Individual Interventions

Two of the most widely used CBIs are self-instruction training and self-management. The main goal of self-instruction training is to teach children to utilize self-directed speech to guide their own behavior with the assumption that this will lead to improved self-control. Russell Barkley and others have observed that children with ADHD exhibit a developmental lag in developing verbal working memory, also known as internalization of speech. The progressive shift from public to private speech in children has been found to influence motor behavior and inhibitory control. According to Barkley, self-directed speech provides a means for description and reflection by which the child covertly labels, describes, and verbally contemplates the nature of an event or situation before responding to that event. Shapiro and Cole (1994) summarized the self-instruction training process in the following manner.

First, the instructor models self-speech out loud and engages in a task while the child listens and observes. Second, the instructor models self-speech out loud while the child concurrently engages in the activity. Next, the instructor observes and prompts the child when needed while the student uses self-speech out loud and engages in an activity. Then, the instructor observes and eventually discontinues prompting while the child whispers self-speech and engages in a task. The instructor then observes while the child engages in the task silently. From then on, the child is instructed to use private self-directed speech only. Shapiro and Cole (1994) note that children may have difficulty generalizing the behavior outside of the training situation. Repeated practice, especially across a variety of settings, helps to improve generalization. It is also important to consider whether or not the child is motivated, as this will be the deciding factor in the acceptability of this type of intervention. Finally, the instructor must also consider whether the child is more focused on the self-speech procedure than the activity in which he or she is to be engaged. Ervin, Bankert, and DuPaul (1996) found that self-instruction training can be effective with children with ADHD if used with concurrent behavioral components (i.e., contingencies of reinforcement).

Another popular set of strategies for helping children develop self-control is self-management. Self-management is often divided into self-evaluation and self-reinforcement. The original impetus behind these strategies was to develop a set of strategies that could allow teachers to shift the responsibility for monitoring children's behavior to the children themselves (Shapiro & Cole, 1994). In a typical procedure, the teacher identifies one or two behaviors the child needs to improve in class. For example, a third-grade teacher identifies "staying in my seat" and "finishing my work" as target behaviors for the intervention. The teacher then creates the criteria for rating the target behaviors. The teacher may create a Likert-type scale ranging from 1 to 4: 1, very low effort; 2, not enough effort; 3, sufficient effort; and 4, very good effort. The teacher trains the child in completing the ratings using specific examples to explain what each of the levels in the scale represents. The child is then instructed to monitor his or her behavior carefully and try to guess what score the teacher is going to give. The goal of the procedure is to enable the child to approximate and eventually match the ratings of an objective rater. Both the teacher and the child complete a rating at the end of each class period and then compare the results. If the child's ratings are within one point of the teacher's ratings, the child is awarded points. If the child's ratings match the teacher's ratings exactly, the child is awarded bonus points. Of crucial importance in these procedures is developing a reinforcement system that is initially managed by the teacher and then management is slowly transferred to the child. The teacher and the child develop a menu of reinforcements containing privileges or other rewards to be given at school or at home. Once the child consistently matches the teacher's ratings, the teacher's participation in the rating and reinforcement is slowly faded out until the child does both without assistance. Self-management is a popular intervention for addressing classroom disruption and off-task behavior in students with ADHD, especially those in middle school and later grades. Self-management has been found to be effective with students with ADHD, although training must occur at the point of performance in order to ensure maintenance across settings (Shapiro & Cole, 1994).

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