Therapy for Children with ADHD through the “Extra Lesson ...



The “Extra Lesson” at work with ADHD children

Assessments, Commentaries, Results and Conclusion

Originally published in Brazil, April 2008 edition of Navegantes Magazine, João de Barro editors

Translation: Maya Theresa Kaough

Revision: Maria Eugênia Obniski

Introduction

The “Extra-Lesson”, also known as “Special Resources in Waldorf Education,” is based on the view point of human development brought by Anthroposophy. Audrey McAllen,[1] a teacher from England, developed the method based on the concept that learning disabilities are related to tardy or interrupted development during the first 7 years of life.

From the point of view of Rudolf Steiner,[2] the human being is not only the sum of hereditary capacities and abilities; there is also a spiritual essence that will be woven into a biography throughout his life. The structural organization of the physical body progresses step by step during the first seven years while the spirit/soul part of the human being appropriates this body. This physical structure is the result of the action of spiritual beings which have created the universe, the spiritual inheritance of humanity.

On earth we share the Archetypal Physical Body, which is a spatial organ for the consciousness of our individuality.[3]

The first goal of this method is to bring consciousness of the bodily movements to the student by means of playful activities. Once the child becomes conscious of his body, he will be able to know and dominate the physical space around him and understand three-dimensional reality. Only after this will he become apt to represent mentally or in symbols his physical movements and spatial three-dimensionality in the various activities of reading, writing and mathematics.

All of the children with whom we worked exhibited difficulties in the learning process, together with disturbances related to their movements, senses and spatiality.

We used the specific assessment of the “Extra-Lesson” method as an instrument to observe and diagnose the structural organization of the physical body, including observation of laterality and dominance, spatial orientation, body geography (body schema), presence of immature reflex responses, ability to copy or express graphically, and visual and auditory abilities at work.

Methodology

The children were assessed in individual sessions in periods between eight and twenty weeks, depending on individual necessity. After the assessments and further on every eight weeks, the interdisciplinary group discussed the direction and development of each case.

Table 1: Presentation of the assessed children, their ages, type of school attended, date of assessment and professional who performed the assessment and treatment.

|Patient |Age |School |Date of Evaluation |Assessment |Therapist |

|KG |9 |2nd Grade Waldorf |3/7/2005 |Torlay |Torlay |

| | |School | | | |

|MLH |10 |4th Grade Public |1/31/2005 |Torlay |Obniski |

| | |School | | | |

|SSA |8 |2nd Grade Public |3/21/2005 |Torlay |Obniski |

| | |School | | | |

|PLF |11 |4th Grade Public |1/17/2005 |Obniski |Salvetti |

| | |School | | | |

|RVL |8 |2nd Grade Private |3/16/2005 |Salvetti |Salvetti |

| | |School | | | |

Table 2: Observation of neuromotor development, spatial orientation, body geography and literacy of the assessed children.

|IMMATURE MOTOR REACTIONS|NEUROMOTOR DEVELOPMENT |SPATIAL |BODY GEOGRAPHY |LITERACY |

| | |ORIENTATION | | |

|Tonic Labyrinthine, |Symmetry phase, vertical |Undeveloped, little |Affected by vertical |Illiterate. |

|Symmetrical Tonic Neck |barrier, dominance |structurization on paper.|barrier. | |

| |established. | | | |

|Symmetrical and |Left/right dissociation, |Needs visual support. |Poor. |Switches letters. |

|Asymmetrical Tonic Neck, |strong vertical barrier. | | | |

|Tonic Labyrinthine | | | | |

|Symmetrical and |Symmetry phase, dominance |Poor, does not put |Poor. |Illiterate. |

|Asymmetrical Tonic Neck, |not established, vertical |himself at the center of | | |

|Spinal Galant |and horizontal barriers. |experiences. | | |

|Symmetrical and |Symmetry phase, dominance |Little spatial notion. |Poor. |Literate with many |

|Asymmetrical Tonic Neck, |not established, vertical | | |orthographic difficulties|

|Spinal Galant |and horizontal barriers. | | |and errors. |

|Tonic Labyrinthine, |Symmetry phase, dominance |Bad. |Poor. |Literate with many |

|Symmetrical and |established, vertical and | | |difficulties. |

|Asymmetrical Tonic Neck, |horizontal barriers. | | | |

|Spinal Galant | | | | |

Through these data one can see that neuromotor development presents significant discrepancy for the children’s ages. Tardiness in neuromotor development leads to difficulties in the postural system and symbolic representation (drawing, reading-writing).

The presence of immature motor responses reveals a discrepancy in development. Reflexes are involuntary motor responses, exhibited by the child in the first years of life, as a response to environmental stimuli. With the acquisition of voluntary movements – dependent on more complex cortical structures – the reflexes called “primitive” should disappear (the “Extra-Lesson” method uses the term “integration” to describe their disappearance and “retention” for their permanence). The permanence of primitive reflexes, which should have disappeared, can interfere in the development of motor abilities.[4]

For example, the retention of the Asymmetrical Tonic Neck Reflex causes lack of visual-motor coordination and the non-establishment of coordination between the two corporal hemispheres. The retention of the Symmetrical Tonic Neck Reflex causes difficulties in assuming adequate bodily positions during manual activities because the organization of limb movement remains dependent on the movement of the head (by means of reflex), and impedes a disassociation between the two segments. The Tonic Labyrinthine Reflex increases the extensor tonus, complicating the maintenance of posture, control of the head and the trunk and the independence of the gaze.[5]

The Spinal Galant Reflex also interferes with the maintenance of posture, principally when the individual needs to stay seated for a long period of time, and can be related to nocturnal enuresis.[6]

During the course of neuromotor development, the primitive reflexes are integrated and a period when the child has a similar motor pattern on both sides of the body takes place; this is the symmetrical stage. The period of bilateral integration follows, when one side of the body can execute one movement while the other side remains in repose. Around five years of age, the homolateral pattern is established, in which the control of one side gradually reaches the level of fine motor skill, culminating in hemispherical dominance. All of the children exhibited irregularities on this parameter, though it should be completed by the end of the first seven years of life.

Spatial orientation and awareness of position in space are abilities which develop enabling the observer to focus on objects in relation to himself. During his development, the young child will experience space considering what is “behind” to be what is “behind him,” and so on in each spatial direction. This internal reference is firmly established in most seven-year-old children, but fails to occur in some. A poor awareness of his own body and body image are also reflected in the child’s drawings of the human being. His visual world is distorted and affected, including his ability to orient himself in the world of the alphabetical symbols and the printed page.

Body geography or body schema develops after birth, beginning with the experience of being born, the course of motor development (rolling, creep, crawling…) and the bodily senses. Beginning with these experiences the child will inhabit his “body map.” All of the assessed children exhibited failings in this “mapping,” that is, they failed to correlate, for example, their right side and left, their upper and lower limbs, and they were unable to establish a concept of their own bodies that would orient them in space (spatial orientation ).

Table 3: Observation of the basic senses (touch, life, movement and balance) in the assessed children.

|TOUCH |LIFE |MOVEMENT |BALANCE |

|Hypersensitivity to touch, |Affected by sensory-motor |Little mastery and immature body|Adequate. |

|tension and immediate reaction |hyperactivity, leading to rare |awareness. | |

|to the response. Imposes |sensations of well being and | | |

|distance in physical contact, or|security. | | |

|is invasive. | | | |

|Normal. |Unlively, dark circles under the|Constant neck movement, needs |Needs visual reference. |

| |eyes, pallid. |visual reference, hyperactive. | |

|Invasive, lacks limits. |Lacks limits in eating habits. |Very compromised. |Adequate. |

|Lacks notion of limits. |Constant dissatisfaction. |Little body awareness. |Compromised, needs visual and |

| | | |tactile support. |

|Seeks contact, lacks notion of |Exhibits circles under the eyes,|Disordered and agitated |Needs visual reference. |

|limits. |lacks limits in preference for |movements. | |

| |food and drink. | | |

Part of the assessment was an observation of the level of maturity of the bodily senses, especially touch, movement and life. They showed impoverished body awareness (proprioception) as well as lack of the experiences of well being and healthy relationship towards own corporality and to the environment, as a consequence.

Academic Science, as well as Anthroposophy, recognizes the existence of a sense for awareness of one’s own body, the proprioceptive system, and its importance to the organizing of the motor pattern, based on the fact that this awareness facilitates motor planning, concentration, gravitational security and emotional stability.

Irregularities in the sense of touch can give rise to: lack of reaction to injury or being touched, lack of feeling of bodily and emotional limits, search for physical contact, often in an abrupt manner that can be confused with aggression. These behaviors can occur when the sense of touch is inactive. When hyper sensible, children react negatively to touch, avoid physical contact and contact with materials of different textures. They can become very selective in their food habits because of food textures. They seem not to be able to play alone, explore their environment or invent games.

According to our observations, the majority of children exhibits a lack of emotional and body limits. They were evasive when faced with interpersonal contact. Children who exhibited hypersensitivity to touch also exhibited selectivity regarding food, smell and taste.

Irregularities in the sense of life or well being generate a constant state of illness, withdrawal and disinterest, motor agitation, lack of concentration and other symptoms. Children attended exhibited a very irregular sense of life. There were examples of hyperactivity and constant search for stimuli; the children demonstrated sensorial insatiability, and in some cases, an insatiability for food as well, inhibiting the absorption of what they received.

Irregularities in the sense of movement (proprioception ) generated uncoordinated movements, frequent falls, an inability to hold objects without looking at them, difficulty in maintaining posture, in moderating pressure on held objects and in moving in general, incoordination of movements in space (tendency to break objects when moving), a necessity to look at the feet while walking and difficulty in differentiating and copying forms (letters).

The children assessed exhibited little command of movement. All external movement in the environment caused movement within the children, which demonstrates immaturity.

Irregularities in the sense of balance (vestibular sense) lead to spatial disorganization and insecurity in movements, as well as ineptitude in activities that require fine motor coordination, difficulty with spatial concepts like inside-outside, above-below, and tardiness in establishment of dominance (a preference for one side of the body for eye, ear, hand and foot). The same difficulties are seen in the task of writing (unequal spacing between words, difficulty with diagramation and spatial location of letters, bad handwriting).[7]

Three of the evaluated children demonstrated irregularities in static and dynamic balance, needing visual aids to maintain balance.

Table 4: Observation of the processes of visual and auditory perception.

|VISION |HEARING |

|Difficulty in processing, memory and sequence. Eye movement |Difficulty in processing, analysis, synthesis and sequence. |

|associated with head movement. Visual learner. | |

|Vision is associated with other senses, overloaded, inhibiting |Failures in discrimination and memory. |

|concentration. Visual learner. | |

|Difficulty in processing and focus, poor memory, eye movement |Auditory learner, repeated instructions to himself, talks |

|associated with head movement. |incessantly without internalizing. |

|Lacks convergence of the eyes, lacks control to the left, eye |Repeated instructions to himself. |

|movement associated with head movement. | |

|Eye movement associated with head movement, vertical midline |Needed repetition of instructions. |

|barrier present | |

As much as the other senses, vision and hearing – two important senses in the integration of the person with his environment and in the process of learning – also presented difficulties.

Visual perception and processing are of great importance in interactions with one’s environment; they help in comprehending the perceptions of the other senses, spatial notion, mental representation, differentiation between two planes (figure-ground) and the establishment of logical order (sequencing). Auditory perception and processing also interfere in spatial localization and differentiation of sounds. They are important in prioritizing multiple sounds (figure-ground) and audio sequencing (the capacity to establish a rhythmical order in a spoken phrase).[8]

Visual processing is the way that visual information reaches the child, as well as the path that visual perception runs in order to realize mental representation. All of the children observed moved their heads simultaneously to accompany the trajectory of an object with their eyes. This is an immature reaction which complicates observation of the world and distinction of its parts. Our eyes travel over the forms of the graphemes (letters) moving with their forms. Part of this maturation has to do with the convergence of the eyes that is established around seven years of age.

In relation to auditory processing, we evaluated how the body organizes responses from information that arrives aurally, whether motor, spoken or written, etc. The children exhibited failures in this aspect; they repeated out loud the instructions given to them, facilitating their perception through speech.

Table 5: Observation of the life vital processes of respiration and nutrition and the middle senses.

|RESPIRATION |ORAL HABITS |SLEEP |EATING HABITS |MIDDLE SENSES |

|Normal. |None. |Good. |Very selective, |Hypersensitivity of smell and |

| | | |hypersensitivity of smell|taste, indifference to |

| | | |and taste. |temperature. |

|Breathes orally. |None. |Irregular, fearful. |Selective. |Normal. |

|Breathes orally. |Sucks thumb. |Agitated, difficulty |Selective. |Normal. |

| | |falling asleep. | | |

|Breathes orally. |None. |Normal. |Normal. |Normal. |

|Breathes orally. |Bites nails. |Difficulty falling asleep|Has phases of compulsion.|Normal. |

| | |and waking up. | | |

Among the life processes, we analyzed respiration and nutrition. The respiratory process does not occur solely within the respiratory tract, but in the entire rhythmic system, in falling asleep and waking up, in social interaction and in the processes of comprehension.[9] We found irregularities in the respiratory process. In regards to nutrition, the following irregularities were found: insatiability, selectivity and hypersensitivity to food textures, related to the sense of touch.

Given individual necessities and difficulties, each therapist developed a unique session plan, seeking to integrate the immature motor responses, neuromotor development, development of the senses, spatial orientation, with the overall aim to improve mental representation (ability to mentally visualize). And beyond this, based on the experience of working with these children other therapies and interventions were addressed, in areas such as Rhythmical Massage, Chirophonetics, Orthoptics.

Table 6: Results

|BENEFIT FROM SCHOLASTIC ACTIVITY |SOCIAL BEHAVIOR |SELF-CONSCIOUSNESS |

|Achieved literacy, academic benefit improved. |Variable. |Much improved. |

|Improved initially, but worsened with family |Improved at school, worsened |Began to dissociate feelings with |

|difficulties. |intrinsically with family problems. |environment. |

|Achieved literacy. |Improved. |Improved. |

|Improved initially but then continued to |Improved. |Improved. |

|decline. | | |

|Greatly improved. |Improved. |Improved. |

Conclusion

Academic achievement of these children improved, although they did not receive any sort of scholastic support. In our understanding, this improvement occurred because of the work accomplished with the elements necessary to facilitate mental representation, body geography, spatial orientation and awareness of three-dimensionality, together with the organization of the postural system, neuromotor development and maturation of the senses. The children’s capacity to process visual and auditory information improved, facilitating their learning processes.

Social behavior also showed improvement, which can in part be attributed to the development of the senses. The sense of touch improved the children’s notion of limits, both bodily and in social relationships. The sense of life helped the children become quiet as they felt more comfortable within their bodies. Movement became more gentle due to increased bodily awareness and environmental movements interfered less in the children’s own movements. Improvement in balance also helped with calmness and security, and permitted the presence of an inner support.

An improved awareness of themselves in contrast to the outside environment helped the children work more autonomously with their impulses.

The “Extra-Lesson” method, used in conjunction with other therapies, helped to diminish symptoms of ADHD, helping patients not only with the integration of their own self, but principally, in integration with family and school life.

Although not our primary objective, we also observed that significant behavior changes were achieved through structural organization of the children attended.

Postural organization is acquired during the first seven years of life, through the child’s environment and caregivers. This leads us to question the cultural patterns surrounding the upbringing of our children, who day by day show increasing behaviors of ADHD.

Complementary Bibliography

1. AMEN D.G., Transforme seu Cérebro, transforme sua vida: um Programa revolucionário para vencer a ansiedade, a depressão, a obsessividade, a raiva e a impulsividade, SP, Ed. Mercuryo, 2000.

2. BENCZIK E.B.P., Transtorno de Déficit de Atenção/Hiperatividade, SP, 2ª Ed., Casa do Psicólogo, 2002.

3. BENCZIK E.B.P., Manual da Escala de Transtorno de Déficit de Atenção/Hiperatividade, SP, Casa do Psicólogo, 2002.

4. HALLOWELL E.M., e RATEY J.J., Tendência à Distração: Identificação e Gerência do Distúrbio do Déficit de Atenção da Infância à Vida Adulta, RJ, Ed. Rocco, 1999.

5. KONIG, K., Os três primeiros anos da criança, SP, Ed. Antroposófica, 4ª. Ed., 2006.

6. LENT R., Cem bilhões de neurônios, SP, Ed. Atheneu, 2005.

7. MC ALLEN, Audrey, Método Extra Lesson, Vol.2, SP, Ed. Antroposófica, 2006.

8. SCHWARTZMAN J.S., Transtorno de Déficit de Atenção, SP, Ed. Memnon, 2001.

9. STEINER, R. Psicosofía – Psicología del cuerpo alma y espíritu, Buenos Aires, Ed. Antroposófica, 1ª. Ed.,2005.

10. SILVA A.B.B., Mentes Inquietas: entendendo melhor o mundo das pessoas distraídas, impulsivas e hiperativas, SP, Ed. Gente, 2003.

11. WAGNER, F. Rudolf, La dyslexia y su hijo, México, Ed. Diana, 1978.

AUTHORS

Rosana Cristina Torlay

Speech Therapist, attended Waldorf Education Seminar, Fully Trained Padovan Method – Neuro-Functional Re-organization,

Fully trained in Extra Lesson / Waldorf Education Special Resources, in Brazil

Works in a private practice - Casa 44.

Regina Célia Salvetti

Biologist, attended Waldorf Education Seminar, attended Curative Education Seminar,

Fully trained in Extra Lesson / Waldorf Education Special Resources, in Brazil

Experienced Special Needs Kindergarten Teacher at Associação Beneficente Parsifal.

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[1] MC ALLEN, Audrey. Método Extra Lesson, vol.1, SP. Ed Antroposófica, 2005.

[2] STEINER, R. A Arte da Educação I, pg.23, SP, 3ª. Ed.. Ed. Antroposófica, 1988

[3] Ibidem

[4] Ibidem

[5] MOM, A. ,BUENO R, SILVESTRES C, GRACIANE Z. O processamento sensorial como ferramenta para educadores. Facilitando o processo de aprendizagem, SP. Artevidade/Memnon, 2007

[6] TORLAY R, Bed wetting: is there a solution?, AHENES, pg.16, November 2004.

[7] Ibidem ref. 1

[8] Ibidem

[9] STEINER, R. Antropologia Meditativa, cap.3, SP, Ed Antroposófica, 1997.

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