Support and education for parents of children with ADHD. An open letter from parents of children with ADHD to the Minister of Education of Russia

Attention Deficit Hyperactivity Disorder (ADHD) is often called the disease of modern children. And although it is diagnosed in 6% of the child population in the population, regardless of region, any primary school teacher can tell you from personal feelings that he has much more such children.

How to understand that a child has ADHD, and how to live with it, how parents can help him, and what help he should ask a school teacher for, at the beginning of the school year, Sputnik correspondent Svetlana Litskevich talked with a psychotherapist, candidate of medical sciences, associate professor Tatyana Emelyantseva.

What is ADHD?

Such children are familiar to everyone - disinhibited, impulsive, disorganized, unable to focus on one thing for a long time. They can jump in place, wave their arms like birds, quickly forget what happened and cannot tell what happened at school today. Their behavior is unrestrained, sometimes completely inappropriate, and the notebooks are full of corrections, sometimes they may even remain empty, the sentences unfinished. As a rule, with a sufficiently high intelligence, children with ADHD study much worse than their abilities, sitting through a lesson to the end is an unbearable torture for them. How to help such a child to adapt at school, and the school to be loyal to the child?

Time works for the child

It so happened that the theme of the application of forces in science to the psychotherapist Tatyana Emelyantseva was prompted by life itself. She had to study attention deficit hyperactivity disorder (ADHD) in children, because her son had characteristic signs of this disease. She does not hide this fact, as well as the fact that everything is fixable - just such children require a lot of parental work. And most often with age outgrow most of their difficulties.

Most often, ADHD becomes a problem when the child goes to school. When his inability to study diligently is revealed, such children are disinhibited, scattered, catastrophically disorganized. In kindergarten, this can go almost unnoticed if you are lucky with the teacher.

- If such a child comes to the attention of a psychotherapist before school, do doctors most often ask to send a child with ADHD to school later?

— Yes, here time works for the child. His nervous system is maturing, and the later he goes to school, the better the results will be. A year for a child is a lot. Let such a child be overgrown in his class, but this will benefit both him and the teacher who will work with him.

- Many people are concerned about the question - should I tell the teacher about ADHD?

“Of course, this must be done. After all, the teacher should become your ally. And only together you can achieve good results. But it may be better to do this gradually, as symptoms come in - for many teachers, this diagnosis is frightening. It is a great blessing if you manage to find an educator who is familiar with ADHD, who has previously worked successfully with such children or has encountered similar in his own family.

A psychotherapist is most often contacted when a child goes to school and his "uncomfortable behavior" becomes obvious to everyone.

You should not immediately become in a pose - as if the teacher owes you something. You need to learn to find a common language. But for the most part, the school is familiar with this. For example, when I tried to explain to my son's teacher that we have "features", she calmly told me: "everyone has features, these are children."

Tom Sawyer is a typical hyperactive child

- It is believed that before such a diagnosis did not exist, this is a feature of modern children, which manifests itself in them more and more often. It's right?

- Of course not. ADHD is not a new diagnosis. It is described in detail by Mark Twain. Tom Sawyer is a typical hyperactive child. ADHD was once called hyperdynamic syndrome. Because this restlessness, disobedience were obvious to others. It is a clinical phenomenon of neurodevelopmental disorder. By the way, they now include not only ADHD, but also autism. And increasingly, these diagnoses can be combined, especially with Asperger's syndrome (one of the autism spectrum disorders). There is, of course, a point of view that children with ADHD are more fortunate - they have less pronounced neurodevelopmental weakness than children with autistic symptoms.

Most often, ADHD is diagnosed in boys. In girls, it occurs 3-4 times less often.

When should parents start worrying?

- Usually ADHD begin to "seek" after 4 years. Signs can be very different, sometimes quite atypical. But some characteristics are recognizable. 30% of these children have problems with speech development. Almost everyone is characterized by capricious protest behavior. They fight in supermarkets not because they are spoiled - they are extremely impatient and cannot control their emotions. They have early, even at preschool age, various tics begin to appear - a sign of weakness of the nervous system. Many have heightened sensory sensitivity. Some may become hysterical from the sound of a vacuum cleaner, "presses - rubs" - this is also about them. I was approached by a family in which a girl came in the first grade from school and stripped naked - everything interfered with her. They are picky about the texture of clothes, the texture of food. Food with lumps for such a child can become 100% conditions for not eating at all. They may have long-term enuresis, encopresis (calomania). The act of defecation may not be formed correctly - while I was in diapers - there were no problems, but it doesn’t work on the potty, protest. But almost immediately he will put in his pants, as soon as he is left alone. And sometimes only on these grounds they turn to specialists, other signs of problematic behavior are not declared. If a child has similar symptoms, this is an occasion to show him to a psychotherapist.

Where can parents find strength?

- What to do if such a diagnosis was made?

“Don't take it as the end of the world and prepare for a long job. In America, these issues are resolved simply - a condition for teaching a child with a severe form of ADHD in a decent school is the appointment of psychostimulants. Their high efficiency has been proven. They increase dopamine levels, which children with ADHD lack.

We do not have such a practice, there is simply no way to prescribe psychostimulants. It is important to understand that this is not an antibiotic that you drank and forgot, they do not cure, they help for a while. Psychostimulants have to be taken for years. Chemical neurotransmitters turn on the brain, attention - they give that drive that helps them finish what they started. Goes away uncomfortable behavior. Children begin to study better - because another problem of such children is that they study worse than their abilities. Much depends on their mood, on their ability to work today. For example, today there is more sun - the child is more adequate, his brains turn on better, he is more collected. But no one thinks about the long-term perspective of the child - what will happen to him next, whether he will be able to do without psychostimulants, what will be his behavior. By and large, this is not a solution to the problem, it is postponing it.

You need to constantly work with a child, know how to help him cope with his restlessness, inattention, make teachers and educators his allies. This is where parental support groups come into play.

I have been dealing with ADHD for over 10 years, working with both children and parents. During this time, many children have grown up - I am surprised at how everything changes over time, how they line up with their peers. Of course, I understand that I am dealing with motivated parents. Children with ADHD with normal attention and care can grow up to be quite successful. Yes - with small nuances. But they make good artists, architects, doctors, directors - they see the world differently, they see images, they have a developed sense of empathy, they live more with their hearts.

- You say that parents should be ready to work with the child. We all sort of bring up children, teach them step by step, etc. Should something be different for children with ADHD?

“You have to be ready to go through everything all over again. If the parents do not have this marathon attitude, the results may not be. Recently I had a family, they live in America, they came here to visit their grandmother. Mom has a second marriage there, there is a small child. She is restless, uneven - I see that she does not have the strength for an older child who has ADHD. Mom needs a specific answer: how to make the child obey, so that he studies well, so that he understands that it’s hard for mom. As a result of the conversation, I had to tell my grandmother that there were no options, except for psychostimulants there, in America. Just because I see that my mother does not have the strength to help. The boy is very difficult, he is 10 years old and he already understands that something is wrong with him. Knows that medication is coming. He asks: “Is it true that I won’t be able to be as happy as before, for example, when my friend scores a goal?” I had to explain to him that it was only for a while to change the attitude towards him. This, in my opinion, highlights the problem of the attitude of the children themselves to the appointment of psychostimulants, as a lack of freedom.

© Sputnik / Viktor Tolochko

Although there is another thing - I have been conducting group classes for parents for many years. I had one dad who came to me year after year. Heard about the same thing over and over again. When I asked why, he said: "I go here so that I have the strength to continue to help my child." In group classes, not only knowledge, but also emotional support, when there is someone else's more successful experience of interacting with the school, for example.

Reach out to him - literally

- If you return to school - what can you expect from a teacher, what help can you expect?

— It is difficult for a child with ADHD to adapt in society, and his behavior is often inappropriate. They are uncomfortable, such children. For parents, for teachers. They have a lot of problems with verbal working memory. The so-called inner speech - the ability to pronounce thoughts "to oneself" is formed in a child normally by the age of 7, and in these children it can be very late. It often happens that the task is solved, but he cannot explain the sequence of actions. Like a computer without a printer. But on the other hand, they do an excellent job with test tasks, here they can show good results.

One of the most common parental and teacher complaints is "he can't hear me."

In order for him to hear you, approach him, touch him, look into his eyes - tactile contact is important for them, let him say your request aloud. This is a way to enhance the efficiency of his memory. And the teacher, knowing how hard it is for such a child to sit through a whole lesson, can send him to rinse the rag for the board or ask him to distribute notebooks, water the flowers. Their attention must be switched to physical activity, then he will cope. If you put such a child next to the teacher on the control, he will try much more. The teacher must take this into account. But for this, parents should first talk with him about the features of the approach to such a student. I give my patients a reminder for teachers so that they know how to calm down, how to switch the attention of a hyperactive child. Information is also available on the Internet. Not everyone is looking for it, unfortunately.

It is important to understand that children with ADHD do get tired more than others. With the immaturity of the nervous system and their mobility, they run ahead of the locomotive. Often, when they get tired, they simply become inadequate.

My son and I had a very understanding teacher who put him on the couch when she saw that he was lying on the desk because he was tired. Or allowed to suck on a lollipop, which turned on attention when doing a test.

- Is it possible for such children to go to aftercare?

- I absolutely do not recommend it. In the extension, his plant will end. And disinhibition, clown behavior will begin. But at home everything will be different - he will change the situation, switch, rest and soon be able to do homework.

One of the theories that explain ADHD is the so-called energy theory, the “weak battery of the brain” theory. Everything is fine with the car engine. But sometimes there is not enough gas. For them, emotional recharging is important. Hugs and kisses help a lot. But many parents underestimate the power of tactile contact.

How can you persuade them to study?

- It is useless to scold such a child for bad grades - but if he got a good one, it is better to encourage him so that he remembers it and wants to do it again. Punishment affects them much weaker than encouragement. They quickly become bored, everything bothers. With additional stimulation, the efficiency of all people increases. And especially for these kids. They need constant rewards. Immediately. A promise - you will study well, in 2 months you will go on an excursion with the class - not for them. Their reward should be immediate.

People on their wave

- Where does such a diagnosis come from and is there any hope that over time the child will even out, outgrow it?

- In the 60s of the last century, it was announced that ADHD is a character trait that is inherited. Now again it is considered that this is a disorder of brain development, due to both hereditary factors and external ones. Including how the pregnancy went, childbirth, in what conditions the child is brought up. And if a child was genetically predisposed to dopamine deficiency, but asphyxia occurred during childbirth, this can become an obvious problem.

ADHD also occurs in adults. And the numbers are different - from 30 to 70% of cases of children's diagnosis of ADHD can pass into adulthood. Young people who are already over 30 years old are increasingly turning to me for advice - they are enterprising, they are engaged in IT, everything seems to be fine. But they understand that something is wrong with them.

What complaints do adults have?

- Many complain about problems of attention, working capacity, severe asthenia, "depression", they do not develop relationships with relatives, with superiors. One young girl expressed her problem this way: "I forgot everything I was taught..."

- So this is the specifics of our education - I passed it and forgot ... Hundreds of adults can tell you this even without ADHD.

- I'm not really talking about that. People with ADHD are on their own. They easily cross social boundaries, do not always comply with social conventions - they can directly say unpleasant things to others. They are often disliked by others, and they cannot understand why. They often have mood swings, are characterized by ambivalence, duality - when they cannot understand what they need. However, they are often very successful. There is a site called "great people with ADHD", but I won't give examples - this is not correct for a doctor.

From my own experience, I can say that in recent years there have been more children with ADHD, as well as children with autism. And this is not only a problem of women's health in the perinatal period. This is a problem of society, its informatization. The child simply manifests this problem, first of all.

Of course, it is not easy with such children - to constantly organize his leisure time, make sure that he is in a good mood, resolve problems, keep abreast.

But in any case, you must believe in your child. While realizing that you can only do what you can do. But it simply cannot be done.

or ADHD is the most common cause of behavioral problems and learning problems in preschool and school children.

Attention deficit hyperactivity disorder in a child- a developmental disorder that manifests itself in a violation of behavior. A child with ADHD is restless, shows “stupid” activity, cannot sit in class at school or kindergarten, and will not do what he is not interested in. He interrupts the elders, plays in the lessons, goes about his own business, can crawl under the desk. At the same time, the child correctly perceives the environment. He hears and understands all the instructions of the elders, but cannot follow their instructions due to impulsiveness. Despite the fact that the child understood the task, he cannot complete what he started, he is not able to plan and foresee the consequences of his actions. Associated with this is a high risk of domestic injury, getting lost.

Neurologists consider attention deficit hyperactivity disorder in a child as a neurological disease. Its manifestations are not the result of improper upbringing, neglect or permissiveness, they are a consequence of the special work of the brain.

Prevalence. ADHD is found in 3-5% of children. Of these, 30% "outgrow" the disease after 14 years, another 40% adapt to it and learn to smooth out its manifestations. Among adults, this syndrome is found in only 1%.

Boys are diagnosed with Attention Deficit Hyperactivity Disorder 3-5 times more often than girls. Moreover, in boys, the syndrome is more often manifested by destructive behavior (disobedience and aggression), and in girls by inattention. According to some studies, fair-haired and blue-eyed Europeans are more susceptible to the disease. Interestingly, in different countries, the incidence varies significantly. Thus, studies conducted in London and Tennessee revealed ADHD in 17% of children.

Types of ADHD

• Attention deficit and hyperactivity are equally pronounced;
• Attention deficit predominates, and impulsivity and hyperactivity appear slightly;
• Hyperactivity and impulsivity predominate, attention is slightly impaired.

• dependence on alcohol, narcotic substances, psychotropic drugs;
• difficulties with the assimilation of information that disrupt the learning process;
• high anxiety, which comes to replace motor activity;
• tics - repetitive muscle twitches.
• headaches;
• antisocial changes - a tendency to hooliganism, theft.

Attention deficit hyperactivity disorder in a child, causes

1. Factors that disrupt the formation of the nervous system in the fetus, which can lead to oxygen starvation or hemorrhage into the brain tissue:

• environmental pollution, high content of harmful substances in the air, water, food;
• taking medications by a woman during pregnancy;
• exposure to alcohol, drugs, nicotine;
• infections carried by the mother during pregnancy;
• Rh factor conflict - immunological incompatibility;
• risk of miscarriage ;
• fetal asphyxia;
• cord entanglement;
• complicated or rapid childbirth, leading to injury to the head or spine of the fetus.

1. Factors that disrupt brain function in infancy

• diseases accompanied by a temperature above 39-40 degrees;
• taking certain drugs that have a neurotoxic effect;
• bronchial asthma, pneumonia;
• severe kidney disease;
• heart failure, heart disease.

1. Genetic factors. According to this theory, 80% of cases of attention deficit hyperactivity disorder are associated with disorders in the gene that regulates the release of dopamine and the work of dopamine receptors. The result is a violation of the transmission of bioelectric impulses between brain cells. Moreover, the disease manifests itself if, in addition to genetic abnormalities, there are unfavorable environmental factors.

Attention deficit hyperactivity disorder in a child, symptoms

Signs of ADHD at an early age

Attention deficit hyperactivity disorder in a child, symptoms which are most pronounced at 5-12 years old, can be recognized at an earlier age.

• Early they begin to hold their heads, sit, crawl, walk.
• Experiencing trouble falling asleep, sleeping less than normal.
• If they get tired, they do not engage in a calm type of activity, do not fall asleep on their own, but fall into hysterics.
• Very sensitive to loud noises, bright lights, strangers, changes in scenery. These factors cause them to cry loudly.
• Throw away toys before they even had a chance to see them.

Main symptoms

1. Attention disorder

• R the child has difficulty concentrating on one subject or activity. He does not pay attention to details, unable to distinguish the main from the secondary. The child tries to do all the things at the same time: he paints all the details without finishing, reads the text, jumping over the line. This is due to the fact that he does not know how to plan. When performing tasks together, explain: “First we will do one thing, then another.”
• The child, under any pretext, tries to avoid routine matters, lessons, creativity. This may be a quiet protest when the child runs away and hides, or a tantrum with screams and tears.
• There is a cyclical nature of attention. A preschooler can do one thing for 3-5 minutes, a child of primary school age up to 10 minutes. Then, over the same period, the nervous system restores the resource. Often at this time it seems that the child does not hear the speech addressed to him. Then the cycle repeats.
• Attention can only be focused if you are left alone with the child. The child is more attentive and obedient if the room is quiet and there are no irritants, toys, other people.

1. Hyperactivity

• The child makes a large number of inappropriate movements, most of which he does not notice. A hallmark of motor activity in ADHD is its aimlessness. This can be rotation of the hands and feet, running, jumping, tapping on the table or on the floor. The child runs, not walks. Climbing on furniture . Breaks toys.
• Talking too loud and fast. He answers without listening to the question. Shouts out an answer, interrupting the answerer. He speaks in unfinished phrases, jumping from one thought to another. Swallows the endings of words and sentences. Constantly asks again. His statements are often thoughtless, they provoke and offend others.
• Mimicry is very expressive. The face expresses emotions that quickly appear and disappear - anger, surprise, joy. Sometimes he grimaces for no apparent reason.

1. Impulsiveness

• Guided solely by their own desires and execute them immediately. Acts on the first impulse, without considering the consequences and without planning. For a child, there are no situations in which he must sit quietly. In the classroom in kindergarten or at school, he jumps up and runs to the window, into the corridor, makes noise, shouts out from his place. Takes the favorite thing from peers.
• Can't follow instructions, especially those with multiple items. The child constantly has new desires (impulses) that prevent him from completing the work he has begun (doing homework, collecting toys).
• Unable to wait or endure. He must immediately get or do what he wants. If this does not happen, he makes a row, switches to other things or performs aimless actions. This is clearly noticeable in class or when waiting for your turn.
• Mood swings happen every few minutes. The child goes from laughing to crying. Short temper is especially characteristic of children with ADHD. Angry, the child throws objects, may start a fight or ruin the offender's things. He will do it at once, without thinking or hatching a plan of revenge.
• The child does not feel threatened. He can do things that are dangerous to health and life: climb to a height, walk through abandoned buildings, go out on thin ice, because he wanted to do it. This property leads to a high level of trauma in children with ADHD.

Additional symptoms

• Difficulties in learning with a normal level of intelligence. The child may have difficulty writing and reading. At the same time, he does not perceive individual letters and sounds or does not fully master this skill. The inability to learn arithmetic may be an independent impairment or accompany problems with reading and writing.
• Communication disorders. A child with ADHD may be obsessive towards peers and unfamiliar adults. He can be too emotional or even aggressive, which makes it difficult to communicate and establish friendly contacts.
• Lag in emotional development. The child behaves excessively capriciously and emotionally. He does not tolerate criticism, failures, behaves unbalanced, "childishly". A pattern has been established that with ADHD there is a 30% lag in emotional development. For example, a 10-year-old child behaves like a 7-year-old, although he is intellectually developed no worse than his peers.
• Negative self-esteem. The child hears a huge number of remarks during the day. If at the same time he is also compared with his peers: “Look how well Masha behaves!” this makes the situation worse. Criticism and claims convince the child that he is worse than others, bad, stupid, restless. This makes the child unhappy, distant, aggressive, instills hatred for others.

Positive qualities of children with ADHD

• Active, active;
• Easily read the mood of the interlocutor;
• Ready for self-sacrifice for the people they like;
• Not vindictive, unable to hold a grudge;
• Fearless, they are not characterized by most childhood fears.

Attention deficit hyperactivity disorder in a child, diagnosis

1. Collection of information - interview with the child, conversation with parents, diagnostic questionnaires.
2. Neuropsychological examination.
3. Pediatric consultation.

1. Collection of information

Diagnostic questionnaire is a list of questions designed to gather as much information about the child's behavior and mental state as possible. It usually takes the form of a multiple choice test. To identify ADHD are used:

• Vanderbilt Adolescent ADHD Diagnostic Questionnaire. There are versions for parents, teachers.
• Parental symptomatic questionnaire of ADHD manifestations;
• Structured questionnaire Conners.

• Violation of adaptation. It is expressed by a discrepancy with the characteristics normal for this age;
• Violation of attention, when the child cannot focus his attention on one subject;
• impulsivity and hyperactivity;
• The development of the first symptoms before the age of 7 years;
• Violation of adaptation manifests itself in various situations (in kindergarten, school, at home), while the intellectual development of the child corresponds to age;
• These symptoms persist for 6 months or more.

Signs of inattention

• Doesn't pay attention to details. In his work, he makes a large number of mistakes due to negligence and frivolity.
• Easily distracted.
• Difficulty concentrating when playing and performing tasks.
• Does not listen to speech addressed to him.
• Unable to complete the task, do homework. Can't follow instructions.
• Has difficulty doing independent work. Needs guidance and supervision from an adult.
• Resists performing tasks that require prolonged mental effort: homework, tasks of a teacher or psychologist. Avoids such work under various reasons, shows dissatisfaction.
• Often loses things.
• In daily activities shows forgetfulness and absent-mindedness.

Signs of impulsivity and hyperactivity

• Makes a lot of unnecessary movements. Cannot sit comfortably in a chair. Spins, makes movements, with feet, hands, head.
• Cannot sit or remain still in situations where it is necessary to do this - in a lesson, at a concert, in transport.
• Shows thoughtless motor activity in situations where this is unacceptable. He gets up, runs, spins, takes things without asking, tries to climb somewhere.
• Can't play well.
• Overly mobile.
• Too talkative.
• He answers without listening to the end of the question. Doesn't think before answering.
• Impatient. Hardly waiting for his turn.
• Interferes with others, sticks to people. Intervenes in a game or conversation.

1. Neuropsychological examination for ADHD

1. Pediatrician's consultation

• Minimal brain dysfunction(MMD) - mild neurological disorders that cause disturbances in motor functions, speech, behavior;
• Increased intracranial pressure(ICP) - increased pressure of the cerebrospinal fluid (cerebrospinal fluid), which is located in the ventricles of the brain, around it and in the spinal canal.
• Perinatal CNS damage- damage to the nervous system that occurred during pregnancy, childbirth or in the first days of life.

Attention deficit hyperactivity disorder in a child, treatment

1. Medication treatment for ADHD

1. Physical therapy and massage for ADHD

• Physiotherapy aimed at strengthening the muscles of the neck and shoulder girdle. Must be done daily.
• Collar area massage courses of 10 procedures 2-3 times a year.
• Physiotherapy. Apply infrared irradiation (heating) spasmodic muscles using infrared rays. Paraffin heating is also used. 15-20 procedures 2 times a year. These procedures are well combined with massage of the collar zone.

Attention deficit hyperactivity disorder in a child, behavior correction

1. BOS-therapy (biofeedback method)

biofeedback therapy

The human brain generates electrical impulses. They are divided depending on the frequency of oscillations per second and the amplitude of oscillations. The main ones are: alpha, beta, gamma, delta and theta waves. With ADHD, the activity of beta waves (beta rhythm) is reduced, which are associated with focusing attention, memory, and information processing. At the same time, the activity of theta waves (theta rhythm) increases, which indicate emotional stress, fatigue, aggressiveness and imbalance. There is a version that the theta rhythm contributes to the rapid assimilation of information and the development of creativity.

The task of biofeedback therapy is to normalize the bioelectrical oscillations of the brain - to stimulate the beta rhythm and reduce the theta rhythm to normal. For this, a specially developed hardware-software complex "BOS-LAB" is used.
Sensors are attached to certain places on the child's body. On the monitor, the child sees how his biorhythms behave and tries to change them arbitrarily. Also, biorhythms change during the performance of computer exercises. If the task is done correctly, then a sound signal sounds or a picture appears, which are an element of feedback. The procedure is painless, interesting and well tolerated by the child.
The effect of the procedure is increased attention, reduced impulsivity and hyperactivity. Improved performance and relationships with others.

The course consists of 15-25 sessions. Progress is noticeable after 3-4 procedures. The effectiveness of treatment reaches 95%. The effect persists for a long time, for 10 years or more. In some patients, biofeedback therapy completely eliminates the manifestations of the disease. Has no side effects.

1. Psychotherapeutic methods

The effectiveness of psychotherapy is significant, but progress may take from 2 months to several years. You can improve the result by combining various psychotherapeutic techniques, pedagogical measures of parents and teachers, physiotherapeutic methods and adherence to the daily routine.

1. Cognitive Behavioral Methods

• Anger management skills and expressing your emotions in an acceptable way. What do you feel? What do you want? Now say it politely. What we can do?
• Constructive conflict resolution. The child is taught to negotiate, seek compromise, avoid quarrels or get out of them in a civilized manner. (If you don’t want to share - offer another toy. You are not accepted into the game - come up with an interesting activity and offer it to others). It is important to teach the child to speak calmly, to listen to the interlocutor, to clearly articulate what he wants.
• Appropriate ways of communicating with the teacher and with peers. As a rule, the child knows the rules of behavior, but does not follow them because of impulsiveness. Under the guidance of a psychologist in the game, the child improves communication skills.
• Correct methods of behavior in public places - in kindergarten, at a lesson, in a store, at a doctor's appointment, etc. mastered in the form of "theater".

1. play therapy

• Games for the development of attention. Find 5 differences in the picture. Define the scent. Identify the object by touch with your eyes closed. Broken phone.
• Games for the development of perseverance and the fight against disinhibition. Hide and Seek. Silent. Sort items by color/size/shape.
• Games for the control of motor activity. Throwing the ball at a set pace that gradually increases. Siamese twins, when children in a pair, hugging each other by the waist, must complete tasks - clap their hands, run.
• Games to relieve muscle clamps and emotional stress. Aimed at the physical and emotional relaxation of the child. "Humpty Dumpty" for alternate relaxation of various muscle groups.
• Games for the development of memory and overcoming impulsivity."Speak!" - the facilitator asks simple questions. But you can answer them only after the command “Speak!”, Before which he pauses for a few seconds.
• Computer games, which simultaneously develop perseverance, attention and restraint.

1. Art therapy

Interpreting the results of the child's work, the psychologist gets an idea about his inner world, mental conflicts and problems.

• Drawing colored pencils, finger paints or watercolors. Sheets of paper of different sizes are used. The child can choose the plot of the drawing himself or the psychologist can suggest a topic - “At school”, “My family”.
• sand therapy. You need a sandbox with clean, moistened sand and a set of various molds, including human figures, vehicles, houses, etc. The child himself decides what exactly he wants to reproduce. Often he plays up stories that disturb him unconsciously, but he cannot convey this to adults.
• Modeling from clay or plasticine. The child sculpts figures from plasticine on a given topic - funny animals, my friend, my pet. classes contribute to the development of fine motor skills and brain functions.
• Listening to music and playing musical instruments. Rhythmic dance music is recommended for girls, and marching music for boys. Music relieves emotional stress, increases perseverance and attention.

1. Family therapy and work with teachers.

1. Pedagogical measures

Proper parenting is the main way to deal with the symptoms of ADHD. Whether the child “outgrows” this problem and how successful it will be in adulthood depends on the behavior of the parents.

• Be patient, keep self-control. Avoid criticism. Peculiarities in the behavior of the child are not his fault and not yours. Insults and physical violence are unacceptable.
• Communicate expressively with your child. Expressions of emotion in facial expressions and voice will help to keep his attention. For the same reason, it is important to look into the eyes of the child.
• Use physical contact. Hold the hand, stroke, hug, use massage elements when communicating with the child. It has a calming effect and helps to focus.
• Provide clear control of the execution of tasks. The child does not have sufficient willpower to complete what he started, he is tempted to stop halfway. Knowing that an adult will supervise the task will help him see it through to the end. Will provide discipline and self-control in the future.
• Set challenging tasks for your child. If he is not up to the task that you have set for him, then next time simplify it. If yesterday he did not have the patience to put away all the toys, then today ask him only to collect the cubes in a box.
• Set the child a task in the form of short instructions. Give one task at a time: "Brush your teeth." When this is completed, ask to wash.
• Take breaks of a few minutes between each activity. Collected toys, rested for 5 minutes, went to wash.
• Allow your child to be physically active during class. If he waves his legs, twists various objects in his hands, shifts near the table, this improves his thought process. If you limit this small activity, then the child's brain will fall into a stupor and will not be able to perceive information.
• Praise for every success. Do it one on one and with your family. The child has low self-esteem. He often hears how bad he is. Therefore, praise is vital to him. It encourages the child to be disciplined, to put even more effort and perseverance in completing tasks. Well, if the praise is visual. These can be chips, tokens, stickers, cards that the child can count at the end of the day. Change "rewards" from time to time. Forfeiting a reward is an effective form of punishment. He must follow immediately after the offense.
• Be consistent in your requirements. If you can not watch TV for a long time, then do not make exceptions when you have guests or your mother is tired.
• Warn your child about what's to come. It is difficult for him to interrupt activities that are interesting. Therefore, 5-10 minutes before the end of the game, warn that he will soon finish playing and collect toys.
• Learn to plan. Together, make a list of tasks that need to be done today, and then cross off what you have done.
• Make a daily routine and stick to it. This will teach the child to plan, distribute their time and anticipate what will happen in the near future. This develops the work of the frontal lobes and creates a sense of security.
• Encourage your child to play sports. Martial arts, swimming, athletics, cycling will be especially useful. They will direct the activity of the child in the right useful direction. Team sports (football, volleyball) can be difficult. Traumatic sports (judo, boxing) can increase the level of aggressiveness.
• Try different types of activities. The more you offer your child, the higher the chance that he will find his hobby, which will help him become more diligent and attentive. This will build his self-esteem and improve relationships with peers.
• Protect from prolonged viewing TV and computer seats. The approximate norm is 10 minutes for each year of life. So a 6-year-old child should not watch TV for more than an hour.

Often children with ADHD have high IQs and are referred to as "indigo children". If a child becomes interested in something specific in adolescence, then he will direct all his energy to it and bring it to perfection. If this hobby develops into a profession, then success is guaranteed. This is proved by the fact that most of the big businessmen and prominent scientists in childhood suffered from attention deficit hyperactivity disorder.

Given the steady increase in the number of children and adolescents with attention deficit disorder around the world and the opinion of experts that students with this diagnosis often suffer from school maladjustment, now there is an acute question about the specifics of teaching such children, about training psychologists and teachers to work with them. Unique characteristics of students with attention deficit hyperactivity disorder may make it difficult for them to learn and develop positive self-esteem and the ability to express themselves and acquire certain learning skills. At the same time, taking into account such features can become the basis for effective learning (Mamaychuk I.I., 2003; Sirotyuk A.L., 2001), and the responsibility for finding teaching methods that help unlock the potential of these students lies with adults who, according to their activities interact with hyperactive children. To do this, it is desirable for teachers to either have additional psychological education (retraining courses), or cooperate with a psychologist who will guide the work of the teacher and help develop methods of interaction in the kindergarten group or in the classroom. Moreover, it is also desirable for psychologists, as part of advanced training (at least once every five years), to take not only a theoretical course, including information about the physiological and psychological characteristics of children with ADHD, but also methodological training that will help them work effectively with children and teachers in the future. and parents. Despite a sufficient level of development and school readiness for learning, children with ADHD are often, in the words of Michael Grinder (1995), thrown out of the “school assembly line”.

Experts note that hyperactive children are more likely to fall behind in their studies, repeat years, conduct disorder, refuse to attend school, and are less likely to successfully graduate from high school and enter a university than their peers without ADHD. The main problem children with attention deficit hyperactivity disorder may be a decrease in the productivity of educational activities, a low level of academic achievement. According to N.N. Zavadenko (1999), many children with ADHD have impairments in the development of speech and difficulties in the formation of writing and counting skills. 66% of the examined children with this syndrome showed signs of dyslexia and dysgraphia, 61% - signs of dyscalculia.

During the lesson, it is difficult for children to concentrate their attention, they are quickly distracted, they do not know how to work in a group, requiring the individual attention of the teacher, they often cannot complete the work, interfering with their classmates. A child with ADHD already at the 7-8th minute after the start of the lesson shows motor restlessness, loses attention. Often, in an effort to be noticed by the teacher and classmates, he achieves the attention of an adult and peers in the only way known and accessible to him - by playing the role of a “class jester”.

Since every teacher faces this problem in the classroom, it is now necessary to introduce a special course for students - future teachers, revealing the specifics of teaching children and adolescents with a diagnosis attention deficit hyperactivity disorder, and train educational psychologists in techniques, methods of interaction with children with ADHD, their parents and teachers. One of the principles of training personnel who will work with children with this syndrome should be the principle of awareness, which implies awareness of future teachers about the development and behavior of children and adolescents with ADHD. This is dictated by the fact that quite often such students are perceived as ill-mannered, capricious, pedagogically neglected. Often, an “uncomfortable” child is trying to be transferred to another class, and then to another school, citing the fact that he is not able to master the program of the gymnasium or lyceum level. Therefore, it is important to tell not only teachers, but sometimes parents as well, that the symptoms they note, although they are of a physiological nature, are by no means always associated with the impossibility of mastering the curriculum and cannot be reduced only with the help of disciplinary sanctions.

In children with ADHD, the frontal lobes of the cerebral cortex responsible for controlling behavior are formed later than in their peers, so they, having a normal and even high level of intelligence, do not have the ability to self-control (Sadovnikova I.N., 1997). This complicates the process of their education and forces the teacher to look for ways to help such children. At the first stages it can be individual, then - group work.

Among children with ADHD, the authors conditionally distinguish the following groups: children with developed visual skills, but reduced auditory skills; children who have reduced visual, but developed auditory skills; children with a decrease in both skills (Gardner R., 2002; Levi G. B., 1995; Sirotyuk L. S., 2000, etc.). The work of the teacher at the initial stage is based on the active use of the strengths of the students, and not on the elimination of shortcomings. With children of the first category, it is important to rely on the visual representations of the child, the inclusion of tactile and kinesthetic stimuli (feeling simultaneously with reading the word); the second category is the phonetic approach (at the initial stage, the multisensory approach); the third category is a multisensory approach: the child simultaneously looks at the word, pronounces it aloud, controls the sensations in the throat (Levi G.B., 1995). Symptoms of ADHD can manifest and intensify with increased stress on the nervous system, resulting in an imbalance of mental processes, which negatively affects the learning process (Aristova T. A., 1998). Therefore, it is advisable not to overload the child with classes with tutors, endless rewriting of sloppy work, and lengthy homework. For this reason, when choosing a school for a child with ADHD, it is better to opt not for a gymnasium with a complicated program, but for a regular class with a basic program. Being in comfortable conditions for him, the child quickly adapts to school life, and during the period of study in elementary school (3-4 years) with an appropriate training regimen (without overwork), the brain function is completely normalized (Yasyukova L. A., 1997). Otherwise, intellectual and physical overload will only increase the symptoms of ADHD, and the child, even with great potential, will not be able to meet school requirements. The child himself attention deficit hyperactivity disorder is often unable to structure his time, so at the first stages of learning (as well as at any other stage, if this has not been done before), adults should help him rationally allocate time so that there are no overloads and school tasks are completed. In some cases, even while giving a fair share of responsibility for the education of the child himself, parents still have to control his homework throughout all the years of schooling. I.N. Sadovnikova (1997) believes that the lack of understanding and help from adults (parents and teachers) can lead to manifestations of aggressiveness on the part of the child, to a refusal to complete educational tasks or to perform them only under pain of punishment). It should be noted that classes with a hyper-responsible parent who wants to achieve perfect homework for the child can also lead to aggressive outbursts, a decrease in motivation and conflicts in the family.

Correction of children with ADHD may include functional exercises (development of volition and self-control, elimination of impulsivity), breathing, oculomotor exercises, etc. (Sirotyuk A. L., 2001; Sirotyuk L. S., 2000). Part of the exercises can be practiced in the classroom with a psychologist, part - in the lesson with the whole class, part - at home. It is important to note that at the initial stages of learning, such children lack learning, since the motivational level of learning is provided by the frontal lobes of the cerebral cortex, which are formed in children of this category later than their peers. Therefore, one of the most important areas of work with students with ADHD is the formation of learning motivation.

Correctional and developmental education for children and adolescents with ADHD It turns out to be effective if teachers and psychologists follow certain principles arising from the characteristics of students in this category.

The results of our research confirmed that assistance should be comprehensive (Monina G. B., Mikhailovskaya O. I., 1999; Monina G. B., 2006). As a rule, the team of interested participants includes a neurologist, a psychologist, a teacher and, of course, parents. Often it is the teacher (educator, teacher) who sends the child to a psychologist, noticing the first symptoms. attention deficit hyperactivity disorder which are still difficult to identify when communicating with him in situations that require less stress than educational activities. And it is the teacher who can give the doctor and psychologist feedback regarding the effectiveness of the method of treatment chosen by the doctor or the methods of work used by the psychologist.

Purposeful joint activity of specialists and parents is necessary for a child who finds it much easier to fulfill the uniform requirements of adults around him, to be in a single educational space than to adapt to conflicting and sometimes mutually exclusive instructions that inevitably lead to stress (Lyutova E. K., Monina G B., 2000). In the event that direct interaction between the teacher and the doctor is problematic, parents can ask the doctor to draw up written recommendations for the employees of the educational institution (psychologist, teachers, defectologist, speech therapist, etc.), which will be taken into account in the process of working in the classroom and during developing a remedial program.

Only with an integrated approach to solving the problems of teaching a child with ADHD can one count on reducing his emotional stress and more fully realizing his potential (Monina G. B., 2004).

The next principle of teaching a child with a syndrome is that measures of pedagogical influence on him will bear fruit only if they are systematically applied. As a rule, single events, even if they involve medical specialists, teachers, parents and psychologists, will not lead to the expected result. And although it is desirable to fulfill this requirement when teaching children of any category, when interacting with hyperactive students, it must be met without fail, since it is difficult for them to structure time and space themselves, they must clearly know what pedagogical impact will follow this or that action on their part. Moreover, in order to feel their safety, they must be sure that the nature and strength of this influence does not depend on the mood of their parents, psychologist, teacher, but is a constant rule. The principle of phasing in work with hyperactive students suggests that, given their individual physiological characteristics, it is desirable to first allocate time to establish contact, then carry out individual work to develop the arbitrariness of actions (the ability to listen to instructions, obey the rules); working off (alternately) deficit functions, developing the ability to reflect and only after that move on to group work in the classroom (Antropov Yu. F., Shevchenko Yu. S, 2002; Lyutova E. K., 2000; Lyutova E. K., Monina G B., 2000). This principle is one of the fundamental ones in the work of a school psychologist who carries out correction. The presence of three types of ADHD (with a predominance of inattention, with a predominance of hyperactivity and impulsivity, combined) dictates the need to identify the dominant symptom and build a phased corrective work in accordance with this. Based on the strengths of the child, the psychologist begins by working with one separate function (for example, control of motor activity). When sustainable positive results are achieved in the process of training, you can move on to training two functions at the same time, for example, to eliminate attention deficit and control motor activity. And only then can you use exercises that develop all three deficient functions at the same time (in the case of the combined type of ADHD). The implementation of this principle assumes that correctional work with a child with ADHD will be of a long-term nature, which is very important to inform parents and teachers. The heterogeneity of ADHD manifestations predetermines the need to implement the principle of individualization when interacting with hyperactive children, the significance of which in this case is due, in addition to heterogeneity and the lack of formation of individual mental structures in a child with ADHD, in some situations, a lack of interest in learning, a style of mental activity, etc.

Individualization of learning- the most important factor influencing the formation of learning skills (Zankov L. V., Zverev M. V., 1973; Kirsanov A. A., 1963; Monina G. B., 2004), and involves the conscious efforts of the teacher aimed at selecting and adaptation of teaching methods, to structuring the educational process in accordance with the needs of each child. This is not only the acceptance and understanding of the child, it is a system of measures consciously used by the teacher in the course of the pedagogical process.

Traditionally, the individualization of the learning process involves not only the acceptance and understanding of each individual child, but also a system of activities that the teacher consciously introduces in the course of the pedagogical process (let's call this type I individualization). According to I. S. Yakimanskaya (1966), the educational program should be flexibly adapted to the cognitive abilities of the student, the dynamics of his development in the learning process. Of course, the teacher seeks, taking into account the characteristics of a child with ADHD, to create the most favorable conditions for his learning. However, this does not always lead to a deep personal involvement of the student, since the initiative comes from the teacher. In addition, under the conditions of the class-lesson system, the efforts of the teacher may turn out to be ineffective. Then the efforts of the teacher become necessary, aimed at creating conditions for the "self-individualization" of the student (let's call it type II individualization), at identifying each student's own style of learning activity and at the transition to self-regulation (Yakimanskaya I.S., 1999, p. 39). Thus, the specificity of teaching students with ADHD lies in the implementation of such principles as complexity, consistency, phased approach, and the need for individualization.

The choice of specific measures of pedagogical influence on a particular student will be determined both by the characteristics of the student himself and by the capabilities of the teacher. In addition, when choosing a strategy, the goal pursued by the teacher will be of great importance: preventive care for the child or an emergency response to an unforeseen event.

What is true individualization

There is not a single teaching method that would be equally effective for all children in the class, which means that they must be taught in different ways, based on the current level of the child, sociocultural conditions, psychophysiological characteristics, teaching style, etc. (Borisova Yu. , Grebenov I., 2003; Levi G. B., 1995).

Even 10-15 years ago, individualization of learning was understood as the selection by the teacher of methods, techniques and pace of learning, the degree of difficulty of tasks depending on the individual differences of schoolchildren, the level of development of their abilities (Maron A.E., Kuzhanova N.I., 2002) . In the works of A. A. Kirsanov (1963, 1980), E. S. Rabunsky (1970, 1975), individualization is interpreted as an adaptation of the learning process to the individual-personal and cognitive capabilities of the student. However, the processes of individualization and socialization are interrelated components of a single process of personal development, a certain level of which gives rise to self-determination, self-government of a person who consciously organizes his own activity (Feldshtein D.I., 1995). In this regard, when speaking about individualization, it is so important to focus on the child's ability to make decisions on his own and be responsible for the results of his studies (Maron A. E., Kuzhanova N.
I., 2002).

True individualization- this is the provision of a wide field of activity for each child both in the classroom and in remedial classes, in order to find opportunities for the successful development of educational material. That is why an adult teaching a child or teenager with ADHD needs to focus on the learning opportunities of each student, create conditions for self-realization, independence of each student, help the student to discover and make the most of the experience that everyone already has, and not force them to act in the image and likeness of their parents. or even teachers. Students should be given the opportunity to complete educational tasks in different ways, so that they choose the best one for themselves among them, but at the same time, it is imperative to assist them in weeding out obviously irrational ones (Rabunsky E.S., 1975). This assistance is especially important in working with children and adolescents with ADHD, who often have difficulty completing their own learning tasks.

First, with the help of an adult (psychologist, teacher, parents), and then independently, the child learns to identify effective methods of activity and reinforces those that are personally acceptable to him.

Our studies (Monina G. B., 2004) confirmed that we can talk about two possible types of individualization (psychologist, teacher - teaching everyone and individualizing the learning process; psychologist, teacher - creating conditions for self-learning - self-individualization of the student). The implementation of type II individualization contributes to a more complete personal involvement of the student in the learning process, in connection with which the level of his cognitive motivation, motivation for success, self-realization increases.

However, as practice shows, in some cases (some psychophysiological characteristics of the child, pedagogical neglect, lack of motivation for learning, etc.) at the first stages of interaction with students who are not ready to take responsibility for their own learning, in the process of corrective work of a psychologist or a teacher on lesson (or the interaction of parents and the child when doing homework), it is advisable to implement type I individualization, which involves adult control over the activities of schoolchildren

Depending on the way the world is perceived (and the educational material in particular), students are conventionally divided into intuitionists and logisticians. It is very important that an adult teaching a child (psychologist, teacher, parent) does not break the child’s inherent learning style, teaches “self-help”: helps to identify, realize the way that is convenient for the student (thereby supporting his desire for independence), giving the opportunity to perform tasks in a different way (Bozhovich E. D., 2002; Murashov A. A., 2000).

For some children (gifted children, children with a formed cognitive interest), it is important to independently search for a solution to an educational problem, an intellectual effort that needs to be applied. In this case, it is desirable to organize search work to identify patterns in the choice of a method of action. For other children, the practical orientation of the study of any rule seems to be especially important, which implies comments from an adult about the importance of mastering this material in further education (or in professional activities). And for individual children, joint work is needed to create a coherent algorithm of actions in certain situations that arise in the learning process.

The transition of students to self-regulation, self-individuation

So, the main task of type II individualization is to form students' own position and responsible attitude to the learning process, to identify their own ways of action associated with the successful completion of educational tasks (for example, mastering by means of a rule or on an intuitive basis).

In addition, a necessary condition for the effectiveness of teaching children and adolescents with ADHD is the obligation to further form those structures that were not fully formed at the previous stages of mastering the curriculum.

Moreover, training will be productive if it is aimed not so much at correcting mistakes already made (in mathematics, Russian, etc.), but, above all, at anticipating the possibility of mistakes. As a rule, the teacher solves these problems in the course of educational activities, often resorting to numerous classes after lessons. Sometimes, in order to improve academic performance, parents turn to tutors for help, who also work with the child after school hours. Some parents try to cope with the difficulties of teaching their son or daughter on their own, sitting with them for long evening hours, eliminating gaps in knowledge. However, practice has shown that such an approach is rarely beneficial, since the child is overtired. Therefore, it is advisable not to overload the child with additional classes, but to resort to the help of a psychologist who, in the process of systematic classes, built in accordance with the age and individual characteristics of the student, will help him feel his own success, increase learning motivation.

The formation of the motivation to achieve success (but not the desire to be the best in everything) is one of the main conditions for the effectiveness of work at all stages of its passage (Markova A.K., 1990).

In addition to the work of a psychologist in remedial classes, the work of a teacher in a lesson on the implementation of the principles of individualization (types I and II), teaching the students themselves effective ways of mastering the material, quite often the question arises of transferring partial functions to the parents of the child. If it is impossible to implement this option, in addition to classroom work, additional individual work with the child should be carried out according to a special individual program, carried out jointly by a teacher and a psychologist. The main strategy for teaching schoolchildren with ADHD is that an adult (psychologist, teacher, parent), offering students a common task, instructs each student to try to determine what benefit the use of one or another specific method of completing the task brings him, that is, to find each a student of that essential information for him, which is important to him.

In general, the process of correctional and developmental education of children and adolescents with ADHD can be conditionally divided into several blocks, each of which, in addition to the general ones, has its own most significant goal for this area. And the task of an adult teacher in the classroom or a psychologist in special classes is to create conditions for:
the formation of students' motivational conditionality of learning; the development of the cognitive sphere of the child, which is directly significant for the development of educational material (the amount of perception, characteristics of attention, memory, thinking, etc.);
the gradual transition of students to self-regulation of their activities and self-control: independent analysis of educational material, the process of arbitrary fulfillment of educational tasks and self-analysis of mistakes made;
reducing the level of negative emotional manifestations of students in the learning process, reducing the level of school anxiety as a factor influencing overall success and the process of mastering literate writing (frontal and individual work of the teacher). Thus, the work on teaching schoolchildren with ADHD has several directions, but the division into blocks is conditional, since in specific types of tasks they are all interconnected. For example, the formation of students' motivational conditionality of learning, the reduction of negative emotional experiences is a necessary basis for the implementation of the content of the remaining blocks of the teacher's work.

The central direction in working with children and adolescents with ADHD is to create conditions for each student to comprehend the methods he uses to successfully complete educational activities, his own style of mastering educational material and for the transition of students to self-control, to self-regulation, to self-management of their own activities (all other areas are woven into this activity).

Vladimirova I.M.,
teacher-psychologist GBOU TsDK SPb,
Candidate of Psychological Sciences, Associate Professor

Introduction.

The number of children with ADHD who have found themselves in the focus of attention of a psychologist has been growing in recent years. The number of requests from this group of people (their families) for specialized psychological assistance to the GBOU TsDK SPb is about 15% of the total number of clients. At the same time, half of them apply on their own initiative, 40% - on the recommendation of a teacher or school administration, 10% of children are sent by colleagues - specialists in the advisory service (more often neurologists and speech therapists). Parents turn to school psychologists for help less often, preferring the opinion of an independent expert. Due to a chronic or "acute" conflict situation, about 10% of families of children with ADHD come to school.
The greatest number of appeals falls on the period of study in elementary school. It never ceases to amaze the fact that many adults interacting with children of this group, despite the large amount of information, educational work carried out by psychologists, still ignore the neurological status of the child, explain (consciously or unconsciously) his behavior by weak motivation, laziness, pampering, poor education in family. Psychologists have to deal with such facts in their daily work. Educators often fail to integrate children with ADHD into the learning process. The behavior of such a child in the classroom is shocking and causes noticeable rejection.
Children of this group do not adapt well to any educational process, especially at the stage of education in primary school. They are characterized by: violations of discipline, difficulties in developing skills of planning, organization, control of educational activities, restlessness and inattention in the classroom, unstable or persistently low motivation for learning, difficulties in developing writing, reading, counting skills. It is these children who have ugly (almost unreadable) handwriting, they are the ones who do not write down homework in a diary. As a rule, such an "energy-intensive" child requires a lot of effort from an adult to involve him in the learning process. Communicating with him, both parents and teachers feel emotionally and physically devastated. No less significant difficulties arise in the child himself. Numerous studies have shown that children with ADHD who have not received timely assistance are at risk in adolescence and adulthood in terms of the formation of various types of deviant behavior.
Summarizing everything said above, I would like to emphasize that a child with ADHD has a rather difficult life both at home and at school. Despite good abilities, a loyal attitude towards classmates and adults, he does not succeed in many things at school, because of this, relations with his parents suffer. Many parents admit that they show aggression towards children (verbal and physical). It is even harder for teachers who have neither the moral nor the professional and ethical right to show hostility towards children.

1. Observable manifestations of ADHD at school age.

Typical complaints of parents: “can’t get ready when doing homework, constantly distracted”, “does not report what was assigned, you have to call classmates”, “disorganized, constantly loses things”, “the diary is all red from the comments of teachers”. In addition, adults report to the specialist that the child is “impossible to captivate with anything for a long time”, “it is difficult to discipline”, he “poorly controls himself in anger, is quick-tempered, impulsive”, “painfully reacts to failures”. Often parents note the child's poor or uneven academic performance, emphasizing his generally good abilities. Problems in communication with classmates are less common.
Typical remarks of teachers: “playful”, “in class he is either with us or not with us” (often distracted), “does not work in class”, “swings in his chair”, “constantly drops something”, “interferes with teaching lesson, shouts out, laughs out loud, jumps up. In addition, they note that the child is “regularly not ready for the lesson, forgets school supplies”, “makes many mistakes due to inattention”. According to their own data, about 20% of children demonstrate only behavioral disorders at school and good, even high, academic performance.
Typical comments of children: “they often scold and punish, often unfairly”, “only my misconduct is noticed at school, but for some reason they don’t see the pranks of other children”, “I do my homework for a very long time, I don’t have any free time at all”, “adults constantly find fault me", "they don't like me". Children, especially in elementary school, are more generous in their assessments of adults (teachers and parents), rarely complain about them.

2. Basic information about ADHD (causes and mechanisms of the disease).

Attempts to find alternative (scientific) explanations for such behavior have been made for a long time. Already in the middle of the 19th century (1845), the German neuropsychiatrist Henry Hoffmann was the first to describe an overly mobile child and gave him the nickname Fidget Phil. Since the beginning of the twentieth century, doctors began to single out such a condition as pathological. Currently, the number of publications devoted to ADHD is constantly growing. The terminology, diagnostic criteria of the disease are discussed in the scientific literature, its boundaries are outlined, and treatment regimens are outlined. Numerous studies have shown the neuropsychological causes and mechanisms of the formation of such disorders, revealed the age dynamics of their manifestations, and studied the prevalence.
It has been established that attention deficit hyperactivity disorder is one of the most common forms of borderline mental states in children. According to Sirotyuk A.L., children with ADHD in Russia are about 18%, in the USA - 20%, in China - up to 13%, in Italy - 10%, in the UK - up to 3%. This neurological disorder is caused by brain dysfunction and in its most general form is manifested by a delay in the development of various functional systems of the brain, an insufficient balance between the processes of excitation and inhibition, with the former predominating. The ADHD anatomical defect zone is considered to be the prefrontal areas of the frontal lobes of the cerebral cortex (responsible for voluntariness and self-control).
Among the reasons, experts most often name genetic predisposition, pathology of the pre- and perinatal periods of development (traumas of the cervical spine are typical), the first years of life, environmental and psychological factors (climate in the family, upbringing, stress). The social, cultural aspects of the formation and maintenance of such a disorder are widely discussed. The positive qualities of children with ADHD are emphasized: cheerfulness, activity, sociability, resistance to criticism and negative disciplinary influences, ingenuity, good abilities. This group is represented by such famous people as W. Churchill and T. Edison.
Specialists refer to the “triad” of the main symptoms as pathology of voluntary attention, excessive motor activity and impulsivity. Hyperactivity is understood as the inability to sit still, motor restlessness. responses to environmental factors competing to capture children's attention. Attention disorders are more often represented by high distractibility. It has been established that the basis of attention deficit is a low level of excitation of the cortical structures of the brain, especially its frontal parts. Therefore, children are highly fatigued, energetically poor. To compensate for reduced excitation, the body is forced to resort to a kind of stimulation of the cerebral cortex through the motor centers. That is, the increased motor activity of a child with ADHD is compensatory in nature and temporarily restores normal interaction between different areas of the cerebral cortex, retains the possibility of full-fledged intellectual development. The signs of the disease also include: coordination disorders, including visual-motor, a specific inability to study in relation to any subject (reading, writing, arithmetic), speech disorders, etc. Typical secondary deviations (negative self-esteem, problems in communication, hostility).
The peak frequency of registration of the syndrome occurs at the age of 4-6 years with a slight tendency to decrease to 10-11 years. There is a positive dynamics of the disease. Motor activity decreases with age, neurological changes are erased. According to a number of experts, with early diagnosis and adequate assistance to the child, the manifestations of ADHD can be leveled by the age of 7 (Sirotyuk A.L., 2002). Other authors argue that sustainable improvements can only be achieved by adolescence. It is believed that some children "outgrow" their disease. At the same time, in 30-70% of children, manifestations of ADHD pass into adolescence and into adulthood (Shevchenko Yu.S., 2003, Lazebnik T.A., 2007). According to the director of the State Scientific Center for Social and Forensic Psychiatry. V.P. Serbsky T.B. Dmitrieva, cognitive and behavioral disorders persist in 85% of adolescents and 65% of adults. There is an opinion that in Russia from 70-90% of children with ADHD remain without any treatment at all (Murashova E.V., 2004).
The prognosis of the disease is influenced by: the severity of the disorder, early diagnosis and treatment, the educational position of the parents, the possibility of using specialized approaches in teaching. Great importance is attached to psychosocial factors.
Specialists emphasize the relevance of early correction of ADHD manifestations. Considering the prevalence of the disorder (up to 18% of the population), the search for ways to integrate representatives of this group into society is a serious social problem. In 2006, the I International Forum "Children's Health in Russia" was held. For this forum, experts collected information, conducted research. According to academician V.I. Pokrovsky, presented in a report at this forum, in 2006 there were about 2 million children with ADHD in Russia. The author points out that 32 to 40% of them drop out of school; only 5-10% graduate from universities; 40% of girls have teenage pregnancy, and 16% have venereal diseases; 40-50% of them are drawn into anti-social activities. Between 50 and 70% of children have fewer friends than their peers (or none at all). In adulthood, from 50 to 70% of people with ADHD do not cope well with work, suffer from depression (up to 30%) and personality disorders.
I would like to comment on the economic component of the problem under consideration. In 2010, the approximate cost of treating a child with ADHD ranged from 85,000 to 105,000 rubles a year. The costs of pharmacotherapy, psychotherapy (two visits per month), massage and exercise therapy (twice a week) were taken into account. At the same time, according to the Federal State Statistics Service, the average annual per capita income in Russia in 2008 amounted to about 145 thousand rubles. In the US, the cost of such treatment is up to 560 thousand dollars.

3. Existing system of assistance to children with ADHD.

The main directions, forms and methods of providing psychological assistance to children and their families are covered in detail in the literature. Among them: pharmacotherapy, the use of feedback methods (neurofeedback), psychotherapy. The high efficiency of individual and group forms of work is shown, the decisive role of the family, an adequate system of education in the correction and compensation of deviations in the development of a child with ADHD is indicated. And this is no coincidence, because it is close people who will have to help the child solve daily difficulties for many years, correctly guide him, “grind” some of the unevenness of his character.
International experience shows that the correction of children with ADHD should be long-term and complex. To obtain a full-fledged therapeutic effect, it is necessary to combine the use of psychopharmacology, neurofeedback, physiotherapy, methods of individual group and family psychotherapy.
The most adequate system of care for children with this disorder has been developed in the USA. According to Dr. J.J. DuPaul, the following methods of influencing children with ADHD are most common in the United States:
- the use of psychotropic drugs;
- situational management at home (training parents in the skills of behavior and upbringing of the child);
- situational management at school (token reward system to consolidate the consequences of behavior);
- teaching children at home (behavioral psychotherapy);
-Filling out a report card daily or writing teacher notes for parents.

The organization of psychological assistance to children with ADHD and their families involves several stages.
THE FIRST STAGE OF HELP- STATEMENT OF THE DIAGNOSIS.
At the initial stage, parents need help in diagnosing the condition of the child. They need to be prompted how to conduct a complete medical examination of the child, provide information on modern methods for studying higher nervous activity. These methods include the following.
1) ELECTROENCEPHALOGRAPHY (EEG) - a method for studying the electrical activity of the brain. It involves the registration and study of the difference in biopotentials, discharged through the intact integument of the skull from its various points. An electroencephalogram is a curve that is a record of fluctuations in the biopotentials of the brain. Reflects the dynamics of changes in the functional state of individual parts of the brain. Children with ADHD often have an increased alertness of the brain.
2) COMPUTER ELECTROENCEPHALOGRAPHY (CEEG) is a direct display of the functioning of the central nervous system. Allows you to describe the topical picture of damage and quantify the dynamics of state changes. It showed high efficiency in the choice of pharmacological preparations for treatment.
3) QUANTITATIVE PHARMA ELECTROENCEPHALOGRAPHY allows you to evaluate the clinical effect of new drugs and their effectiveness. Based on the statistical assessment of changes in the main EEG rhythms under the influence of drugs, computerized profiles of various psychopharmacological drugs have been developed.
4) ECHOENCEPHALOGRAPHY (ECHO-EEG) is a method using ultrasound. The information is carried by the signal (M-echo) reflected from the midline structures of the brain, normally located strictly along the midline. Deviations from the midline by more than 2 mm indicates the presence of a tumor, a zone of increased intracranial pressure.
5) Ultrasound examination (ultrasound, neurosonography) - a volumetric study of the brain using ultrasound, which has a higher accuracy than the EEG. The data is processed by a computer.
5) COMPUTED TOMOGRAPHY (translated from Greek - “layered image”). The inventors of the method, Nobel laureates in 1979 A. M. Kormak and G. N. Hounsfield, used the theory of X-ray absorption by various tissues of the human body and computer imaging of this process. A brain scan reveals a possible pathology.
6) NUCLEAR MAGNETIC RESONANCE TOMOGRAPHY (NMRI) - a method based on fixing the content and properties of water in various organs. It is used in the diagnosis of congenital changes in the central nervous system. Outperforms computed tomography in image clarity, is more harmless.
7) POSITRON ELECTRON TOMOGRAPHY (PET) allows you to study images of anatomical structures. To do this, a substance used by the brain during its normal operation is injected into the blood washing the brain, in which one of the atoms is replaced by a radioactive isotope C11, which emits a positron, which, colliding with an electron, emits gamma quanta. They are registered by a detector connected to the computer. The PET screen displays parts of the brain that activate its work when a subject is presented with a particular task.
8) SINGLE-FATON EMISSION COMPUTED TOMOGRAPHY - a close analogue of PET. It is used in the study of the blood supply to the brain. It has been established that the level of brain blood flow correlates with the neural activity of one or another part of it. The introduction of the isotope is carried out by the inhalation method.
9) DOPLEROGRAPHY - a method based on the Doppler effect (change in the frequency of oscillations when reflected from a moving object). The method allows studying disorders of cerebral circulation. Ultrasound (from 2 to 8 MHz) is sent to the vessel under study, it is reflected by red blood cells and measured by a piezoelectric transducer. The change in signal frequency (“Doppler shift”) is processed by the computer.

Such research methods should be used for the earliest possible diagnosis of ADHD in a child, since the earlier the diagnosis is made and treatment is started, the greater the chances for recovery. I would like to emphasize that the central link of the pathological system can be quite difficult to determine with a standard neurological examination. Some children with “erased” manifestations of the disorder “escape” from the close attention of doctors in the context of mass examinations, therefore, do not receive timely assistance.
Parents should be aware that the signs of ADHD appear very early. In newborns, these are: increased anxiety, irritability, sleep disturbances. It matters how the baby suckles the breast, whether he blinks often. Quick fatigue, physical activity, poor coordination and inaccuracy of movements should alert. At preschool age, it is difficult to cope with a baby, not to keep track of him, he is aggressive, loves to break everything, “delays” in a period of negativism, loves a team, but often conflicts with his comrades. At school age, a child cannot sit in one place, he is unorganized, sloppy,

THE SECOND STAGE OF HELP for children with ADHD and their families involves TREATMENT AND CORRECTION.

If a child is diagnosed, it is important to properly orient the parents on how to help him. When treating a child with ADHD, an integrated approach is important. The following methods are currently in use.
Treatment methods for children with ADHD.
In world practice, the most commonly used drug treatment (PHARMACOTHERAPY). Pharmacological action is aimed at suppressing the pathological activity of generator structures. Symptoms are reduced, but typically recurrence of the symptom when the drug is discontinued. Individual selection of drugs is important. There are side effects. Many experts consider pharmacological methods of influence to be preparatory. Since the diagnosis of ADHD is usually made at the age of 5, and the compensation of the syndrome is achieved by the age of 15, long-term use of drugs frightens parents, they refuse it.
Another popular approach is to use the BIOFEEDBACK method. It is supposed to activate the reserve capabilities of the brain. Neurofeedback is a directed modification of cerebral electrogenesis. The method is focused on the mechanisms of plasticity and changes in the configuration of the trunk-thalamus-septal nuclei-hippocampus-striatum-prefrontal cortex network. Sound or light signals are used as feedback. Experts note the high efficiency of the method: a stable result (deep remission or recovery) is observed in 70-80% of children. On average, 40-50 sessions are required. The effect persists for 18-24 months.
The PSYCHOTHERAPEUTIC CORRECTION OF ADHD has the longest lasting effect. In the United States and other developed countries, behavioral therapy is used for children with ADHD. In Russia, systemic family therapy has been shown to be highly effective. It has been established that it is impossible to treat a child outside the family. Various options for progressive muscle relaxation, kinesiotherapy, and autogenic training are also used.

4. Helping a child with ADHD at school.

In addition to the activities listed above, ASSISTANCE TO THE CHILD AT SCHOOL is needed, which can be considered as the THIRD STAGE in the system of assistance to children and their families.
Experts say that the problems that arise in the process of teaching children with ADHD in recent years have become comparable in severity to medical problems with this disorder. Numerous studies have shown that comprehensive care for children with ADHD is impossible without the prevention (elimination) of school maladjustment, which is the most acute problem of modern school. Usually such children do not find understanding in schools. Often, the administration insists on sending them to home schooling, transferring them to special classes, or changing educational institutions. The situation is worsened by the small number of school psychologists. In foreign countries, work is being done with teachers.
The question of the organization of special classes is ambiguously discussed in the literature. A number of authors note the expediency of creating such classes, referring to foreign and domestic experience (Bryazgunov I.P., 2001). In the 70s of the twentieth century in Czechoslovakia, a group of specialists led by Zd. Trzhesoglavy conducted research in this direction. The need for special attention to children with ADHD from the very beginning of their schooling has been shown. The creation of specialized classes was seen as a healing factor. A small class size (10-15 students), a shorter duration of lessons (up to 35 minutes), a special training program while maintaining the full volume of classes were proposed. The equipment of the classroom assumed the absence of distracting objects, the location of the students separately at a considerable distance from each other. Academician Shtark M.B. also recommends the creation of classes of increased comfort for children with ADHD, but with the obligatory condition of simultaneous intensive neurobiological correction. According to the author, received in 2002-2006. in Akademgorodok, Novosibirsk, neurofeedback in 50-70% of cases led to a deep remission of the state of children or a cure. Separate education of children was recommended in the first two years, then the children "dissolved" in the usual team.
Other authors (most of them) argue that the transfer of children to specialized classes only worsens the situation (Murashova E.V., 2004, Zavadenko N.N., 2001). Children are deprived of the experience of school socialization, communication with peers, their support, orientation in personal educational achievements to classmates. With this approach, all work with the child is reduced exclusively to individual assistance. However, successful correction is possible only under the condition of intensive work with children in schools. In such cases, in 70% of children, a safe exit from the condition is possible (Berdyshev I.S., Yakovenko V.V., 2006).
The world interdisciplinary practice provides for the following areas of work with a child with ADHD at school:
- training of teachers of elementary grades (from 1 to 6) in proactive forms of pedagogy;
- integration of the efforts of the school child support team with the efforts of their parents;
- teaching children to control their behavior, manage anger, contain aggression;
- prevention of academic (educational) failure and improvement of educational competence of children with ADHD;
- optimization of reference (increasing the level of respect) of children in the eyes of their classmates.
I would like to note that a system of assistance to children of this group that has been developed and introduced into pedagogical practice at the state level still does not exist. At the same time, many methods and scientific developments have been proposed, the use of which could significantly make life easier for children, parents, and teachers.

5. Features of the psyche and aspects of the behavior of children with ADHD, which must be taken into account when organizing work with them.

Psychologists, in particular Yasyukova L.A., identify the following psychological characteristics of children with ADHD, which must be taken into account when organizing work with them. They make clear and reasonable practical recommendations for teachers and parents.
1. Children are characterized by rapid mental fatigue and low mental performance (the child works without a break for no more than 5 minutes, while physical fatigue may be absent). Typically, a significant increase in the frequency and duration of relaxation cycles in the activity of the brain (every 5-7 minutes of work there is a relaxation shutdown for 3-5 minutes, conscious control and fixation of something in memory are completely lost). WHAT TO DO: children's intellectual activity should be coordinated with activity cycles, wait 3-5 minutes until their brain rests and restores working capacity.
2. In children, the possibility of self-government and arbitrary regulation in any kind of activity is sharply reduced (cannot fulfill a promise, make a plan, follow it). WHAT TO DO: adults should take over the organization of their activities, not indicating what needs to be done, but doing everything together with the child.
3. There is a significant dependence of children's activity (especially mental) on the nature of external social activation (the child is lethargic, sleepy alone and completely disorganized in a noisy crowded environment). WHAT TO DO: understand that a child can only work in a calm environment in dialogue with a patient adult.
4. There is a clear deterioration in activity during emotional activation (not only negative, when scolded, but also positive, when the child is cheerful and happy). WHAT TO DO: when working with a child, pay attention to the psychological atmosphere, create an emotionally neutral environment.
5. There are great difficulties in the formation of voluntary attention. WHAT TO DO: in addition to the direct development of attention functions, work should be preceded by reasoning, this transfers control of its implementation to a conscious level. It is necessary to develop thinking and replace visual control with intellectual control, which reduces the load on attention. Work that requires the distribution of attention should be avoided, replaced by step-by-step switching from one type of activity to another with detailed instructions.
6. A decrease in the operational volumes of attention, memory, thinking is characteristic (the child can keep in mind and operate with a rather limited amount of information). WHAT TO DO: you should teach external forms of fixing information, avoid lengthy explanations when presenting the material, use its visual representation, taking into account visual perception.
7. Difficulties in the transition of information from short-term memory to long-term memory are noted. Memorization requires more repetition. In a state of fatigue, not only are temporary ties not strengthened, but newly established ties can also be destroyed. WHAT TO DO: do not rape the child, do not teach at night, etc.
8. There are defects in visual-motor coordination (they make mistakes and inaccuracies when quickly translating visual information into a motor-graphic analogue), therefore, such children do not notice inconsistencies when copying and copying, even during subsequent comparison. WHAT TO DO: a preliminary speech analysis of any forthcoming work and an element-by-element comparison of the correctness of the performance is necessary.

To solve the strategic tasks of the development of a child with ADHD, it is important to facilitate the process of adaptation for him to the conditions of education in elementary school. You should help him navigate the page of a notebook, textbook, teach him to distribute his forces during the lesson. Children with ADHD often have writing and reading difficulties, and it is important to help the child overcome difficulties in developing these skills. It is necessary to explain in detail the rules of behavior in the lesson and at recess, suggest how best to interact with the teacher and classmates. The greatest emphasis should be placed on the development of the stability of voluntary attention, the formation of volitional delays, ideas about "possible" and "impossible", maintaining motivation for learning. The teacher should involve the child’s motor activity: such children love work, they will wipe the board with pleasure, run away to “wash the rag”, water the flowers. It is important to remember that a child needs excessive motor activity precisely to stimulate brain activity, so he cannot sit still and listen attentively at the same time, he can listen attentively only by swaying in a chair. Teachers should take into account that such children do not work well for a delayed result, the “here and now” principle is important for them, and it is difficult for them to gradually develop a skill. Therefore, among the favorite subjects are practical disciplines: work, drawing, physical education. Compared to collective species, they are more suited to small group activities. It is better to put the child on the first desk, where he will be the focus of the teacher's attention. It is important to find a reason to praise the child, to compare his achievements with his personal results, and not with the activities of more successful children. In elementary school, many children inattentively write down homework, it is better to give them in printed form, to place them on stands accessible to parents for viewing.

Psychologists refer to the main directions of compensatory development of a junior schoolchild with ADHD:
- development of socialization skills, especially the ability for social forecasting (due to high impulsivity, it is difficult for children to imagine the consequences of their own actions, to understand the motives of the behavior of others; they need to explain and show algorithms for communicating with people around them);
- the ability to follow the instructions of an adult, on the one hand, and a certain independence, on the other hand (children are oriented to the assisting help of an adult, so it is important to gradually teach them to occupy themselves, plan and organize their activities);
- strengthening the ability to concentrate and the stability of voluntary attention;
- improvement of fine motor skills of the hands (including coordinated movements of both hands); drawing with a pencil, hatching, tracing along the contour, coloring are useful;
- strengthening of volitional qualities (organization, discipline, accuracy, independence, initiative, responsibility for the task assigned), the formation of the concepts of “should” and “should not” (for this it is important to impute something to the child as a duty, often assign the role of duty). In order to form internal control when interacting with such a child, it is very important to maintain regime moments (the principle “from discipline to self-discipline”). In the development of strong-willed qualities and maintaining a positive self-esteem, team sports, collective games help, where you need to act according to the rules and coordinate your activities with other players;
- maintaining interest in learning.

RULES OF WORK WITH HYPERACTIVE CHILDREN
(cheat sheet for adults, Lyutova E, Monina G.)
1. Work with the child at the beginning of the day, not in the evening.
2.Reduce the child's workload.
3. Divide work into shorter but more frequent periods. Use physical exercises.
4. Be a dramatic, expressive parent and educator.
5. Reduce the requirements for accuracy at the beginning of work to create a sense of success.
6. Plant the child during classes next to the teacher.
7. Use tactile contact (elements of massage, touch, stroking).
8. Agree with the child about certain actions in advance.
9. Give short, clear and specific instructions.
10. Use a flexible system of rewards and punishments.
11. Encourage the child immediately, do not put off for the future.
12. Give the child the opportunity to choose.
13. Stay calm. No composure - no advantage.

7. Psychological assistance to parents.

It has been established that, having sufficient potential, children with ADHD, due to a number of circumstances, cannot show them in the classroom. Often this is facilitated by the lack of psychological competence of the adults educating and teaching them. It is extremely rare that parents are explained the psychological meaning of the diagnosis of ADHD, they are not told how to raise a child in order to compensate for his congenital neurological dysfunctions.
There is also the opposite aspect of the problem under consideration: it is extremely difficult to raise a child with ADHD. According to the successful expression of the English researcher Susanna Dosani - "ADHD lasts twenty-four hours a day, seven days a week." . Often parents feel annoyed and devastated. According to our own research, the pathology of the parenting style was detected in 60% of families of children with ADHD (questionnaire "ASV" E. G. Eidemiller). The following deviations predominate: instability of the style of upbringing, educational uncertainty, indulgent and dominant hyperprotection, rejection of the child. Many parents admit that they show aggression (verbal and physical) towards the child. Accordingly, 80% of the children in the surveyed group (128 people) showed signs of emotional discomfort, low self-esteem, disturbed family relationships (data from the M. Luscher test, CTO, projective drawing tests, personality differential). For this reason, psychological assistance to parents can be considered as an important element of helping children.
So, PSYCHOLOGICAL ASSISTANCE TO PARENTS is the FOURTH most important STAGE of the above system of providing assistance to a child with ADHD.
Experts point out that the leading link in the correction of ADHD is precisely the change in the behavior of parents in relation to the child. It is important to remember that the syndrome cannot be stopped. Compensatory mechanisms in the nervous system proceed slowly. After the diagnosis is established, parents should set themselves up for a long hard work to normalize the child's condition. It is especially important to pay their attention to the formation of a stable adequate self-esteem in the child. Parents definitely need to find allies (relatives and specialists). The role of a specialist (psychologist) is to provide information, psychological support for the child

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