CENTRE
by
TinaR..Parsons, M.Sc.
AT~:~::~o~~~~~~~uate
requirements for the degree of Master of Education
Faculty of Education Memorial University of Newfoundland
May 1998
Thisreportdescribesan internsb.ip at theCalgaryLearningCentre. The report detailstheinternshipanda research componentwhichwascompleted at the internship site. The goals of the internshipincluded: development of psychometric skills and report writing, development of individual counselling skiUs. increasing the knowledge of cwrent intelligence, interest, achievement and diagnostic instruments and conducting research ontheeffectiveness of the problem solving strategiesusedat "Camp ADDventure",
Thetwelve week internship was completedat the Calgary Learning Centre, locatedinCalgary, Alberta. There was extensive opportunity to meetwiththe professional staff about services offered at the Centre and to gain insight into the varied theoretical perspectives of each psychologist. Throughout the placementtheinternmet withandprovided psycho educational assessmentswithfour staff psychologists.
Much aCthe intern's time was devoted to researching the effectiveness of problem solving strategies used at Camp ADDventure on increasing socially·appropriate and self- corrective behavioursinchildren diagnosedwithADIHD.
encourage the life-long pursuit of knowledge.
rextend my sincerestthanksto theCalgary LearningCentreandthestaffwho participatedinthis study. I woulde~iallylike to thank my on-sire supervisor, Dr.
Anne Price,andmy faculty supervisor,Dr.Gary Jeffery, for their support and guidance.
Last,and perhaps most importandy,l extend mythanksto the parents and children who participatedinCampADDventureandso willingly allowed me to conduct research.
iv
NOTE TO USERS
Pagels) missing in number only; text follows. Microfilmed as received.
v-vi
UM1
Abstract Dedication Admowkdcemeats List of Tabla
PART I: INTERNSHIPCOMPONENT 1.1latroduction
-Rationale for Interu.hip -Introduction I.2 SettiDC
-Criteria~orSekdinCIntenuhipSettiDc
• DcKriptioD. of latenub.ipSettiDC - Listof StaffElllployedatSdtiac -Descriptioa ofServicesOffend atSettiDc 1.3Supervision
..supenisioa of latent 1.4Goals for Iatcnubip
-Goal I -Goal 2
Page
iii
viii
,
.11
13 '4
-Goal3 -Goal' -Goal5 -Goal6 -Goal 1 -Goal8 1.5 Coac:huioa
PART 2: RESEARCH COMPONENT 2.1Overview
·Ratio••le tor Research Compoacat -ReNanb QaatioDS 2.2 Review oftlae Litenture
·Desuiptioa of CbildreowithADIHD -social Skills: ProblemSotviDgAppro.dles...
.V.lae of Summer Camps
1.
1.
IS 15 IS IS 16
18
I'
20 21 21 26 30 -Structarelpurposeore.lpry LearaiDl Cnrn(CLqCamp 32
-TraiaiDCofCLC Camp CoUllSdors 33
Pre-aIDP 33
Oacoiag Activities J.4
viii
-OVerview 3S
-GelleralGroap lDfo...tioa 3S
·ActivitiaOfferedby
nc
Camp J6-Gatberia& ofData 37
-AnalysisofData 38
2.4 Resultsud Fiadiap
-Fiadinp 01Study 40
-Commeats ODFLadiDp 41
-Commeats OD ADecdotal Data 42
25 CoadasiollS,.lDterpmatioDS, aDd RecommeDdatioDS 43
·LimitsofStudy 45
Relerea«s 48 .
Ap_
52be
Page Table1.Meu NQ.IIlberofSociaUy appropriate aad sdf-cornctiYe 42 bt:bavioan dilpblyltdbycampen over tbree weeks.
INTERNSHIP COMPONENT
Ratio_ale forIIItlEruiaip
The decision todoan internship came after much intema.l debate and deliberation.
Guiding the intern's thoughtsweremany factors, including the opportunity to workwith experienced psychologists and to receive further guidanceinshaping her own skills as a psychologist. Much aCthe intern'spastexperience bas beeninexperimental psychology so an internship affords an excellent opportunity to develop applied skillsinanticipation ora career. The main goal of the internshipwasto further enhance the intern's skills as awould bepsychologist. The intern also soughtinsight into the concerns of professionals workingwithchildren/adults who have been diagnosed as having ADIHD andlor learning disabilities.
This interest:wasreflectedinthe project completed during the internship.
IDtrodadioa
Memorial University of Newfoundland offers aRW'llbet"ofoptions to those seeking to complete the Masters of Education (Educational Psychology) program.The options are a thesis. project, paper folio or an internship.Theinternship period is len to thirteenweeksinwhichtheinterngains pmctica1 experience in their chosen field of study.Duringthis time the intern willwork.toward achieving individually set goals while receiving continuous feedback from the facuIty and on-site supervisors.
appropriateness oftbe internship as a supplementto the academicandprofessional trainingforthepsychologist..
I.ItcaDcommeoce only after satisfactory performanceisachievedinanapproved practicum.
2.Itcommences only aftersuccessfulcompletion ofallcourse work required for the degreeprogram asdefined in the University Calendar.
3. Firstconsideration willbegivento candidateswhohavehadlittle experience: inthe working milieutheywill enter.
4. Interested students must submitandhave approved by the Faculty of Education. a formal internship proposal. including among other points, a statement of professional goalsand expectations for the internship.
5.Anintern must be enrolled full-time during thetimeofher internship. She: may not receive reimbursement for servicesrendereddtDing internshipbutwillbeeligible for fellowships and assistantships asprovided by university regulations (Faculty of Education, 1996).
Criteria for
Sdectiac
IatenulUpSettiIIcTheguidelines forthe Internship Programme. as out1iDedbythe Faculty of Education(1996).statethattheinternshould workwith. wide variety ofclientele to furtherenhancesJcillsinan area orwith • populationinwhich the internwillworkinthe future. When choosing a setting,ODemust assess the foUowing considerations:
I.Thequality of professional supervision.
2. The quality of learning opportunities and experience.
3.Therelevancyto, aDd usefulness ofsuchexperiences inthe actualsetting in which theintern ultimately expects toWOIk..
4. Tbeavailabilityoftimeforfull-timeinvolvementoftbe intern foraminimumorlO consecutiveweeks.
S. Availability of aqualified field supervisor on·site.
6. Ready accessto the university supervisor.
Provision shouldbemade whereby the internhasopportunityto integrate theory and pnteticeunderthe guidance ofskilled practitioners.
Whatfollowsis a descriptionoftheiDtemsbip settingc.bosc:n,a listofstaff employedatthe setting.,aDdthe services provided by thesetting.
TheCalgaryLearning Centre (CLC)wasthe chosensiteforthe internship placemcnL1bis sitewas~forthefollowingreasDl1$.Itofftted:
I. Quality learning opportunities and experiences. Includedwereopp:>rnmities to use and study a variety of psycho educational assessmentadministratiOI1$and styles ofreport writing.
2.The:opportunity to workaspartof an interdisciplinary team which consisted of trained psychologists. social workers, educational consultants. and a paediatrician.
3.Theopportunity to participate in Camp ADDventureYlithskilled professionals (for example, psychologists and counsellors).
4.Theopportunity toworkYlith bothchildren and adultsYlithpossible anentionaJ or learning disabilities.
s.
The:oppommitytodirectinitialiDtake iDterviewsforadults iDterested in counselling or assessments for leamingfanentionalproblems.The CalgarySociety for StudentswithLeaning Disabilities operatesTheCalgary Learning Centre (CLC), which isanon-profit, charitable organizationlocatedinCalgary, Alberta. ItopeDedinDecember, 1979withtheprimarygoal of improvingservicesfor people with learning difficulties. The Calgary Learning Centre is a joint project of the Alberta Children's Hospital, Alberta Vocational College, CalgaryBoardof Education, CalgaryCatholic Board of Education, Calgary Health Services, Kinsmen Club of Calgary,LeaningDisabilities Association of Alberta (Calgary Chapter), University of CalgaryaDdFriends ofthe Leaning Centre. Support forThe eLCcomes from Alberta Education, the sponsoring agencies, specific project grants from local, provincial and federal agencies, fees for serviceand donations from the conununity. The mandate of The CLCis threefold: research, professional development and service to clients.These three spheres of activity are carried outina highly integrated manner to ensure continuity betweenknowledge generated inresearch,experiencegainedinclient service and the content of professional education program
List o(StaffE.ployedby
SdtiDc:
Belowisalistofstaff attheCLC. whichinsome cases includes a listing of spcciaIinkrestsoftbe staffmcmber{Asterisksindicate:personstheinternworkedmost closely with}:
• AnnePrice (Executive Director) Cbanered Psychologist
'ShawnCrawford(CharteredPsychologist) Adult and children leaming assessments Counselling both childrenandadults
KimberlyEckert (Cbartc:redPsychologist) Counsellingboth childrenandadults Adult and children assessments Oppositional defiant disorder Gifledn."
C4nttoctual
-RitaHumphreys (Language/Leaming Clinician) Reading, language, learningmainlywithchildren
Gillian Hutton (Psychologist Assistant)
*MelanieLoomer(Chartered Psychologist) Adult or children ADD cases Emotional assessments I.Q.t<sting Counselling
Susan Maunula (CharteredPsychologist) Contractual
Children assessment Attention clinic
Ka=Se=t(Clwt=d P",clwl",",,) I.Q.tests
Consultation
Adult. adolesccot. child educationalissues
-Gayle Reid (Educaliooal Consultant) Adult learning assessments R<a<ling,leaming
Simone Shindler(Social Worker) Adult or children ADD cases Family interviews School observations Attention clinic Counselling adultsandfamilies
GttaldineFurelly (paediatrician) Attention clinic
foUowing services:
Intake·Thepurpose of the intake service is to provide information to prospective clients.
friends, parenu and professionals about Calgary Learning Centre servicesandthe appropriateness ofa referral here. Depending on clientneeds., the callers maybedirected el.sewbere.Calliare initially scrceoed by the Intake Worker.
Assessment· A multi-discipliaary staff is available toprovideasscssmenU on a fee-for- service. or contractualbasis., to clients from the ages of 5[0adulthood. to explore reasons for difficultyinschool or in the workplace. Assessments which are focused on a particular area (such as reading. anention, numeracy. language) mayrequire8·10 hours while fullin~epthassessments can take up to 15 hours. This time includes preparation.
assessment, report-writing and feedback.Itusuallytakesapproximately 6 weeks from the time oftbe first appointment to the feedback.interView.unless otherwise arnlllged.
Consultation - This service is offered on a fee-for-service, or contraetual basis. to dienu.
family members. employers and/or other professionalswhowishto consult with a member oftbe Client Service Team. Reasons for this may be a desire on the part of the client for "advice6as to thetypeor location of the most appropriate service. Often clients
willhave previous assessmentdatawhich can form the basis for the problem-solving.
Consultations to professionals mayCODCem interpreWiODoCbebaviour or test data ofone oftbeircliezus.ThisservicecaDbe carriedouton·site (e.g.ataschool.workplace. or other institution) atthe:CLe,or00thetelephone.ifprevious financial anangements have been""""'.
Programs -Manyprogramsare offered attheeLC to children and/or their parents, to adultsand their spouses aswellas to professionals. They arebasedupon client need.
interest.andthe availability ofstaffexpertise. Some are offered free-of-charge, but for most programs fees are charged.
Counselling - Services are available on a fee-for-service basis for individuals and families whoselaming and/or anention issues impact heavily on their daily functioning. Calgary LearningCentre staff arealsoavailable to consultwithcounsellors. social workers, and psychologists who are counselling individualswithlearning difficulties.inorder to promote professional developmentinthis area.
Tutoring - Services are available for kinderganen to adWL lndividual tutoring and small groupsare offered.
Attention Clinic - Provides a range of services to families of chiJdrenfadolescents who have anentionaJ difficulties and who arefaced witha unique set of problems: academic, sociaUcmotional. behavioural.andmedical. Services include a diagnostic service.
Supe:rrisioll of hltcra
The supervision oftheinternshipwasthejoint responsibility of Dr. Anne Price andDr.Gary Jeffery. As outlined by the Faculty of Education (1996), the selected field supervisor met the following criteria:
L Shepossessesa Master'sDegree oritsequivalentappropriateto theworkoftheintern.
or equivalent and appropriate c:xpcriences as determined by the Faculty of Education.
2. Hada minimum oftwoyears experiencein thefield as determined by the Faculty of Education.
3. Was involved full-timeinthe placement setting.
4. Hadsufficient time., as dctenninedbythe Faculty of Education. to consult reguJarly 'Niththegraduate student.
TheUniversitysupervisormetthereUowingcriteria:
1. Was professionally trainedin thearea ofschool psychologyandindicated an interest in psychology training.
2.Hadsufficienttime, asdeterminedbytheFaculty,tocoosult regula:rI.ywiththe intern.
J.Inconsultation with the fieldsupervisorwasresponsible fordirectingthe preparation and evaluation oftbc report on intern activities.
Peno....Goals(or~elatenlsbip
Theinternship was completed primarily becauseitallowed the intern the opportunity to gainfurtherc:xpcrience and professional competenceinthe field of psychology.Theintern.identifiedeightgoalsforherinternship placemenL The following is a statement of these goals alongwitha description ofactivities undertaken to meet lhesegoals.
Goal1: Togainfurtherpracticalexperienceinpsychological assessmentandreport writing.
This goalwasaccomplished through the following activities;
(I) The intern observed (for about 10 bours) other staff psychologists administer a variety oftests,some ofwhicb included theWISe-ill.WlAT. and the Standard Progressive Matrices (dynamic administration vs. standardized administration).
(2)Theintern reviewedreportspreparedby otherpsychologists.Approximately two reportsperweek over fourweekswere reviewed.
(3)Theinternwasactiveinthe administration and scoring ofbothpreviously administeredtests and a number of previously unfamiliar tests.~intern administeredthreeWISe·m.twoWIAT.ODeLeiter, one Piers-Harris. two Kaufman TestofEducational Achievement (K-TEA) and one Social Skills Rating Inventory(SSRJ)assessments.
Theinternwasalso activeintheinterpretationand report-writingassociatedwith these assessmentsinconsultationwithpsychologists.Theinternplanned andcompleted two psychoeducational assessments whichconsistedof a completebatteryof tests including measures of achievementand intelligeoce.Theinternalso explainedresults of assessmentstopumts.Psychological reports included recommendationsandwere forwarded totherefenal source.
Goa12: Togainexperience as a mem.berofaninterdisciplinaryteam.
(I) The intern workedinconsultationwiththe social worker. educational consultantsandother psychologists.
Goal 3: To conduct field observations.
(1)Theintern conducted fourdassroom observations, interViewedtheteachers andwrotetheaccompanyingreports.
Goal4: Togain experiencein"IntakeProcedures", as relatedto individual screening.
(1)Theintern conducted 24 adult intakeinterviews from May 27 - June 13, 1997.
GoalS:To have field supervision.
(l)Theinternmet weeklywithfield supervisor forODebour. As well. incidental contactswiththefieldsupervisoroccurred on a regular basis.
Goal 6: Togainexperiencein theadministrationandorganiDtiODora non-profit ageocy ..aing.
(I) Staffmeetingswereattc:Ddcdon abi-week1ybasis.The agttJdausuallyl included approval of prior minutes. business arising from minutes.
correspondcocc, current reality. staff reports,assessmentupdates.future programslworksbops., and committee reports (client services technology, consultation, ethics. intake. library,prognms.social, and staff development).
Goal7: To learn about the nature and treatment of children diagnosed ashavingAnention Deficit! Hyperactivity Disorder (ADIHD).
(I)This goalwasmetthroughthestudy which the intern conducted (see Pan 2 of this report), andbyday to dayCODtactwithADIHD children.
Goals: To complete a study00the effectiveness ofproblem.solving strategies on increasing socially appropriate and self.corrective behavioursincampers.Arepon of this research canbefoundinPart 2 of this report.
Thisgoal was accomplished through the following activities:
(I) Anindependent study of strategy developmentinADIHD childrenwas conducted three days a week forthreeweeks at the internship site.1be literature review consisted of examination ofjoumals., articles and books related to the use of problem solving strategies with children who had been diagnosed as ADIHD.
(2)Theinternpresentedon the topic of her research topamltsofchildren attendingCampAddvennue.
(3)The inlc:rnattmdedCampADDventuretb:m:: days aweek at the CLC.Owing thistime
w
collecteddataon the effectivenessandthe use of problem solving stralegicsiniDcreasingsociallyappropriateaDdself.corrective behavioursin ADIHDchildren whowereattending the cantp.(4)Theinternanalyzeddatacollected fromthe CampmembersandcOWlSCllors andcompleted the report foundinPart 2.
COlllclusioa
TheCalgary Learning CenU'tisan excellent placement for students in the Educational PsycbologyMasters Oegn:cprogram.individuals can meet requirements as set by the Faculty of Education and one can achieve abroadrange of individualized goals indevelopmental psychologyandpsycbocdueationa1as.sess:Imnl.Theinternship allowed the intern to become familiarwiththe delivery of servicesina noo·profitsettingand providedtheopportwlitytoworkwithmcmben of an interdisciplinary team. Through thissettingtheinterngainedmany valuable learning experiences which prepared the intern forfutureworlcinthepractice of psychology.Theintern found,ingeneral. that an internship offered unparaJleled learning experiences and preparation for work as a professional. However, students considering completing an internship in another province should recognize the main difficultythatdistance presents, communication. A faculty supervisorisnot alwayseasyto reachifthere are lime differences between different
provinces.However,with theincreasingu.seofelearoaiccomallmication(e.g..fax..E·
mail)thisbecomesless ofa problem.. As well, ensurethattime is alJotted forreport drafts tobereceivedand retUrnedthroughthemail.
PARTZ
IncreasingSocially Appropriate BehaviourinADIHD Campers: A Study of the Effectiveness of Problem-Solving Strategies
2.1Overview
This stUdy shouldbecormdered a "pilot" study toidentifyvariables which may be usedas a part ofperbaps a later largerandmore formal evaluation. Unfortunately, littleis written about the impact and success of campbasedprogramsingeneral. This study hopefully addsto the researchinthisareaandisuseful for informing the eLC about remucturing and supporting the camp_
The purpose of this studywasto record the effectiveness of coping strategies.
taught at camp. on increasing the sociaJly appropriate behaviours of children diagnosed with Attention DeficitIHyperactivity Disorder (ADIHD). Throughoutthecamp.
behavioural information was gathered on a sample of 19 childrttlinthe form of observation samples and counselor comments.Thefrequency oftargct behaviours. thatis the number oftimcseachchild displayed socially appropriate or self<orm::tive bebavioun:.wasgalheredthrough observations. Socially appropriate behavioW'S were defined for the purposes armis study as behaviours which society deems as appropriate or desirable, for example,tum takinginconversation or activities. sharing of resources.
and helping others. Self-<:orrective behaviourwasdefined as a child realising an inappropriate behaviour or mistake was made by themselves and correcting it spontaneously, withoutbeing remindedby outside sources, e.g., camp counselors.
Examples of inappropriate behaviours included, bitting, pushing. yelling or ttfusing to shareresourceswithothers.
RatioDaieforRac:ucbCompoaellt
ne
CLCisinvolvedin researchoncauses.assessmentand tn:annentofleaming difficulties.The:Ceotn:alsooffers servicesto children and adults.Theseservices include assessmeot. individualllDd group~tprogramsand consultation.Inparticular. the CLC offersprogramsincluding attention clinics. workplace literacyservices.tutoring services.anda three-week camp for childrenwithAttentionDeficitIHyperactivity disorders.Staff members include three full time psychologists, four contract psychologists.
two educational consultants. one sociaJ worker, onespeechandlanguage clinician. two contract occupational therapists, two intake workers. and two paediatricians.
Staffat the CLC identified that they were interestedinhaving researchcarriedout 00the effectivenessandimpact of the camp.Itwas hoped that research might aid future decisions aboutrestIUCtUringandsupponingthe camp.
Researd.Qaatiold
Thisstudywasaimedatevaluatingtheeffectiveness ofthe camp program and experience for enhancing coping stmegiesandincreasingsociallyappropriate(Barkley.
1990)behavioursinADIHDchildren attending CampADDventure.
In evaluatingthe effectiveness oftbese strategies the following questions were od<h=ed,
1.What isADIHD?
2.What are socially appropriate behaviours?
3.What are self-corrective behaviours?
4. What is the purpose of Camp ADDventure?
5. Whatson oftrainingdo the counselors receive?
6. Whatkindcoping strategiesdo thecounselors usc withthecampers?
U Reriew ortheLiterature
1M W-l1dutCollsMake TM But Horses
-1bemistocles., 512-499 B.C.
Descriptio. of Childree. With Atteatio. DdkitIBypen.ct:ivity Disorder (ADIHD)
It isquitenormal for childrentobemore active. more exuberant, less attentive, and more impulsivethanadults.Itisbardly surprisingthatchildren have more: problems thanadultsinfollowing through on directionsandconsistently finishing theirwork.
Whenparentscomplain that their childbasdifficulty paying attention, controlling his or her activity, orresistingimpulses. others maybequick to dismiss these problems simply as normal behaviour.andreassureparentsthatthesearenaruraIqualities of children., that thereisDOneedfor alarm.Ifa child's behaviours seem a little excessive, even for a child.
itistoooften asswnedto havebeenthe casethat beor sheissimply a little immature.
andwill likely growoutoftheseproblems (Barkley, 1990, 1995).
Usuallyitistruethatchildrenwilloutgrow these problems.Thereare times.
however.whenitisDOttrue.Insome cases a child's attentionspanis so shan, activity level sohigh, and impulse control so limited that hisIber behaviourinthese areas are clearly extreme for hisIher age (Barkley.1990). Most people have known such a child, one who ishavingtrouble completing schoolwork. and DOtbegetting along wellwiththe neighbourhood children, a child whose inability to follow through and complete assigned chores withoutparentalsupervision is causing conflict at home.
Behaviour problemsin theseattaSthatare so severe asto impair a child's adjustment areDOtlikelytobeoutgrown. can hardlybeconsiderednonnaI.Children with significantproblc:rnswithanc:ntion, ovcractivity,aDdIacll: of inhibition reach a level have a developmental disability known as Attention Deficit Hyperactive Disorder or ADHD.
Children whoseprimaryproblemisattention without evidence ofoveractivity have Attention Deficit Disorder or ADD (Barkley, 1995; Woodrich. 1994).
Attention DeficitIHypentctivedisorder(ADIfID) is a neurological conditionthat affects learningandbehaviour which occursinapproximately5%to10% of the population,dependingonthe scientific studies you review. Symptoms oCtile disorder mayincludeattc:ntioDdeficits, impulsivity, hyperactivity,mood swings,lowfrustration tolerance,anddifficulty falling to sleepaJ:night (Barkley. 1995;Quinn.1994). his important to distinguish ADHDfrom otherdisordersthatmayinclude similar symptoms such ashyperthyroidism or conduct disorder.TheDiagnostic Statistical Manual: 4th Edition (DSM IV. American Psychialric Association, 1994) is a helpful tool that many clinicians use to decrease the possibility of an inappropriate diagnosis (sec Appendix 1 fortheDSM IVdefinition of ADIlID).
Recently, scientific studies have suggested thatADJHDis not primarily a disorder of paying aneotionbutODeof self-JegUlarion (Barkley, 1995; BntsWell k Bloomquist.
1991). Thus. AOIHD children are rarely judged as significantlymo~activethan others in freeplay sinwions but are frequently observed tobe so in more structured inler3ctions or classroom observations (Braswell&Bloomquist. 1991).
Recentresearchinthe area of ADIHD bas dispelled many aCme misconceptions Connally held. For example, the followingpastbeliefs about ADIHD have been chaUengedbyBarkley(1995),aleadingexpertinthe field. He points outthat itwas believedthatAMIDwascausedbybraininjury orpoorparenting;thatchiJ~would evenwally outgrow it byadolesc:eDCC;thatstimulant medicationswouldbe effective only with children (not'Nithadults or older adolescents)andonly on school days;andthat ADIHD childreD would benefit from adiet free ofcertain food additives and sugar.
RecentresearchsuggeststhatADIHDispartofanintema1mechanisminindividualswith the disorder (Barkley,1995; Braswell&Bloomquist. 1991).
PsychostimuIant medication isthe most common treatment for childrenwith ADIHD. Psycbostimulant medications are so named because of their ability 10 increase the arousal or alertness of the central nervous system (CNS). The three most commonly employed CNS stimulants are Ritalin, Dexedrineand Cylen (Barkley, 1990).
Ritalin, ..dllylpbtaipte Ilydrodlloride.isthe mostcommonlyusedmedication for attentiondisorders..the one most frequently tried first, and the one generally considered the safest.Itisavailableingeneric fonninSmg., 10 mg.. and 20 mg., tablets.
Ritalinisavailableina sbort-acting tablet (S mg., 10mg., or 20 mg.)whichlasts approximately three to five hoursand it is also availableina long-actingsustainedrelease tabletthatlasts approximately seventoteDhours. Ritalin is typically initiatedinsmall doses. usually at 5 mg. Ritalin-Slow Release (SR) is often utilized after the therapeutic dose levelhasbeen determined. Ritalin-SR is available in only one size. 20 mg.
(Copeland, 1991).
Dexedrine,dextroamphetamine sulfate,is the medication of choice for those children who are unresponsive to Ritalin.It is theonlypsycbostimulant approved for childrenunderthe age ofsix.A generic fonnisavailablein12.5 mg.and20 mg.
Dexedrine is availableina shon.-acting. four hour. tablet fonn onlyina 5mg.size. The sustained release form. Dexedrine, Spansule. is availablein5 mg., 10 mg., and 15 mg.
capsules. Dexedrinealsocomesinan elixir, Dexedrine Elixir. One teaspoon (5 mL) is equivalent to5mg. (Copeland. 1991).
Cyler\, pemoline, is the newest stimulant on the market. Cylert is supplied as tablets containing 18.75 mg., 37.5 mg., and 75 mg. of pemoline.Itisalsoavailable as chewable tablets containing 37.5 mg. of pemoline.Itis currently not availableingeneric form. Cylen was fonnulated tobeadministered once a day. When discontinued. the medication requires severalweeksto fully dissipate from the bloodstream. Since it does have a build-up effect, it shouldbediscontinued gradually, unlike Ritalin and Dexedrine which canbefully discontinued at once. Side effects. such as liver dysfunction, and that it lacks thedegree:of positive benefit achieved with Ritalin or Dexedrine make it a third or fourth choice medication for most physicians (Copeland. 1991).
Approximately one million of the school·age populationinthe United States take medication annually for management of their attention deficit symptoms (Copeland.
1991). When the medication works as it is designed to. there is improvement in a child's ability to attend andinhislher impulse control. behaviour, cooperativeness.
reasonableness. and sensitivity to social cues and expectations (Copeland. 1991). The goal of all medications used to treat AOIHD is the nonnalization ofattention, focusing and behaviour. When drugs~work~,a child will simply accomplish whatever hislher
goalsareD1O~successfuJ.Iyon medicationthanoff.
TheabilityofmedicatiODto~negative behaviour and enhance positive.
more appropriate behaviour basbeendemonstrated. Children on medication are moreco- opc:rarive;theytalk out inappropriatelyinclass less;theyinteractless aggressively with peers;andattention-seuing behaviours decn:ase(Barkley,McMurray. Edelbrock,&:
Robbins. 1989)
MedicatioD aloneisDOt enoughtotreatchildrenwithADIHD. For example.
Kavanaugh&:.Truss (1988), who havestudiedattention disorders for over two decades, found that adolescents who received. psychologicalandeducational assistance.inaddition to medicine were significantly better adjustedthanthose who received medication alone.
It appears that medication enables an ADIHD child to benefit from interventions which an::ineffectiveintheabsence oftbe medication.
According to Braswell&:.Bloomquist (1991)A.DIHDcanbeconceptualized as an inability to modulateODe'Sactivity level tomatchthedemandsoftbe environmmt.
Barldey (1995). takes this idea one step furtherandarguesthatADJHDisreally a distwbanceinthechild's abilitytouse self-controlwithregardtothefutw'e. He proposes thatchildrenwithADIHD suffer from aninability touse a sense of timeandthat they are less able to use a knowledge oCtile past and future to guide their behaviour. What isnot developing properly is the capacity toshiftfrom focusing on the here and now to focusing on the future.Based00these views. itislikelythatchildrenwithADIHD should benefit from strategies that help them to focus on thoughts that precipitate actions.
Behaviour management based problem solving approaches or cognitive behaviour therapy often encourage strategies ofatypepotentially useful 10 ADIHD children.
SocialSkills:ProbklDSolYiD.gApproacllestoBdlavioar MaIlagemeut
ADIHDchildren are at highriskforpeern:jcction.Thisappears tobeduetotheir tendency to display a relatively bightaleof~.bothersome. or even aggressive behaviourwhilealso showing problemsintheirsocial maturation.particularlywith respect to prosocialsiriUs.Theseproblems withpeerrelations frequentlyresult inlow self-esteem.looeli.ness.andeven depressioninthose experiencing rejection (Landau&
Moore, 1991). Moreover, theriskfor maladjustmentinlater lifeappearsto be significantlyincreasedbypoor childhood social relations(Barkley,1990; HaUoweU&.
Raley,1994; LandauAtMoore, 1991). Intervention programmingthatinvolves the learning and generalization of socially appropriate behavioursandself-monitoring is crucial toADIHDchildren. An example of such interventionis theuse of problem·
solvingapproachesas apartof a behaviour managementprogram.
Ingeneral.probleoHolvingapproachesto behaviour management stress the role aCme client learning to (through thought) control tmIber actions. They rely on the development of intrinsic motivation, and on the child learning to regulatehis/berown behaviour. Theyalsostressthatthe generalizationofbebaviour management solutions is initiallytimeconsuming(butbecomes less so as child becomes self-regulated)andplaces responsibilitywiththe caretaking adult and thecbHd (Blakemore. Shindler,&.Conte, 1993; Braswell&.Bloomquist, 1991). Thus, in the problem solving approach the adult identifies the problem, gives descriptive feedback. provides alternatives,andallows the childtogenerate alternatives to make a choice (Haywood&Weatherford,inpress). Some
stmeg:ies. ouilinedbyHaywood&:Weatber:ford,toteachchildrensociallyappropriate behaviours include: modelling,practice.positivefeedback. social perception.relaxation, andcognitive approaches.
Modellingisdefinedby McGinnisaDdGoldstein (1984) as "learning by imitation"and hasbeenshowntobean effectiveteaching methodfor children. Most social behaviours arelearnedthroughsocial modelling. .Essentially,thechild learns by observing amodelwho illustrates effective behaviour.Thechild does not, initially, become involvedinpractisingthe behavioW".Itispresumedtha1, as a~tofbeing exposedtothe appropriateuse of askill.the child will show an increased probability of usingordisplaying the effective behaviolD'".
Although mode1liDgisa useful compooentinthe teaching of social skills. it is not coougb. tocreatethe maintenaoce of skills or transfer to other environments.Itis unlikely that behaviours will be remembered. repeated, and maintained if the child is not given the chanceto practicethem. Even though modelling and practice are considered highly effective ways ofacquiring socialskills.,their effects often do not last (McGinnis&
Goldstein, 1984). Eventhougha child mayknow what 10do andbow 10 do it. bc/sbe typicallyrequiresan iDce:ative tokeepperfonning the aet(s). Social reinforcement, praise or approval from othersisimportant as it then allows the child to see exactly what behaviours arc viewed as desirablebyothers. Positive feedback shouldbeused whenever the goalisto stmlgthen and maintain a behaviour (Abramowitz&O'leary, 1993).
Itisalsoimportant tohelpchildren become aware oftheimpactoftbeirown thoughtsandfeelingson social behaviours.Social perceptionisandinvolves undemandingasocialsituation·knowingwhenandbow to makeanappropriate _ _ (Haywood& W<athcford, inJl"SS).
Teachingthechildbowtorelaxisthought to enhanceb.isIherability to control thoughtsandfeelingsthatmay interferewith b:is/berabilitytoperceive social situations accuratelyandtherefore respoDd appropriately. A belief heldbyauthors ofseveral social skillsprograms(Haywood&:Weatherford,inpress;Landau&:Moore. 1991) is that a child who can use relaxation techniques maybeable to alter negative feeling stales and delay impulsive expression of negative emotion long enough to'think: of alternatives.
Cognitive behaviour therapy or "StopandThink"is a technique to help students problem solve more effectively. or tostopandthinkbeforethey act. Thisrype of therapy isparticularly useful for students who are impulsive orlackself-control strategies. In cognitive behaviour therapy, students are taught to slow downandwork through problems methodically ratherthanimpulsivelyapproaching tasks. 10 order tobest understandthe strategy. studcnts are taught tofirstutilize this techniquewhencompleting academic tasksandlater to usethistechniqueindealing withinterpersonal andsocial situations (Blakemore, Shindler&:Contt, 1993).
The steps oC"Stop andThink"include teaching students to;
-define and recognize the problem (clearly understand the exact difficulty or requirements of thetask).
·set goals(dc:tc::n:ninebow.students wantthingsto endup),
·tbinkofall thepossible solutioasto reach thisgoaland possible consequences ofeach of thosesolutions.
-focus.
cooccntrateand choosethebestor most workable solutionandevaluatethe performance(Blakemore et aI., 1993) .Studentscanbetaught to usc·StopandThink-through self-instructional training, modelling. cuesanda reinforcement system. Self-instructional training includes baving students verbalizeeachoftbesteps employedintheprogramand become cognitivcly aware when consideringand dealingwithproblems. By taking time to "just say· each stepsrudentswill slow themselves down. According to Blakemore et al. (1993) students shouldbeencouraged to say:
Let's see,what islbe problembffe?WhatdoI have 10do?I haveto setagoal.
HowdoIwant things toendup? Now I haveto think of all the possible ways to reach thatgoal andthinkoftbe consequences oreach army possible solutions. I badbetter focusand concentrateDOWand choosethebestsolution. Did this solution help me reach my goalandarcthe consequencesgood?Yes? Great, I focusedand figureditout, (or) No.that solution did notwort.I bad better tryagain. How do I know I've finished? (page.
7).
Eventually. students are encouraged Co "fade out"theverbalizationsandsilently gothrougheachstep.Thefinalstep. evaluating. is particularly importantinbelping students recognizr:wbeotasks are completed correct.lyaDdrealize thatwbc:nmistakes att made.they simplyDeedcorrecting(An example of a cognitiveapproac.b. to problem solving canbe foundinAppendix 2).
Cognitive behaviour therapyis most effective when students are provided with reinfon:ement for usingthe Sttatcgy (Abnlmowitt&O'Leary, 1991). Reinforcement appearsnecessary for most students.bothtolearn,asweUasto continue using the strategy.Acamp,such as Camp ADDventure, provides an excellent opportunity to test thisapproachinthe treatment ofADIHD.In such a setting ADIHD children could learn and practice cognitive strategies from models while receiving consistent positive reinforcementina highlystructuredmanner.
Value OfSullUllcrCamps
Summer camps provide an organizedsettinginwhichchildren make newfriends.
acquirenewskills, develop independence and responsibility,andhavefun.Researchers have found that the camp experience promotes andenhancesthe development of three traits considered to be importanl to becoming a healthy, productive adult: positive sclf- esteem, strong self-confidence. and good social skills (Edelman. 1995). Building social slcills is extremely important summer work for all children. Summer involves more socializing and self-planning
man
does the school year. A large percentage of individualswithADIHDhavedifficultyacquiringandapplying socialskills.
Acampprogramwhichisa highlystructu:red,. meaningful, and motivating experience can make an outstanding differenceininappropriatebehaviour ofallchildren (Zwaig.1974).Thelogistic functions ofacamprequiretheco-operation ofall participanls..Co-operation canies overinto theclassroom.faciliwespeerinteraction,and canbedevelopedthroughactivitiesdesignedto reward theteam thatisbestable to function as a co-openltivegroup.
At camp, ADIHD children are removed from parental anxieties about behaviour andacl1ievement. They do not have to copewiththe prejudicesandstereotyping which adults and childreninlheir community may have built around them. A camp provides a settingwithinwhichthe campers can develop competence and confidence_ The counselorsdo notdemandoCthe campersthat which they cannot accomplish, but they do encourage maximum achievement.
Improvementsincbildren's self-concept following summer campshasbeen documented. For example.Roswal. RoswaI. Harper&:Pass (1985)studied 22 learning and mentallychallengedstudents,8-12 -YCllfS..OId,enrolledina summer day camp program..Theyfoundthatthecamp programdid have a significant positive effect on the self-concept aCthe students. Similarly, Zemke. Knuth.&.Chase (1984) found that attending a thcnlpcutic summer residential camp ledinimprovements ofself-conceptin 161eaming and intellectually challenged children,aged6-16 years.
StractarelPa.rpctM oftIaeCalpryI..eanliq:Carre(CLC)Camp
Itmustbemadeclear thatitis not poSSIblewithinthe scopeofthe projectbeing completed as apartoftbe Memorial University of Newfoundland M.Ed. requirement, to do a comprehension evaluation of the effectiveness ofthecampprogramoffered by the CalgaryLearning Centre. What is possible, however. is an impressionistic description of the camp. Fromtheresearcher's perspective.twotypesofdata were collected which were deemedtoreflectkeyaspectsaCtheprogram..Thebroadgoalofthisstudy is to assess the effectiveness ofdelivering a therapeutic campbasedprogramaimedat developing self-eonection strategiesinchildren diagnosed as displaying the ADIHD syndrome.
Thisstudyfocw;es specificallyon the gathering of data00thefrequencywith whichthechildren display evidence ofdirectlywingthesestrategies by looJcing at the incidence, as observed by the counselors and the researcher, of socially appropriate behavioursina specific summer camp milieu (Calgary Learning Centre camp).
It is hypothesizedthatthe children will display anincreaseinsocially appropriate behaviours as a result of an increaseintheir use of coping strategies taught at the camp.
CampAddventureis a summer daycampsettingfor male/female children (ages 7- 12 yean)whohavebeendiagnosedwithADIHD. University level malclfemale g.radualc students.usually from the Education faculty, arehiredas camp counselorstoworkwith thechildren(seeAppendix 5 for individual profiles ofcamp counselors). Each counselor is responsible for a group of three·four children. The counselors are expected to guide and
support childrenthroughproblem6solving situatiOI1S. Counselors havethe mandateto helpchildren tobemoreaccepting andknowledgeable about ADIHD.itsimpacton their lives. andto help them experience success throughout the camp experience. Counselors record theirdailyobservations oftbe children's positiveand negative intnaetionswith othersandtheintervcntioPS thatwen:implemented. Counselorsalsoassistchildrenin settingiodividual goals. Daily supervisionisprovidedby the camp instructors. As well, counselors are involvedinparent meetings (See Appendix 3 for camp weeJcJy schedule andAppendix 4 for the camp brochure).
TraiDiDcofCLC Camp ColllUdon Pre--Camp
Thetraining given counselors isaimedat developing practica.llcDowlcdgeand intervention strategies in the area of anentional difficulties in children. Counselors are involvedinpre-camp insttuction.
The~pinstruction involves oneweekoflectures onthe natureof ADIHD, associated manifestationsandinterventionskills.Counselors are trainedinthe use of cognitive problem-solving style of behaviour management, and how to foster the development of social skillsand anger management skillsinthe children. Role play and modelling activities are usedthroughoutthe pre-camp course.Thetraining program offeredisone developedby the
etc
specifically for use withthecounsellors.Oa-GoiDgAdivitics
Counsellorsan:involvedinplanningcamp activities. During the camp, counselors are responsible for coDductingactivities, monitoring the bebaviowof children aodimplementingthebehaviour management approach. Counselors areexpectedto developaDdmonitor goalswithindividual childrenandkeep records 00 children's progressanddifficulties. Daily supervision ofCOUDSCUOrs byprogramleaders is held throughoutthecamp period.
Theprogramleaders are twostaffmembers oftheCalgary Learning Centre. A chartered psychologistanda psychological assistant were theprogramleaders for the 1997camp.
After the camp, counselors are involvedinfollow.up sessions10debrief and reflect00the entire camp experience and to document the progress of individual campers.
Each counselor alsowrites in-depthfinalreports onhisIbergroupof individual campers.
Thereport in<:ludes informationgatheredfrom camp observations (see Appendix 6 for an example ofafinalreport).
103M"'''''...,.
ThissectiODincludes a discussion oftbe methodology involvedinobserving a groupof ADIHD children during a three week day camp. Childrenwereselected to attend camp ADDventure after a screening interviewwiththeparentsand the children themselves. Referrals for the camp come from twomainsources. ID some cases children had received services from theLearningCentreinthe past, orinother cases, the parents hadseen a brochure advertising the camp. All children had been previously diagnosed withADIHD. The children that art identified as needing the benefit aClbe camp experience most were selected.
GCDualGroup I.CormatioD
In all19 children were selected to attend camp.They rangedinage from 7 to 11 years old (see Appendix 7 for individual profiles ofcampers).Thechildren, six girls and 13boys. were identified as needing helpwithsocial inleraCtions and aggression control.
They were also deemed tobeinneedof a greater awam1eSS oflhcir ADIHD.1be small sample sizewasdue to thefactthata limited nwnber ofchildrenartadmined to the camp each year. The children selected to attend Camp ADDventure were a heterogeneous group.Anumber of children were experieocing other problems such as learning disabilities.
Thecampcommeoced00July7. 1997andcootinued forthreeweeks.Thecamp sessions were beldat the CLC. Facilities attheeLC include an outdoor playground.
indoor classrooms.and a close proximity to outdoor swimming pools. Thiswasa convenientplace:to meet sinceparentscoulddropoffandpickup their children after each day.Thedaystartedat 9:00 a.m.andendeda13:30 p.m., Mondayto Friday.
Thecamp offeredthe children variousstructured andunstructuredactivities. In particular,ADIHDawareness classes.art therapy (see Appendix 9 for a description ofart therapy). orienteering, swimming,karate. music, cooking,sports.and field trips were scheduled(See Appendix 3 for a copy of the camp schedule).
Thefmlucncy oftarget behaviours wasgatheredas obscrvations.lnformationwas alsocollected informallythroughfield ootes takenbythecoW15Clors.andcamp screenings (see Appendix 10 for examples of informal field notes on campen taken by the counselors and Appendix 11 for examples of excerpts ofconversation from the campers madeduringthe camp onwgetday!and notedinthe counselors' field noles as representative ofthegenent1camparmospbereatthattime.)
GatlaeriDc or Data
Twice a day,threetimes aweek,obsc:rvati.oos ofeach childYtUemade.The resean:bcrobservedthe target behaviours at diffcent timesthroughouta day and across theweek..Sociallyappropriatebehaviourswerefocusedupon.Thefailure to display sociallyappropriatebehaviourswasidentifiedin theliterature as a major area of difficultyfor mostchildren diagooscdwithADIHD.
Parents signed a consent form createdbythe researcher (see Appendix 8 for a sample aCme consent formused)following a presentation by the researcher on the nature of the proposed study.Allof theparentscontacted agreed to allow their children to participateinthe research.
lnformation on socially appropriate behaviourswasattainedduring the pre-carnp and<:ampphases. Each counselorandtheresearcherwereresponsible for tracking the frequency of occurrence of socially appropriate behavioursin.groupof three or four cbildren.Datawas collected on daysJ.5, 6, 8, 10, II, IJand1Sof camp. The target bebaviO\us of interest were socially appropriate and self-eontttive behaviours.During camp training, counsellors weretrainedtorecognise target behavioursandwerechecked periodically throughoutthecamp regarding the accwate use oftbese terms. Observations look place for fifteen minutes twice a day (at approximately 9:30 a.m.and12:30 p.m.).
1be fifteen minute observations were timed using a stop watch. Counsellorscarrieda slip ofpaperto record the target behaviours as they worked. Counsellors only observed their own group ofthree/four children for each fifteen minute timed interval. Dueto the
spreadina;outof childrenduringdifferent activities,the groupofchildrenthateach counsellorobservedchanged betweeDeachtimedinterval.ThetotalDumberoftarget behavioursineach oCtile two categorieswen:countedineachgroup.Oneach day the 5 observers observed each oftbe fourgroups twice. Atotalofthirty-eight samples was collected oneachoftheobservation days.
Thetypes of"sociaJly-approprialc" behaviours observed included tum taking in conversation.. raising a band beforespeaking,andpraising or helping another camperwith atask."'Sclf..correct:ioo"included any spontaneous correction of socially inappropriate behaviour, for example.talkingout oftumand thenraising abandto speak.interrupting aoothc:rspeakerand thenapologisingforthe interruption, and/or jumpingaheadof somcooeinalineandthenreturningtotheend aCme line.
Anecdotal informalDOteson counselor commenuabout the children's behaviours during thecamp was alsokept bythe researcher.Thesenotes were not formally analysed (seeAppendix 10).
AaalysiJofDa..
Thenumber oC"socially-appropriatc"and "self<orrectivc" behaviourswere comparedineachcategory overthe8targetdays(da)'!3. 5. 6, 8, 10, II, 13.and15). It washypothesizcdthatchildren would display an increaseinsocially appropriate bcbavioursand a decreaseinsclf-eorrective behaviours as aresult of coping strategies taught at the camp. At the end oCtbe camp, all oCtile counselors' and the~ber's observation samples were combined to ensure thatdata wasavailable on each child attending camp. The frequency of socially appropriate and self-correction behaviours
observedineach child acrosseachweekofthe three week campbythe counsellorsand therescan::berwen::combined intoODepoolto produce an overall mean for~one (basedaD atotaltwoobservationdays), weektwoand week three(based 00 atotalof threeobservatioodays).Thesignificance oftbe differcncesbetweenthe meanswas analysedusing a t·tc:st (alpha level=.OS).
2.4Raalts And FiDdillp:
FmdiDpofStDdy
After reviewing the literatureandthelistofpre-<:ampactivitiesitwasfeltbythe researcherthat theactivities designed tobecaniedoutinthe campandthepreparation of theco~Uorswasdeemedtobe:potc:ntially beneficialtothecampers.
Thepattern.inindividual campers was compared atthebeginningof camp (sample days Iand2)andatthe endof camp (sample days 7and8).Thecomparison soughttofindifafterweekone (orientation)therewas a change.Therewere only 2-3 campers who "improved" while the othersremained"unchanged" and one "got worse,"
[fthis comparison is legitimate.itwould appear that the camp programhad"no impact"
on mostindividuals.
However.whenall the frequency data fromalltheobservations was combined acrossthethreeweekssome "'trends" becomeappamlt.According tothe datadisplayed inTable Ithereappearstobeanincreaseinsocially appropriate behavioursanda decreaseinself<:orrectioo displayed overthe three weekcamp. Examples ofsociaUy- appropriatebehaviour includedraisingabandbeforespeaking. tum taking,praising or helpingother campen.Sclf-<:onection involved the spontaneous (i.e.• without prompting from counseUors) col'TeCtion of a socially inappropriate behaviour, for example., talking out afturo andthenraisinga hand beforespeakingor skipping in front of others in a tine and then returningtothe end oftheline. None aCthe differences between daysineither category reached statistical significance.
Tboughitcan notbesaidthatthe camp experiencewasclearly related to an increaseordecreaseintheobserved bebavioW'S,trendsare suggestedinthe data..In particular,week.two oftbe camp was whenthemost socially appropriate behaviours (mean'"5.1)and theleastamom! ofself-correction (mean"0.1)wereobserved.During weeksoneandthreeless sociallyappropriate:behaviours (3.9 and 4.3 respectively)and more selfmonitoring(0.3and0.2~vely) ~observedthanduring week 2 (see Appendix 12for. moredetaileddatatable).
Tablel.Mean aumber of lOCially appropriate aDd ,elf-rorredive bebavioun displayedbyCIImpersover three weeks.
SodaUyAppropriate Beh.avioun SelfCorrective Deb.viaan
Weeki Week 2 Week 3
3.9 5.1 4.3 0-19
0.3 0.1 0.2 0-3
CommeatsODFiDdiDp
q
There are few definitive comments that canbemade on these findings. Perhaps weekone is highlyDOvel for the children so they~aetup".Similarly, during week three they are busy preparing for the end oflhe camp and they know they willbeleaving new friends. a familiar routine etc. and hence may "act up". However, during the middle aCthe
camp (week2) theyan::settledinto.routineandblowthe rules aCthe camp well. lD this situationmcm:socially approprWe behaviours may be more likelytobeseen.
Ontheother band,withself<orm:tionthe childrenare catching themselves when they make mistakes orpoot'socialjudgement calls.Thus,.weekODCmay involve a lot of selfcom:ction.In weektwotherules are generally~llknownso less self-corm::tion maybeDC:Cded..Byweek threetheclUldren are awaretba1 campisending sotheymay increase inappropriatebehavioursandthereforeincreasetheamoUDt ofsclf-correction they need to usc.
CommeatsaDAnedoctalDab
Throughout the camp, the counsellors and the researcher kept brief informal notes onindividualcampers. This anecdotal informationsuggested that,overall, the camp experience: was a positive experience for the campers.IIwasthe viewofboth the researcherandthe counsellorsthatchangesintarget behaviours were noted by both counsellorsand parents. Parents, counsellors.andcampers openly~regretwhen the campended.
Forthe~,itwaseasy 10 see (for example,when the children andtheir puents wereopenlycxpres.singregretandsadness that camp was ending) why thereis general publicdemaDd aod •loog wait list for this camp every year.Theprogramwas wellorganizedand acceptedbycampers,counsellors andparents.
2.SCoadasiou,IaterprdatiollU,ADd Reeoauaeadatiou
This pilot study sought to assesstheeffectiveness ofa specially developed camp expericoccdcsigDedto enhance social interactionsandself~rrectivebehavioursin ADlHDchildren.
To evaluate Camp Addventu:re the researcbcr collected information from the following sources:(i) literaturereview.(ii) counsellor ratingand(iii)personal observations by counsellorsand theresearcher. Clear findings supportingthe effectiveness oftbe program were not found.
Literature supported theneed andlegitimacy of support programs for ADIHD. In summary, the subjective. anecdotaldatacollected by the researcher also seems to support such a program. Atthevery least.thecampwasdeemed by parents, counsellors, and participants tobean enjoyable and qualitatively worthwhile experience.
implementation of the camp observation consisted oftwophases. Thefirstphase occurredODeweekprior tothestart ofcamp. This phaseinvolved agreatdeal ofeffort on the partoftbe researcher. Beforeactualobservations could takeplace.the researcher was facedwiththe cbaUenge ofprese:ntingtheproposed topic of research toparents aCttle campersina coherent manner, requestingandcollecting consent forms, assimilating information about each individual camperand training the coW'lStliors how to record socially appropriate and self-correction behaviours. The secoodphaseinvolved acrual observations aCthe campers.
Evaluation oftbc: campers'displayof socially--appropriatebehavioursand self·
monitoring involved collectingdata&omthefoUowUlgSOW'CCS:(i)timedinterval observations.aod(ii) counsellors' anecdotal notes. Based onthetypeand amount ofdata collected bytheendofthc: camp, itisfcltbytheresearcherthatthe observation process usedduring the camp shouldbemodifiedif used inany subsequent (onnal study.
Inparticular, data collection times during the day cou.ldbe increasedfrom twice to threetimes.The increase incollection times might control for effects of ADIHD medication on children's behavioursthroughouttheday.Itwouldalsobe helpfulifthe context oCtileactivity the children areengaginginat observation timeswasDOted.The resean:bc:rnoticedthatthe frequency of socially-appropriate behaviours displayed by the children seemed to be somewhat directlyaffected by the level of stimulation provided by an activity (example swimming field trips were highly stimulating for the campers whereas the routine of craft making atthe learning Centre seemed to be not as interestingfstimulating for the campers). Therefore. low stimulation activities seemed to leadtoadecreaseinthe amount of socially-appropriau:andself-monitoring behaviours displayedby the childIen.Whencollecting subsequentdata, the context/activity of the children must thus alsoberecorded. Significant interactions between social interaction andself correction ofscheduled activities may exist.
As well. subsequent studies should include: more clearly developing"operationaJ~
definitions of targetnaits (including a distinctionbetween~prompted~and
"spontaneous~self-correction), making sure that the data collectors are not involved directly in camp activities, and having two observers observe the same campers for
reliability purposes.
LimitatiollS of stady
Thepilot methodologytestedbytheresc:arcberforthepurposesofassessingthecamp did ootworlcwell.Basedonthe findings:ofthisstudyitissuggestedthalcbangesbemadeto themethodologyoffuturestudiesaddressingthisor asimilarissue. In particular. the following limitationsinmethodologywerenoted:
1. No interrater reliability establisbed.
2. Short duration ofcamp.
3. Small number of campers anending camp.
4. Difficultyofdefining socially appropriate behavioursandself-correction.
5. Campers oftendispersedover a large area,bardto keep track of them during a fifteen minutetimeperiod.
6. Depeoding on activity (high stimulation such as swimming versus low stimulation such as smallgroupdiscussion) campers'responsescould vary. Futuredatacould sepanatc:high stimulation activities from low stimulation activities.
7. Lack ofconttol group for comparison..
In summary, according to the data collected.thereappeared to be IinIe or no change inindividual campers as a result ofthetreatment program. According to the counsellors' views.. there maybean increaseinsocially appropriate behaviours and a decreaseinself correction displayed by the campers acrossthreeweeks. The researcher
feltthatthe problem solving stJalegiestaughtandused bycamp Addveutwe may have: an ovcnll positiveimpactonthe amOlmt ofsociallyappropriatebehaviour displayedby campers.Givenlbesmallscopeof this research project andthe lad: ofstatistica1 significance any implicaJ:i.ons drawn based on thisdata should be viewedwithsome caution. According tothe~b(Barldey,1990; 1995; Landau&Moore, 1991) ways of enhancing social abilities is an important area of investigationinchildren diagnosed withADIHD.1bereare some: recommendations for thosewhomight be inlerested in pursuing this research longitudinally.
To collect more definitive dataODewouldneedtoincrease the reliability and validity of thedalaby,
-Pre-testing campers threeweeksprior to camp to establish a baseline of social skills.
•Testing campers three weeks post-camp to dc:tennine ifthcre was a generalisation of problem solving slcills 10 environments outside ofcamp.
-CoUectingdatafrom multiple samples. for example over the course of two or threeyears of Camp ADDventure.
Additionaldatashouldbe collectedto:
-Assess the impact ofcamp experienceODyoungerversus older children.
-Assesstheimpect of campexperieuc:eon male versus female children.
-Assesstheinteractionbetweenlevels of stimulation(basedon activities) and children's usc ofsocialskills(self-moaitoringandsocially-appropriate behaviours).
Abramowitz, S.J.,&;O'Leary, S.G. (1991). Bcbaviowal InterVentions For the Classroom:
ImplicationsFor- SchoolPsychologists. School PsychologyRm-.20(4), pp.
220.234.
Amcncan Psychiatric Association (1994). Diapostic aad Statistical MallualOf Meatal DUorden (4th EditioD), Washington.
Barkley,R.A..McMwray, M.B.• Edclbrock, C.S.,&Robbins, K. (1989).Theresponse of aggressiveandnonaggressiveADHDchildrentotwodoses of methylphenidate.
JOllm•• of the Americao Academy of Child and Adolesceat Psychiatry, 28.
pp_ 873-881.
Barkley, Russell A. (1990). AttcatioD Deficit Hyperactivity Disorder: A Handbook for Diaposis ud Trutment. New York:TheGuilfordPress.
Bark.J.ey. RussellA. (1995). TakiDa:C1large ofADHD:The Complete, Authoritative Gllide for P.,eots. New York:TheGuilfordpress.
Blakemore. B., Schindler. S.,&:Conte,R...(1993). A Problem Solving TrainingProgram For Parents Of Children With Attention Deficit Hyperactivity Disorder.
CaD.dian Journal OfSc:bool Psychology, pp.66-85.
Braswell, L.&Bloomquist. M.L. (1991). Cogaitive-Behavioural Therapy with ADHD Cbildru. New York:TheGuilfordPress.
Calgary Lamme Ceqm Policy and Procec1ura Manua"September1996.
Copeland. E.D. (1991). Medications for Atteatioa Disorden (ADHD/ADD)aDd Related Medial ProbiedlS. Atlanta: SPI Press.
Edelman,L.(1995). Choosing and getting the most out ofa summer camp. for the child withADD.InAttcatioa: The Magazine ofChild~Daad Adults With AttcunODDeficit Disorden,1 (4),pp.18-23.
Haywood, H.C.&Weatherford, D.L.(inpress). Cognitive Mediational Behaviour Management. InRe.Haywood,. P. Brooks and S. Bums, Cognitive Curritulum for Young CbUdttn. Charlesbridge.
Hallowell. E.M.&Ratey, J.R.(1994). Driven to DistradioD. New York: Pantheon Books.
Kavanaugh.,J.F.&Truss, T, (1988). Learning Disabilities: Proceedings of the Nanoaa) Conference. Parkton: York Press.
Landau, S.. '" Moore. LA (1991). Social SIrilIs DeficitsInCbildn:nWithAttention Deficit Hyperactive Disorder. Sdaool Psydtology Review. 10(1), pp.235-251.
McGinnis. C.&.Goldstein, G. (1984). Cognitive-behavioural Therapy for Impulsive Child"D. New York: Guilford Press.
Memorial Uainnity of Newfoudlaad:FacultyofEduCSItioaHaadbook for Gnd.ate Stadeatl(1996).
Quinn. Patricia (1994). ADD aDd the CollqeStade.t.New York: MaginationPress.
Roswal, OM., Roswal.P.M.•Harper, C.H.&Pass. A.L. (1985). The effect ofa positive reinforcement-based campprogramon the self-concept of handicapped and nonhandicapped students. Americaa CorrectioD Therapy Journal, 40 (4), pp.
91-94.
Woodrich., David L. (1994). What Every PareDI WaatJ To Kaow: Atteution Deficit Hyperactivity Disorder. London: Paul H. Brooks Publishing Co.
Zemke.R-.Knuth,S.&.Chase,J.(1984). Changeinself-<:oncepts of childrenwith learningdifficultiesduring.residentialcampexperience.Occupatioaal TherapyiaMeatal Healtb, 4 (4), pp. 1-12.
Zwaig, M.S. (1974). Asucc:essfu.Icamp experience fortheLOchild.Academic Tkerapy,9(6).pp.44S-449.
APPENDIX I : Diagnostic Criteria For ADIHD (DSM.fV)
DEFICITIHYPERACTIVITY DISORDER as outlined by the DSM-IV A. Either (I) or (2):
(I)Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
Inattention
(a) often fails to give close attention to details or makes careless mistakesin schoolwork, work, or other activities.
(b)often has difficulty sustaining attention in tasks or play activities (c)often does not seem to listen when spoken to directly
(d) often does not follow through on instructions and fails to finish schoolwork, chores, or dutiesinthe workplace (not due to oppositional behaviour or failure to understand instructions)
(e) often has difficulty organizing tasks and activities
CO often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
(g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
(h) is often easily distracted by extraneous stimuli (i)is often forgetful in daily activities
(2) Six (or more) of the following symptoms of hyperactivity·irnpulsivUy have persisted for at least 6 months to<tdegree that is maladaptive and inconsistent with developmental level;
Hyperactivity
(a) often fidgets with hands or feet or squirms in seat
(b) often leaves seat in classroom or in other situations in which remaining seated is expected
(c)often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, maybelimited to subjective feelings of restlessness) (d) often has difficulty playing or engaging in leisure activities quietly (e)is often "on the go" or often acts asif"driven by a motor"
CO often talks excessively Impulsivity
(g) often blurts out answers before questions have been completed (h) often has difficulty awaiting turn
(il often interrupts or intrudes on others (e.g., butts into conversations or games)
were present before age 7 years.
C. Som~impairment from the symptomsispresentintwoor more settings(e.g., at school [or work] and at home).
D. There mustbeclear evidence of clinically significant impairment in social, academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder andarenot better accounted forby another mental disorder(e.g.,Mood Disorder, Anxiety . Disorder, Dissociative Disorder, or a Personality Disorder).
Code based on type:
Attention·OeficiUHypuactivity Disorder, Combined Type: ifboth Criterion Al and A2 are met for the past 6 month
Attention·OeficiUHyperactivity Disorder, Predominantly Inattentive Type:ifCriterion Alismet but Criterion A2 is not met for the past 6 months.
Attention·OeficitIHyperactivity Disorder, Predominantly HyperacHve·Irnpulsive Type:
ifCriterion A2 is met but Criterion Al is not met for the past 6 months.
APPENDIX 2: Example of cognitive strategy approach to problem solving
1. e- 9 -~
--
What is the problem?2. Q9c;:J Q -
What can I do about it?
3. U
Putastaronthe"bestUplan.
4. [57
Do the plan!5. 0 Q
Did your plan work?
APPENDIX 3: Camp ADDventure weekly schedule
COUNSELLOR TRAINING SCHEDULE
Friday June 27 Monday June 30 Wednesday July 2 Thursday July 3 Friday July 4 -Getting 10 know you -Grief Cycle -Communication ·Reactive Techniques -Crisis
-About the CLC & -Listening to feelings -Choices and Intervention
Camp ADD-Venture -Impact of AD/HD ~Clearcommunication consequences
-Tour on family&child: -Self esteem -contracts ·Planning&
-Policies and academics. Room Setup
procedures - Carolyn social/cmolional -Mediational Teaching -Camp Rules
Meier -Problem Solving
-How Difficult Can -Conflicl Resolution -Planning It Be? Video
-ADD What Do We
I
Know -Barkley Video .Planning -Diagnosis
-Medications -Related Difficulties and Disorders -Karate
-Camp Schedules -ArtTherapy - -Awareness (Talking -Planning
~Goalsheets Marianne Snyder to kids about AOO)-
-ABC Sheets Melanie Loomer -Team
-Camp Reports ~Planning Building
·Planning Activities ·Planning
-About the kids and groupings
TIME 9:00 - 9:30
MONDAY 7 Greetings Tour
TUESDAY 8 I WEDNESDAY 9 Small Group
THURSDAY 10 FRIDAY 11
9:30~10:20 10:20 -10:40 10:4 -11:30 11:30-12:30 12:30-1:00 1:00 -1:30 1:30 - 2:00
2:00 - 2:15 2:15 - 2:45 2:45 - 3:00 3:00 - 3:30 3:30 -4:30
AWClrcncssl Art Therapy SNACK Awarenessl Art Therapy LUNCH Orienteering
Orienteering
Swimming
SNACK Return Counsellor planning and supervision
Karatel Music
Karate!
Music
Cooking!
Sport Cooking' Sport Swimming
Musicl Art Therapy
Musicl Art Therapy
Big Group
Sport
Cooking' Orienteering Sn<lck!
Orienteering Cooldngl Oricnteerinq
Small Group
AW<lrcncssl Karate
Awarenessl KcJr<lte
Arts & Crafts Sport Arts and Craftsl Sports Mad Science
Small Group
Awarenessl Arts & Crafts
Awarenessl Arts & Crafts
Trip to Southland
Return
i
C:llg:uy Learning Ccnlrc·
June 23, 1997 H:\prosrnms\c:lmp\schcd'J7
TIME MONDAY 14 TUESDAY 15
I
WEDNESDAY 16I
THURSDAY 17I
FRIDAY 16 9;00 -!I;309:30 -10:26
10:20 -10:40 10:40 -11:30
11:30 -12:30
12:30 -1:00 1:00~1:30
1:30 - 2:60
2:00 -2:15 2:15 - 2:45 2:45 - 3:00 3:60 - 3:30 3:30 -4:30
i
SMALL GROUP Awareness!
Art Therapy SNACK TIME Awareness!
Art Therapy LUNCH
Sport Encrgium
SmallGroup Music!
Art Therapy
Music!
ArtTherapy
Awareness!
Sport AwarcnessJ Sport Orienteering Orienteering Orienteering
Karatel Music
Karate!
Music LiJke Sikome
TIm Hortons AWilrenessf
Karate
Awareness!
Karate Arts &Crartsl Cooking
Sw,mm,ng-A.I,,t;H
J
U-ll /(/'F'j
CI\I;:uy Leaming Cenrre June23,1997 H:\progr:lms\Co\mp\schcd97
