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Attention Deficit Disorder
Reprinted from NARHA
Strides magazine, October 1997 (Vol. 3, No. 3)
Attention Deficit
Disorder Attention deficit disorder (ADD) is a developmental disability
estimated to affect between 3-5% of all children (Barkley, 1990). The disorder
is characterized by three predominant features: inattentiveness, impulsivity,
and in many but not all cases, restlessness or hyperactivity. The disorder is
most prevalent in children and is generally thought of as a childhood disorder.
Recent studies, however, show that ADD can and does continue throughout the
adult years. Estimates suggest that approximately 50-65% of the children with
ADD will have symptoms of the disorder as adolescents and adults (Barkley,
1990).
What Causes ADD
Scientists and medical
experts do not know precisely what causes ADD. Scientific evidence suggests
that the disorder is genetically transmitted in many cases, and is caused by a
chemical imbalance or deficiency in certain neurotransmitters (chemicals that
regulate the efficiency with which the brain controls behavior). Results from a
landmark 1990 study showed that the rate at which the brain uses glucose, its
main energy source, is lower in subjects with ADD than in subjects without ADD.
Even though the exact cause of ADD remains unknown, we do know that ADD is a
neurologically-based medical problem and is not caused by poor parenting or
diet.
From ADD Briefing
Paper, National Information Center for Children and Youth with Disabilities,
800-695-0285.
Typical Characteristics of a Child With Attention Deficit
Disorder
ˇ
Fidgets,
squirms, is restless
ˇ
Has
difficulty remaining seated when required
ˇ
Is
easily distracted by extraneous stimuli
ˇ
Has
difficulty awaiting his turn
ˇ
Difficulty
following instructions
ˇ
Difficulty
sustaining attention in task or play
ˇ
Often
shifts from one unfinished activity to another
ˇ
Has
difficulty playing quietly
ˇ
Often
talks excessively
ˇ
Often
interrupts/intrudes on others
ˇ
Often
does not seem to listen
ˇ
Often
loses things necessary for tasks or activities
ˇ
Often
engages in physically dangerous activities without considering possible consequences
According to the
Diagnostic and Statistics Manual, version III, revised.
Medical Considerations for Therapeutic Riding
By
Colleen Zanin, M.S., OTR
For years, therapeutic
riding programs have been a haven for riders with ADD with and without hyperactivity.
The triad of symptoms that characterize the hyperactive riders (impulsivity,
distractability and hyperactivity) have frequently prevented success in other
attempts at organized sports. However, the individuality and novelty inherent
in therapeutic riding appears to be a natural medium for these
"motor-driven" children.
As researchers gain
more knowledge about individuals with this disorder, it becomes apparent that
there is a considerable amount of diversity within the scope of attention deficit
disorders. Frequently, children with attention deficit disorder with
hyperactivity (ADD/H) also have secondary difficulties with learning or
language disabilities, fine or gross motor delays, and behavioral/social
problems. Many children with ADD/H are on medication. The school or parents
should inform the riding program about the medication so the riding instructor
is alert for side-effects and medical problems. As part of the enrollment
process in a therapeutic riding program, it is important to consult with the
rider's parents, teachers, psychologist, therapist, etc. to develop a more
accurate rider profile. Keeping in mind the environment of the riding facility,
the nature of horses, and the potential hazards that occur in the setting, it
is wise to develop a questionnaire to help you prepare for the rider prior to
their arrival. The questionnaire may include questions regarding some of the
predominant features of a child with ADD/H (Hanschu, 1997).
Poorly Sustained Attention
Is the rider easily distracted
by extraneous noise?
Does he have difficulty
organizing tasks?
Does he fail to finish
what he started?
Does he seem to
"not listen" to directions?
Is he forgetful and
frequently loses things?
Impaired Impulse Control
Does he usually act before
thinking?
Can he delay
gratification, or does he want things now?
Does he blurt out
answers in a group?
Can he wait his turn
when playing or conversing?
Does he intrude or
interrupt others who are speaking?
Excessive "task irrelevant" Activity
Is the rider
excessively restless, fidgety, or squirmy?
Does he frequently
shift positions?
Does he have difficulty
staying seated or waiting in line?
Does he have difficulty
with quiet times or quiet tasks?
Does he have difficulty
adapting his behaviour to the task?
Secondary Psychological Complications
Is the rider developing
a pattern of underachieving?
Does he become easily
frustrated?
Does he appear sad or
depressed?
Does he lose his temper
easily?
Once the riding instructor
has an accurate diagnosis of the rider and has discussed the results of the
secondary deficits with the child's educational team, a lesson plan can be
developed. External limits and controls are very important when working with
these specific riders. Concrete examples and repeated demonstration will help
the rider organize his actions and develop a feeling of security within the
therapeutic riding setting. An orientation to the riding facility and to the
rules of the facility will help the rider determine the boundaries of the
setting. Consistent routines allow the rider to start developing a sequenced
approach to this new setting. Posters with rules, lists of procedures, and
pictures of grooming/tack supplies are helpful visual cues to assist the rider.
Many riders may need one-to-one assistance with grooming and tacking due to
their impulsivity and difficulty with remembering how to sequence multi-step
tasks. The novelty of the barn with animals, hay, tools, wheelbarrows, etc. may
also prove to be great distracters. It may be more beneficial to tack the
horses in their stalls than in an open aisle to decrease the amount of
distractions during class preparation. The rider may also benefit from
reinforced learning by using hand-over-hand training techniques coupled with
precise language during grooming and tacking. Predictability is important to
riders with ADD/H. Therefore, an established routine helps to allay some of the
insecurities that may arise in this environment. Consistent use of leaders, sidewalkers
and the same dependable mount will initially help to establish trust as the
rider becomes immersed in the "equestrian world."
The long-term goal for
most riders with ADD with or without hyperactivity is to become an accomplished
rider. This is an achievable goal as long as the proper framework is provided.
Initially, a small group is essential to reinforce the principles of a balanced
riding seat, proper use of the reins, and independent use of the legs, seat and
trunk. Frequently these riders will exhibit subtle motor or sensory delays
which may require a longer period of practice and repetition to gain
proficiency. The strong sensory input provided by the moving horse helps
reinforce the rider's body scheme, which usually results in improved motor
reactions (greater ability to follow the horse's movements, improved use of the
reins for guiding the horse, greater ability to stabilize the leg underneath
the body). As the rider becomes more familiar with the language used in riding
(inside, outside, right, left, reverse, change of rein, etc.), he is able to
make a spontaneous language/motor match. This process of linking the words with
the actions enhances attention and memory. Additional teaching techniques of
task analysis (breaking down large tasks into small tasks), and the use of
strong proprioceptive input (heavy work, such as standing in the stirrups,
pushing hands down on the pommel and cantle of the saddle, the use of weighted
props) also helps to reinforce the rider's position in space and proper
sequencing of motor tasks.
Many therapeutic riding
programs now offer remedial or sports vaulting. This may be an outlet for the
more distractible rider who has difficulty with independent control of the
horse. The compulsory figures prescribed in vaulting present an ideal
opportunity for the rider to learn how to move his body in space. The various
positions (flag, kneel, mill, flank and stand) incorporate a variety of
motor-planning and proprioceptive opportunities. Learning to work as a team member
is an important component for riders participating in a vaulting group.
However, the rider with ADD/H may have difficulty waiting his turn and sharing
the horse. The instructor may consult with the rider's parent or educational
staff to determine if there are specific behavioral interventions that are
effective for this rider. It is important to remember that many riders with
ADD/H are easily bored by mundane tasks, often lack a "healthy
respect" for danger, and may shift gears at a moment's notice.
The following are
a few general behavioural interventions that may be effective:
1.
Build
rapport with the rider from the first lesson. Try to develop understanding and
a sense of empathy for his very real difficulties with behavioral controls.
Plan ahead to decrease distractions and to offer a novel, quick-paced lesson.
Try to arrange for a special "buddy" who will help to monitor the
rider, especially if there are several riders in the session.
2.
Take
time during the initial sessions to teach the behaviours you expect. Often
riders with ADD/H have difficulty with inferences. Be very clear with
behavioural expectations.
3.
Provide
positive attention by using the rider's name. Praise specific behaviours
("You are keeping your hands very quiet today. I can see that your horse
appreciates it!"). These riders become immune to neutral praise, such as,
"good job!"
4.
Some
riders respond to the instructor's proximity. A rider may respond positively to
private attention, but negatively to public attention. Asking the rider to
dismount for a "private discussion" is a tool that may be useful if
the rider is not paying attention or is starting to take excessive risks.
Many parents of
riders enrolled in a therapeutic riding program marvel at their child's
newfound skills. The riding center may be one of the first places where their
child experiences success and acceptance. The motivating lure of the large,
gentle animal, the calm and consistent support of the therapeutic riding team,
and the naturally accepting environment of the "stable" provide
opportunities for the child to learn and develop. These opportunities may help
to turn the often disparaging label of ADD into a child who is Absolutely
Delightfully Driven.
Barkley, R. 1990.
Attention Deficit Hyperactivity Disorder, a handbook for diagnosis and
treatment. New York: Guilford Press. Hanschu, B. 1997. Autism and Attention
Deficit Disorder/Hyperactivity: a Sensory Perspective. Lecture Outline and
Supplemental Materials. Phoenix, AZ 85032.
Colleen Zanin, M.S., OTR is the founder of LIFT ME UP! Therapeutic Riding
Program in Great Falls, VA. She is an occupational therapist employed by
Fairfax County Public Schools. Colleen currently serves on the AHA Board of
Directors.