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Introduction
SEBD stands for social, emotional and behavioural difficulties that children or infants suffer from during the early stages of their development. SEBD is a broad term that is used to categorise various behavioural disorders that affect the performance of children in learning activities as well as in peer and family socialization.
One of these disorders that will be the focus of this study is the attention deficit hyperactivity disorder (ADHD). Children who suffer from SEBD present a special challenge to parents, teachers or other related guardians as their behavioural deficiencies causes them to interfere with the daily activities in the home or in school.
In the classroom setting, SEBD behaviour usually manifests itself in the form of uncooperativeness, rebellion to authority, oppositional behaviour and general disruptiveness (Clough 2005).
While the classroom is the most common place for the symptoms of SEBD to be displayed, the same situation occurs in the family setting where parents and siblings are engaged in a 24 hour cycle of conflict with a child that suffers from SEBD.
The unifying factor of all SEBD disorders is that they are disturbing to both school teachers and parents of the affected child, meaning that any interventions and concerted efforts to deal with the disorder will involve parents, teachers, paediatricians and therapists.
Strategies that will be used in SEBD should, therefore, consider the important role that the society, the family and the school environment plays in the overall development of the child’s social, emotional and behavioural needs (Carsch 2006).
Literature Review of ADHD in Infants
Attention deficit hyperactivity disorder (ADHD) refers to a behavioural disorder that affects the overall development of a child psychologically and mentally. ADHD is usually characterised by poor or low attention in class or family settings, hyperactivity, restlessness and disruptive behaviour.
Each of these behaviours occur at infrequent times within different settings where in one instance the child might be attentive to what is going on and in the next minute they might display disruptive or inattentive behaviour.
This type of SEBD neurobehavioural disorder is one of the most researched and studied psychiatric disorder in children and infants. This is because it is seen as one of the most continuous behavioural and emotional traits that exist in the world population causing a general deterioration in the mental development of the child (Biederman 1998).
The research work conducted on ADHD has categorised the disorder as a type of SEBD disruptive disorder that affects the behaviour of children as well as their cognitive capabilities.
The number of children who are diagnosed with ADHD amounts to between 3 and 5 percent of the worldwide population of children where 16 percent of this number are school-going children.
The percentage of children that carry the disorder well into their childhood averages between 30 to 50 percent where they continue to suffer from the various symptoms presented by the disease.
Adults and teenagers tend to develop coping mechanisms that will enable them to deal with the behavioural impairments that come with the disorder which is not possible for small children and infants (Nair et al. 2006).
ADHD has further been divided into three sub-categories which include predominantly hyperactive-impulsive disorder where the sufferer exhibits hyperactive and impulsive behaviour and inattention to surroundings, predominantly inattentive where the symptoms exhibited by the sufferer are mostly hyperactivity and impulsivity as well as combined hyperactivity-impulsive and inattentive behaviour where the child or infant suffering from the disease demonstrates hyperactivity and impulsivity.
These are the key categories and symptoms that are demonstrated by children suffering from ADHD. Identifying and defining the symptoms of ADHD is however a difficult process as it is usually difficult to determine which levels of hyperactivity, impulsiveness and inattention constitute a symptom of ADHD.
Therefore for a proper diagnosis of the disorder to be made, the child or infant has to be observed in multiple settings for a period of six months or more (Ramsay 2007).
As mentioned in the previous paragraph, ADHD falls into three sub-categories which exhibit different symptoms in children. Other symptoms that are used to determine whether a child is suffering from ADHD include becoming easily distracted, forgetting certain details, poor attention or difficulty in focusing on a particular task, easily confused and difficulty in processing information in an accurate way.
The effects of these symptoms on a child’s ability to concentrate on their schoolwork are low as they develop a poor working memory and they have a low ability to retrieve vital information that will be important in their learning process. These symptoms also cause children to have poor organizational skills as well as difficulty in predicting certain outcomes from their learning experiences.
Children that suffer from ADHD have a low tolerance to frustration and disappointment, which might cause them to react poorly to overly stressful situations. They also tend to be very talkative and impulsive in their behaviour which makes it difficult for the concerned parties to deal with them properly (Lougy and Rosenthal 2002).
While children and infants are unable to control their impulsive and hyperactive behaviour, teenagers have been able to demonstrate a certain resistance to some of the symptoms that are related to ADHD.
Just like adults, teenagers are able to develop resistance mechanisms that will enable them reduce their hyperactivity, impulsivity and inattentive behaviour to a manageable level.
The symptoms from any of the three sub categories of ADHD usually diminish as children approach adolescence but in some teenagers, the symptoms remain making it difficult for them to engage in social interactions within the school setting.
These teenagers experience cases of hyperactivity which are demonstrated through antisocial or delinquent behaviours and also overactiveness and impulsivity which are on the extreme side (Jensen et al. 2007).
Educational, Psychological and Medical Assessment
According to the American Academy of Paediatrics for Clinical Practice Guidelines, to be able to gain a reliable diagnosis of ADHD, three criteria need to be meet and they include obtaining information about the child’s behaviour from more than one setting, determining conditions that might make it difficult to properly diagnose the disorder and the use of explicit criteria to diagnose the disorder through DSM-IV-TR.
For these criteria to be effective in diagnosing a child with ADHD, the following symptoms have to be present so that the child can be labelled as having ADHD; the child has to have had behavioural impairments from the age of 7, the child should have demonstrated behavioural and psychological deficiencies for a period of at least six months, the symptoms have to had created a major handicap in the following institutions of a child’s development: the classroom, home, society, playground and the community.
In this case for the child to be termed as suffering from ADHD, they have to demonstrate behavioural deficiencies in all these social institutions (Smucker and Hedayat 2001).
Educational assessments of ADHD are usually conducted within school or educational settings where the child or teenager’s behaviour is observed to found out if they are suffering from ADHD. Although the signs for this disorder are usually evident during the infancy years of the child, the disorder is usually diagnosed during the school going years.
Apart from paediatricians and therapists, teachers have been able to identify whether a child suffers from ADHD or not. This is mostly attributed to their ability to observe children’s behaviour during the learning process which has proven to be important when designing suitable learning strategies (Rader et al. 2009).
Educational assessment of the disease is, therefore, done by observing the performance of the child in class activities and learning activities. The teacher notes how the child is able to respond to certain learning tasks by determining whether their level of focus to completing the task as well as their attentiveness to class instructions.
If the child or adolescent demonstrates an inability to concentrate in class and has learning disabilities, then they can be termed to have attention deficit hyperactivity disorder. If they also demonstrate disruptive behaviour in class and increased hyperactive levels, they can be termed to have ADHD (Erkulwater et al. 2009).
Because the disorder causes children to be hyperactive, they might times disrupt classroom lessons by making a lot of noise or exhibiting restless behaviour which might be a cause of disruption to other children in the class.
This disruptive behaviour could also be attributed to how easily bored children suffering from ADHD get when they are involved in less enjoyable activities such as classroom learning.
For educational assessments to be effective in determining whether a child suffers from ADHD, they should be conducted with the assistance of therapists, paediatricians and other people who are qualified to perform such diagnostic assessments.
Parents are also encouraged to participate in the educational assessment of children to ensure they are informed on whether the child suffers from ADHD or not. For the assessment to be successful it has to include information of what support services will be needed to deal with the disorder in the learning and educational activities of the child.
The educational assessment will, therefore, be important in determining what educational plans need to be drawn up to ensure that the child’s learning needs are adequately dealt (Reynolds and Kamphaus 2003).
Psychological assessment of ADHD measures the potential ability of a child suffering from ADHD by focusing on what needs to be learned instead of what has been learned in the educational context.
Psychological assessments measure the cognitive strengths and weaknesses of children and adolescents who are suffering from the disorder by assessing their learning capabilities and potential to retain information during and after the learning process.
At times, psychological assessments are usually conducted through the use of capability tests such as the WAIS-III to measure the overall potential of the child and they at times also measure the intelligence quotient or IQ of the child (Olin and Keatinge 1998).
Psychological assessments play an important role in the diagnosis and treatment of ADHD as the results of the IQ test are usually used to determine whether a child suffers from the disorder.
The use of psychological assessments in the diagnosis of the disease mostly occurs when the symptoms exhibited by the child, adult or adolescent are consistent with the symptoms of other multiple diagnoses which makes it difficult for the physician to determine whether the individual suffers from ADHD.
Psychological assessments are useful in developing treatment options in the event clinicians are unsure of the most suitable types of treatment that can be used to deal with the disorder (Pliszka 2007).
Since the psychological assessment is able to measure critical aspects such as impulse control, emotional, behavioural and cognitive capabilities, it can be used by physicians and paediatricians to design suitable treatment plans that will help the patient deal with the behavioural impairments that are caused by ADHD.
The results of psychological assessments are also important in determining what educational plans will be drawn to suit the behavioural deficiencies of children suffering from the disorder.
Because it can easily identify the potential and cognitive abilities of sufferer’s, this method of assessing ADHD can be used to develop psychological recommendations that will be used to guide the parents, teachers and caretakers of the child on how they should handle them (Olin and Keatinge 1998).
Apart from measuring the behavioural potential and cognitive capability of the child believed to have ADHD, psychological assessments measure the self-control abilities of individuals by identifying the factors that infringe on a child’s ability to exercise self-control within certain settings.
For example, a psychological assessment can be used to help paediatricians and psychologists determine the factors that cause children with ADHD to develop disruptive behaviour during class time.
There are various psychological assessment models that are used to measure the cognitive and behavioural abilities of children believed to suffer from ADHD.
One of these models was developed by Cushman and Scherer in 1995 and it involves a series of steps one of which involves determining the type of information that will be gathered from the test and identifying the people who will be involved in the test.
Other steps in the model require the people involved in the assessment to identify the aspects that need to be measured and also select the measures that will be used to determine the outcome of the assessment (Olin and Keatinge 1998).
A medical assessment of ADHD, on the other hand, deals involves diagnosing the signs and symptoms of the disease to determine whether the child suffers from disorder. Medical examinations are the most common tools that are used to determine whether infants, young children, adolescents or adults suffer from ADHD.
These types of assessments have however been criticised as many clinicians argue that they are inadequate when it comes to diagnosing the symptoms of ADHD. Medical examinations that are done as a routine on children who have been diagnosed with ADHD rarely provide any useful medical interventions that can be used to manage or treat the disorder.
The results of a medical examination always support the results used during the diagnostic process by providing clinicians with important information that will be used to support the diagnostic process (Brock et al. 2009).
While medical examinations are viewed to be inadequate in determining whether a child suffers from ADHD, a medical diagnosis through the use of psychiatric assessments has proven to be effective in providing the right results.
The psychiatric assessment eliminates the symptoms that are used to diagnose ADHD through the use of techniques such as laboratory tests or physical examinations. In many of these psychiatric assessments, the DSM-IV criteria are what is commonly used to diagnose the symptoms of ADHD.
These DSM-IV criteria include six or more symptoms of inattention present in the infant, child, adolescent or adult for at least six months, the presence of six or more symptoms of hyperactivity and impulsiveness in the patient, the presence of socially impairing symptoms before the age of 7 years and the presence of these symptoms in a school, community, playground, home or social setting (American Academy of Paediatrics 2001).
The use of the identified DSM-IV criteria in diagnosing the symptoms of ADHD is usually highly effective when used with psychiatric assessment tests. The DSM-IV criteria are extensive and they cover all the symptoms of ADHD, which might be displayed by the child in any of three sub-categories of ADHD.
They, therefore, have a higher efficacy rate of ascertaining whether a child suffers from ADHD. Apart from medical assessments, other tools that can be used to determine whether a child or adolescent suffers from ADHD are self-reports.
The child is given an evaluation form where they tick off the symptoms that they think best depict their current behaviour. A commonly used tool in the self-report is a checklist where the sufferer ticks of any symptom that might be similar to what they are experiencing (Mash and Barkley 2008).
However, this method faces some discrepancies where according to Mash and Barkley (2008) the child might be unable to provide any useful information that will be used to diagnose whether they have ADHD.
Young children might also be unable to provide an accurate account of their behavioural impairments beyond what is usually provided by collateral informants.
These self-report are however effective in measuring the cognitive abilities and potential capability of clinically referred adults and teenagers as they have the cognitive ability to perform these self-evaluation tests.
Family reports, on the other hand, are usually performed by members of the affected child where they evaluate the behaviour of the child against a checklist of listed behaviours which are used to determine if a child is suffering from ADHD.
The parents of the child and any older siblings with the help of a paediatrician or therapist identify any behavioural impairment that the child might have which can be used to explain whether they are suffering from ADHD (Mash and Barkley 2008).
Treatment Interventions
Once a child or adult has been diagnosed with ADHD, the next step will involve identifying a suitable intervention for the person’s treatment plan. The traditional method of treatment for children diagnosed with ADHD has mostly been a prescription of Ritalin which is a stimulant that reduces the level of hyperactivity, impulsivity and inattentiveness.
However, the use of this drug has proven to be ineffective in dealing with the number of infants and young children that are being diagnosed with the disorder. This has seen the development of modern treatment interventions that are used in combination with drug therapies so as to alleviate the symptoms of ADHD in children (Brown 2009).
In the case of educational interventions, the school in collaboration with the parents of the affected child and therapists develop individualized educational plans that will be used for the students to cater to any learning deficiencies the child might have in the classroom setting.
These individualised plans do not however include drug therapy as they focus solely on improving the learning outcomes for the affected child. Under the individualised plan, an ideal classroom setting for the child suffering from ADHD would be one that has clearly defined rules and well-organized classroom structures.
It would also ensure that the child is not isolated from the rest of the class but is placed at the front near the teacher to facilitate guidance when the situation necessitates it (Hendriks 2010).
The amount of stimuli present in the classroom should be reduced to ensure that the child is not easily distracted or disrupted from their learning routine. The teacher should also observe class schedules and routines to ensure that there is less fluctuation in the energy levels of the child diagnosed with ADHD.
This will ensure that their hyperactivity is kept at a minimal as long as they are engaged in a mixture of low and high energy activities. Students who suffer from ADHD can also be involved in designing learning environments that will be appropriate for their behavioural impairments.
This will provide them with an opportunity to own their situation and also participate in change processes that will allow them to achieve learning outcomes.
Teachers can help children with ADHD in self-monitoring activities by selecting and explaining the behaviours that come with the disorder and also explaining to the student how they can be able to improve on their behaviour within the learning environment (Brown 2009).
Once particular behaviours of the disorder have been selected, the teacher helps the child develop a rating scale that will be used to rate the behaviour of the child based on whether they have improved or not.
The teachers show the child how they should use the rating scale to ensure they gain accurate and reliable results which they will use to determine whether their behaviour has improved.
Another educational intervention which can be used in the classroom setting is the positive behavioural interventions which involve creating positive school environments that will sustain the behavioural improvement of the affected child.
Positive behavioural interventions ensure that the school environment is able to improve the lifestyle of the affected child or teenager by reducing their behavioural impairments to a less desired level (Safran and Oswald 2003).
As mentioned earlier on, the most commonly used medical intervention that are used to treat children suffering from ADHD is Ritalin which is used to provide a calming effect to ADHD sufferers to reduce their levels of hyperactivity and restlessness.
Ritalin is therefore a type of a psycho-stimulant medication that decreases the stimulation levels of children suffering from ADHD. Various clinical guidelines have supported the use of pharmacological treatments as one of the drug therapies used to treat children, adolescents and adults (American Academy of Paediatrics 2001).
A study on the pharmacological treatment of ADHD revealed that 2.5 million children used psycho-stimulant medication in treating the disease, a number which had increased rapidly by about 12 percent every year for the number of children that were affected by the disease (Brown 2009).
Psycho-stimulant medication usually produces immediate improvements to the behavioural impairments that accompany ADHD as well as improving cognitive and social functions of the sufferer, thereby enabling them to participate in social interactions with their peers.
Psycho-stimulant medication also ensures that the cognitive and potential capabilities of the sufferer have undergone major improvements. The efficacy of this type of medication in treating ADHD sufferers has been documented in controlled clinical trials conducted by Gadow et al. in 1992 and Schahar in 1996 where the success rates have been notably high.
However, the psychological processes that underlie the use of psycho-stimulant medication have not been clearly understood by many of these researchers as well as the long term benefits that go with taking psycho-stimulant drugs (Schahar et al. 1996).
The psychological interventions that are used in treating children with ADHD involve the use of self-monitoring techniques where the affected patient observes their behaviour so that they can initiate impulse control measures and techniques to control hyperactive and impulsive behaviour.
Psychological interventions that have focused on the behavioural treatment of ADHD have proven to be effective in the past where individuals suffering from the disorder have been able to experience a behavioural change in their cognitive impairments.
Clinicians and therapists have recommended that psychological interventions should be conducted on preschool children that have been diagnosed with the disorder to ensure so as to sustain their behavioural change process (Fabiano et al. 2009).
The techniques that are used in psychological interventions include psycho-educational inputs where the performance of the child is observed in an educational setting, behavioural therapy where the child is taught techniques that are meant to reinforce and institute desired behaviours while at the same time eliminating the undesirable behaviours, cognitive behavioural therapy which deals with the treatment of dysfunctional behaviours and uncontrollable emotions that are some of the major symptoms of ADHD as well as solving problems that are caused by these behavioural deficiencies (Robertson 2010).
Other psychological interventions that are used to treat the disease include interpersonal psychotherapy which focuses on improving the interpersonal skills of the person suffering from
ADHD and family therapy where family members (parents and siblings) of the affected child are involved in nurturing and development activities that are meant to improve the socialisation process of the child (Kratochvil et al. 2009).
Psychological interventions are beneficial for children, adolescents and adults suffering from ADHD as they provide the right approaches for adjusting to their behavioural impairments while at the same time offering treatments that can be used to improve the cognitive and behavioural abilities of the individual sufferers.
Therapists who recommend the use of psychological interventions in treating ADHD should emphasize on the strengths and weaknesses of the sufferer to ensure that the outcome of the intervention leads to an improvement of the behavioural patterns of the ADHD sufferer.
Therapists should highlight and focus on the positive characteristics of the patients which will be used to necessitate change in cognitive behavioural therapies as well as the other techniques that are used in psychological interventions.
Psychological interventions provide patients with the opportunity of increasing their social skills so that they can be able to function more successfully in social situations (Young and Bramham 2007).
The aspects that are usually considered when developing psychological interventions to treat ADHD include considering the attention span of ADHD sufferers more importantly young children who are more than likely to have a high a lower attention span than teenagers.
Other aspects that need to be considered when developing psychological interventions include the memory capacity of the patient where their ability to retain information is measured as well as their potential capabilities which will be important in ascertaining whether they can be able to withstand psychological behavioural therapies (Ryan and McDougall 2009).
As mentioned earlier the medical intervention of treating ADHD has a lower efficacy rate when compared to that of psychological assessment as it focuses on repressing the symptoms of the disease rather than the behavioural deficiencies that accompany the disease.
The results of taking psycho-stimulant medication vary with many children who suffer from ADHD where children who are under psycho-stimulant medication such as Ritalin and generic methylphenidate might not show any improvements after beginning their treatment plans.
This means that there would be no difference between a child suffering from ADHD who has been placed under psycho-stimulant interventions and a child who is not under any ADHD medication. Doctors usually recommend discontinuation of psycho-stimulant medication if after a year there are no visible improvements in the health of the child (Faraone 2006).
Evaluating the Effectiveness of Treatment options
In their review of the effectiveness of educational interventions in treating children and adolescents suffering from ADHD, Chambless and Ollendick noted that interventions which involved parents, therapists and other qualified professionals had a higher efficacy in treating children with the disorder than when the intervention involved teachers only.
The effectiveness of these studies in determining the behavioural expectations and educational demands of young children has yielded different results from those of adolescents and older children. Chambless and Ollendick in their 2001 studies called for more research how the educational interventions could be conducted on preschoolers so as to determine the efficacy of these interventions on preschoolers (Mowder et al. 2009).
A study was conducted by Fabiano et al. (2009) on the effectiveness of psychological interventions in treating children that were suffering from ADHD.
The researchers conducted a meta-analysis that would be used to identify the relevant behavioural treatments needed for behaviour modification processes in children suffering from attention deficit hyperactivity disorders.
The researchers analysed over 174 behavioural treatment studies that had been documented by various researchers over the years where they noted that there was strong and consistent evidence that supported the effectiveness of the various psychological treatments in dealing the ADHD symptoms (Fabiano et al. 2009).
Another study that was conducted to determine the effectiveness of psychological interventions in treating ADHD was conducted by Cohen et al. 1981 where they noted that psychological interventions that were combined with psycho-stimulant medication were effective in treating children that were suffering from ADHD disorders.
Overall, research and studies conducted on how to treat ADHD in the past decade have shown that the combined use of medication with psychological behavioural treatments has a higher efficacy in treating ADHD in young children, adolescents and adults.
Studies that researched on the short term benefits of using psycho-stimulant medication alone without any behavioural therapy were less effective than when they were combined with psychologically therapy (Wolraich 2002).
The National Institute of Mental Health carried out a multimodal study of 579 children that were suffering from ADHD over a period of fourteen months.
Each of the 579 children received four different types of interventions which included medical interventions, psychological interventions that were focused on behavioural therapy, educational interventions and interventions that combined psychological, medical interventions.
The results of the study revealed that ADHD children who were treated with psycho-stimulant drugs only without the combination of psychological therapy had a lower efficacy when compared to children that received a mixture of behavioural therapy and medication who were able to record an improvement in their ADHD symptoms.
The results of the NIMH study revealed that combined treatments were the most effective in reducing behavioural impairments in children, adolescents and adults suffering from ADHD (MTA Cooperative Group 1999).
Recommendations
The best treatment options that can be used in treating children, adolescents and adults suffering from ADHD are the psychological treatment options which according to research studies have been determined to be more effective than medical or educational interventions.
This is mostly attributed to the fact that psychological interventions focus on reducing the behavioral impairments that children or adults with ADHD suffer from by eliminating the symptoms presented by the sufferer of the disease.
When psychological treatments are combined with medication, they have a higher efficacy rate of treating children, adolescents and adults that suffer from the disease. To therefore effectively deal with the disorders that are caused by ADHD, psychological therapy can be combined with medical treatments to achieve a high efficacy.
Conclusion
The research has focused on the social, emotional and behavioural difficulties or disorders that affect children, teenagers or adults. The SEBD disorder that has been focused on in this study is the attention deficit hyperactivity disorder otherwise denoted as ADHD.
The research has provided a literature review of the disorder by identifying the various sub categories and symptoms that make up the disorder.
The various educational, medical and psychological interventions that are available to treat the disorder were assessed and the treatment interventions that were incorporated by any of these three methods were discussed to determine which method was effective in treating or improving the symptoms of ADHD.
Based on the discussion, psychological interventions were identified as the most effective and medical interventions were deemed to be effective when they were combined with psychological therapy.
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