the consumptio nofsug ar,food additives end dyes, vitam in deficiencies,leadpoisoning. perinatalinfluences,birthcomplications.braindamage.
and inappro pria teparenting (I-Iusl,1994). Alt houghth e sevariablesarcnolong e r consideredsufficientcausesof A01-ID.insomecasestheymay combinewithothe r variables10bringabut AD IID.exacerbate ex istingADHD.or cause ADI-II)·li ke symptoms(Amaya-Jackson.Mcsco.McGough.&Cantwell. 199 2;Barkley,1990). Recently.increasingfocus has beengiven10biologicalvariablesaspossible causes(11'AD I11),Forexample.somere searcher s arcinvestigatingthehypothesisthat AD I-Inmaybeihcresult ofaninheritedtende ncy towardsdopnmincdepletion.or unde ractivit y inthose parts of thebrain affect ingattention. response inhibitio n (impulsivity),andsens itivityto thebehavioralconsequences(Amaya -Jacksoncral..
199 2: Barkley.19(10). Otherresearch er sarcinvestigating the chemicalbalanceof ncurounn srn lncrsinchildrenwho arcdiagnosedwithAD HD.Thereis someevidence
'"
that somechild renwithADiID nmyhave nnine ff iciency or imha].mccufscvcrul neurotra nsmitters(Bust.1994)andIUIVe I(J\\w glucose metabolism intheir-lvnius (Zamc t kinctal. , 1990).Similarly.thereis tcnnuivc evidenc eofllo.'c rc'lscdblood[lnw 10the st r iatum andprefro ntalreg ions01'1110.)' bruinsofsmncchildrenwithAI)! I!)[Lnu.
Henrik se n,&Bruhn. 1984; LOll.Henriksen.Bruhn.Bomer.&Nielsen,IlllM.Overall.
itappearsthathinlo!,!ical factors11111yptn y a roleinsome casesofAUl ln hulnor others. Furthermore. even whe nbiologyis im p licated then:is no evide n cetlau biolog ica lvariablesnrc sufficient10caus eAIl/l D. Instead,blulogjcnl mcclumbms interact with psy chologic al and environmentvnriubles[0producethe symptoms01"
ADHD(Jacobv ltz.Sroufe.Stewa r t.&Le f fe rt,IQ( 0 ).Clcmly.considerable re search isneed ed 10eluc idatethecnusnlvurieblcsand!"a thwuysinv olvedin1\[)1I1l.
HolV Co mmonIsThe UscOfStimuluntMl'tlk ationTnTrcul
Allcnti o n-Dclic it/l-ll'ncrnc til'iw Disorder?
Theprescription ofstimula ntmed icationsisthemo stfrequentlreillmenl li,r ADl-ID in theUnitedSta les. Be tween70% lind NO%uf childrendingnoscdwith AmID arc treat edwith stimulant medica tion (Burkley.1(77).Acc ording tu Siller (1988). thismean sthatapproximal cly 3%orrhcelementar y sthuol pupulntlon in the United Stutes.overI million children . istrea tedlor I\llll)) with stim ulants. Unfortu nately. there are no publis h ed stat istics on thenumber uf ch ild ren diagllllSCu withhDI-1I)or beingtreated withstimula n tmedic a tion in Ncwlenndl und,
41
Theueccstimulantmedicationsusedmostco mmonly 10 treatAIJHDan:
me thylphenidate(Ritalin).dcxlrOOm phl.'larninc(Dexedrine)andpemoline(eylcl'll (Du Paul.Burkk:y.&McMurrny.1991 ). Or these,Ritalinisthemost commonlyused andi.~flrt:scrilll.')formorethan90%ofchildrcnreceivingstimulantmcdications{Safer
&KrJI;I.1'.J911K).Between4%and 6% oltho sconstimulantmedicationforauention tJisun\c1Sarcrrt.oscrih,:dDexedrine(Safer&Krager,1988;VirginiaDepartmentof Ed ucation. 1(91). Cylcrtistypicallygiventochildrenwooarcunresp o nsive to the traditional stimulan tsu'opchmd.19 (1).The United Stares Drug Enforcement AJminislr..-innhasclussiflcdbothRi talinlind Dexed rine asSchedule IIcontrolled :iuh:-;lall\:Cswithlegalrcseictions onusageandprescript ion renewal.Th erefore,their uscisml.lnilon.-dhyphy~icians aswdlasdrugenforcementagencies{Copc land.1991:
Hancock.19%1.
lkuhRitalinand Dexedrine arcavailab leinshcrt-ectlngandsustuired- release forms, nil:~hut1·aclinl:formisedminiacredmorefrequentlythanthesesaincd- rclcuseIorrn:li~ii'seffectivenessdiminishe smorere adily.The short·actingfo rm isUSU<lUytakentwicea dayalk! thesustained-releasefo rmistypicallyadministered (IIICCdaily(Cufll.·land.19Q1). Resea rchershavefoundthatsustained-release Ritalin mil)' helesseffective thantheshort-a ctingfor m(Pelhamcrat.. 1987), Therefore.
phPlicillnSarc1111ln:likely10 recommend theshort-actingformexcept insituations wherein-sehoulndministration
or
thedrugis problematic(e.g..110school nurseis ll\'ail'lbk10dlsrcnscthemed icationorwhereteenagersrna)'beproneto leasingbypeers ) (Pelha rnctnl.,1(87).
RitalinandDexedrineme typica llyinitia tedinsmalldoses.1l~llnllyat5mg (Copeland.19 ( 1).Because theydo notbuill! up intheMood srrcmn.Iheireffects nrc oftenobserva blefromthefirstdose.The dosagecan heincreasedeverythreeInseven daysor mere gradua llyuntil themostthcmpcuticlevel
or
medication has1....'l.·11 determined(Cop eland .19(1).Theumoumof mcdicutioutlun<lchillitakesdepends011manyvariables.incl udingthechild'sgeneralsensitivity to Ihe dyesillrhctah!l:ls and his/hermetabolism(Copeland,1<)91).
Onceachild's"optimal"dosageis established.Ritalin ruul Dexedrine ;Ire usuall ydispensedtwice a day (athrenkfasrnndlunch).Mcdlc.uionisgcncra llygiven atoraftcrme alstoavoidcomptlcntonsInvolvingappetite11lSS.sromachuches.;ll ld
headaches(Copeland.1(91).AnolherreasonI'mthisadrninisrnuion scheduleislhat thebehavioraleffectsofhothRitalinandDexedrineuppcurto peak betweenIami2 hours post-ingestion andtodissi pate within4 III 5hours{Donnelly&Rapopurt .19115 1.
Cylcr tisusually adm inistered inthe murning wuhbehavioraleffects !lIsting appro ximately 7to8hours(Donnell y&Rapoport.19K5 ). lJnlikc Ritalinnud Dexedrine. Cylert mustbe givenon weekends IIImaintainit' s effectiv eness during the schoolweek (Copeland.1( 91).
SinceI<)IJO. the numberofUnited Stales ch ildren takingRitnlinhill'grown 2·112 limes (Hanco ck.19 96).Accordingtil the UnitedSl;llesDrug Enforcement Administratio n. prescriptions of Ritalinhaveincrea sedmore
unm
600% over thcPJ-ISt43 Iivc years(Bailey.1995).The rateofRitalin usc inthe United States is at leastfive umcshigherthan inother countries,forexample,the UnitedKingdom(Hancock, 1996).The mainreasonlo rthis seems 10bethatin theUnited Statesthe diagnosisof ADII])may belipto20timeshigherthanin theUnited Kingdom .However,when thediagnos ticrate is controll edthereis lillie difference in the percentage ofUnited Slatesvers u s Britishchildren whorece ivestim ulantmedication (Taylor,1988).
What Arc TheBeneficialEffectsorStimula nt Medicati on'?
Themode of action of stimulant medicationisnot completelyundersto od.
However. contrarytopopula r belieftheir effect s on childrenwithADHDarenot
"pnradoxic nl", That is, childrenwith ADl-1D de monst rate simila rphysiologicaland behavioraleffectstostimulant medication aschildren withoutAD HD(Rapoport etat..
1( 80). Sti mulantmedicationcannotcureAD HD bUIsometimes ittemporarily moderate s the sym ptoms. Stimula nt med icat ionappearsto heeffective for upprnxinuucl y 70%to 8()f/oofthechildre nwho take it(Barkley,1977).Theremainin g 20%to30%eitherexhibitnoresponse orthe irAD HD symp tomsworsenwith treatment,thusindicatingthe need(oralternativemedicationsortreatmentapproaches (Barklcy.1976: Safer&Krage r.1984).Becausemostchild rentreat ed withstimula n ts linnulcontin ue10uscmedicationbeyond aj-yearduration (c.g.•Satterfield, Cantwell,
&Satterfield.lQ79;Sutterfield. Satterfie ld,&Ca ntwell.1980.1981) lind beca useha lf uf allchildrentreatedreceive only one prescripti o n(She rman&Hcrtzig,1991).littl e
isknovv" about the IonJ:,-tcrmeffectsorthisucarmcru.C(lll:-"·l.\lll.'lll y_1\.1lUriSllrtho:
beneficialeffects orstimul;mlSshouldbeinterpretedwith..:tmtiun.
Thebeneficialeffectsof stimulantmedicatio nsincludeincreasedl11ili nl cn:IIII.'l..·
or attentiontota sks(Douglas. Barr.D'Ncill,&Britton19R6~ Rapport l1ul.,IIIHR) noddec reasedim pulsivert..'Sponding(Brow n&Steerer .lint);RJf'l(1O rI~"1al..)lllt7).
Further,thesemedication s significantlyreduceanumberof tuskirrelevantuctivltics suchasfidgetiness andlingertapping (Cunningham&Barkley.ICJ79).Problems with aggression{Klar manctnl..ICJHIt). classroomdisruptivebchuvinr(Barkley, 11)7 1) ).uud noncomplianccwithautho rity ligures(Barkley,Karls son Strzclcck.&Murphy.11)H4) have alsobeenshow n10 improvewiththesemedicat ions.Furthermore.childrennrc round tobelessag gressivewithothers,behavemore uppmpriutclywithotberchildren, and10beaccepte d10 agreaterdcgfC\lby theirpeers(Cunningham.Siegal.&.O!Tllnl, 1985;Pelham&Hcza,1987;Whalenetal., 1989).However,thl,:scdiffcrcrccsinp:t..T relationswere foundonly ina highlys1ruC!UI\.'iJ. simulatedschuill sellingand nlltin Irce playand cooperativetask settings.
\\IbMAre Th£NCI'.:l tiveSide-Effec tsorStimu lantMc ujclIt jn n'>
Transient sideeffec tssuch as headaches.stom aclnchcs.decreased appetitennd sleepproblems mayoccurbutortcnsubsideifmcdicaioniscontinued (Copclmlll, 1991).However,someside effectsdopersist. Themosrfrequ entlyreported:Il..lvcr.;c reactions arcdecr easedappetite.insomnia. stomach pain,hca dachl.'S.,irrimhility and
45
weightIllS'!(Ka~ICn.Coury,&Ileron, 1992).Also.recenteviden ce suggeststhat stimul<lnlsmayhave n nq;ativc effectongrowthand precipitate motorticsand Tcurenc'sSyndromc(Copcland.1991).Motorticsan:involuntarymusclemovements such aseye-blinkingorgrim:x:i ng.II is estimatedthatl% ofchildrcntreated with stimulantswill dev elop atic disorder.lindthat in 13% ofchildrenthesemedications maycxacctercpre-existin glies(Barkley.1988).Thereisconsiderab leevidencethai child re nwitha family historyofliesorToercttesSyndromearemore likely10 develop them(Copeland.1991).
Lethargy.depression. becoming "glassy-eyed"or"zo mbie-like"nrcnotside- dTccts ofthemedication.Rather.theyindicatethateither the dosag eof med ication is100high.the childis onthewrongmedication forADHD.or the diagnosis is incorrect(Copeland.\')91).IIis crucialthatneitherperemsnor teachers believe!hat theseoresideeffects whichmustbe toleratedtogainthebenefitofthemedicine.
Childrenon appropriatemedication neitherhavepersonalitychanges nor dothey bccorrsc depressed(Cop.:huv.l.1991).Rather.theyare\'Cf}'much them sclves butmay havethcabilityto conce ntrate. controltheirimpulse s. and haveItmore appropriate activity level(Co peland.19(1).
Clinicalreportsindieutcthatsome children.especiallythose with pronounced hyperactivityand impulsivity.may exper ience increasedhypernetivitywhenthe medicinewearsoffThiseffectis calledthe"reboun d"andisobservedin arelat ively smallpercentageofchildrenwhotakeRitalin(Copeland.1(91 ).Itcanbemanagedby
