PARENTING A SCHOOLER

Submitted To: Tita C. Senal, RN, MN, PhD Submitted By: Sarrosa, Jerly Mae P. Solidum, Mark Leonard S. Tan, Kristti Lei B. Togado, Justin Matthew C. Uytiepo, Keziah Marie B. Valde, Lovely Faith G. Vargas, Jayvee Jayson G. Villarias, Donnaline R. BSN3-C

COMMON BEHAVIORAL PROBLEMS

UNDERACHIEVEMENT Definition
Underachievement occurs when a child's performance is below what is expected based on the child's ability. Underachievement can be defined as an inability or failure to perform appropriately for ones age or talents In other words, unfulfilled potential. Given this definition, it can clearly be extremely hard to identify underachievers, and to note when underachievement is taking place.

Personal characteristics of underachievers

Self-Perception Low perception of abilities Poor self-concept and low self-esteem Self-critical Fear of failure, fear of success Anxious, nervous (especially over performance) Goal Orientation Unrealistic standards; perfectionist Lack of or low educational and occupational aspirations Lack of persistence Impulsive reaction to challenges Peer Relations Lack of friends, lonely, alienated, and withdrawn Immature or ineffectual social skills, not liked by peers Feel rejected Authority Relationships Overtly aggressive, hostile Discipline problems, delinquency Rebelliousness, independence-striving Lack of self-control, manipulative Irresponsible, unreliable Passive-aggressive Locus of Control External control, blame others for problems Hypercritical of others, negativistic Emotional Expression Flat affect, apathy Emotionally explosive, poorly controlled emotions Underachievers are not a uniform group, and they may exhibit a variety of characteristics. A comprehensive model has not yet been devised that can organize educationists current understanding of underachievement. Until that is achieved, checklists of characteristics may be especially useful. Montgomery (1996) suggests that the presence of five or more of the following indicators should lead teachers to suspect that a student is underfunctioning:

 Inconsistent pattern of achievement in schoolwork subjects Inconsistent pattern of achievements within a subject area Discrepancy between ability and achievements, with ability much higher Lack of concentration Daydreaming Clowning and other work avoidance strategies Poor study skills Poor study habits Non-completion or avoidance of assignments Refusal to write anything down Overactivity and restlessness Overassertive and aggressive or over submissive and timid social behavior Inability to form and maintain social relationships with peers Inability to deal with failures Avoidance of success Lack of insight about self and others Poor literacy skills Endless talking, avoiding doing Membership of stereotyped minority group (not Caucasian, male, middleclass).

Principles to keep in mind

Focus on success It is important, in a calm way, to express your confidence in your childrens abilities and to let them know that you expect them to be successful in those activities and endeavors that are important to them. When they are successful provide them with reasonable, measured, and precise acknowledgment of their successes (however small you might think them to be). Provide success experiences Encourage your child to be active and involved in a range of activities where you think that they might enjoy small successes. Give them responsibilities (such as regular household chores and duties) so that they will learn that they can be competent and successful members of the family. Maintain a positive relationship with the under-achieving child Under-achieving children can be frustrating children. It is easy to become impatient and angry with children who don't do what we think they should do. However, it is important to remain calm with our frustration and to be as positive in tone with the under-achieving child as we can be. It is important that we maintain a positive relationship with the under-achiever, striving to be supportive to the child in constructive ways and to remain the child's ally. It may be impossible to be helpful to the underachieving child who perceives us as adversaries. Hold the under-achieving child accountable! It is extremely important that we be firm and consistent with our expectations of underachieving children and that we enforce the limits and rules that we establish for them. Just as we recognize and acknowledge their successes, we must hold them accountable for misbehavior, lack of effort, and lack of compliance with appropriate expectations. Emphasis "competition" with the child's past performance, not with others As was mentioned previously, many under-achieving children are intimidated by competition and will avoid direct competition with others. We should make efforts to emphasize the child's

improvement relative to his or her past performance. It can also be helpful to encourage cooperative competition in groups (such as in team sports activities). Be careful and judicious with criticism Never criticize the under-achieving child in front of his or her peers or in the presence of other family members. It is extremely important to avoid sarcasm. Never use labels (such as stupid or lazy). As was mentioned above, limit your attention to negative behaviors (and focus on positive and successful behaviors). Avoid emotional overreaction, making every effort to remain calm and pleasant in your responses to negative behaviors. Use short-term consequences Many parents of under-achieving children attempt to entice the under-achieving child by offering long-term rewards for good grades (for example, offering a child a new bicycle if the child earns grades of "C" or better). Many under-achieving children lack persistence and stamina and are simply unable to work for long-term rewards. Small and more immediate rewards (and consequences) for short-term successes tend to be more helpful. Be realistic in your goals It is extremely important that adults who are attempting to work with under-achieving children keep in mind that nothing we can do will yield dramatic benefits for the under-achieving student in the short run. We should be prepared for the long-run. Especially at first, focus less on grades and more on changes that will lead to improved grades (such as compliance with a regular homework). It is important that we target our efforts on specific achievable short-term goals and less on the longer term goals (such as good grades) that are harder to control in the short run. Recognize that under-achieving children may be lacking in certain useful skills Many under-achieving children can benefit from efforts to teach them useful study skills, useful goal-setting skills, and practical organizational skills. Sometimes parents can be helpful in these areas; sometimes tutors in the schools can provide the needed instruction in these areas. Engage Professional Help For many parents, the choice to seek help from a counselor, psychologist or other professional's depends on their tolerance level. Sometimes they act at the first signs of a problem, but often they wait until the problem corrodes daily family life. Making the decision anywhere along that spectrum is a difficult and personal one. Before choosing this option, observe your child for a while, then, attempt intervention. This conservative approach is recommended to avoid overreaction by the family. A small number of underachievers quickly demonstrate that they are amenable to change. It is helpful, though, to have the child evaluated by a psychologist if underachievement symptoms persist. The student's intellectual potential, achievement level, emotional maturity and the possible presence of learning disabilities should be determined so as to eliminate these factors as causes. The psychologist can then diagnose the problem and guide the parents in evaluating their observations. This allows for establishment of reasonable parental expectations and to see if, indeed, the child is underachieving. Remember, to be identified as an underachiever, the child should have at least a several months pattern of underachievement. The underachievement generally surfaces both in academic areas, as well as in other, nonacademic responsibilities. With few exceptions, up to the age of eight, parents should restrict their actions to observing and co limited parental interventions. Until about age eight, wide variations in development occur that can be considered normal. Pushing the child too hard

at this time can be counterproductive. Every so often, parents will come to the Center with a very young child. They complain that their five-year-old would rather play with Legos than use flash cards to learn a third language. Their expectations are out of whack. I offer to treat the parents, instead of the child. After age eight, if patterns of underachievement continue, other response options should be seriously considered. Allowing the underachievement to progress, generally means the unwanted patterns will become more firmly ingrained and, therefore, more difficult to change. The greatest risks lie with letting children fail and ignoring their problems. The belief that if only these two approaches are used the children will change is doubtful and very limiting. When positive action is called for, parents must be ready to assume the responsibility for taking it to correct the problem of underachieving children. It is important to remember that underachievement, once it develops, is a long-term problem and one that may take years to fully remedy. We should be modest and reasonable in our short-term expectations of the under-achieving student. Nothing we do in the short run should be expected to help the under-achieving child dramatically. Every strategy we develop should be a long-term strategy. We should expect changes in small steps over the course of months or, perhaps, years (and, specifically, not days or weeks). We should emphasize positive, attempting to maintain a balance between sensitivity, warmth, and support on the one hand, and the ability to be firm on the other. We should recognize that many under-achieving children will attempt to control our attention, the attention of his or her teachers, or the attention of his or her peers. We need to respond to those attention-seeking behaviors calmly and firmly, without anger or annoyance. Good luck!

ATTENTION DEFICIT HYPERACTIVITY DISORDER Definition

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity).

Three Subtypes
1. Predominantly hyperactive-impulsive Most symptoms (six or more) are in the hyperactivity-impulsivity categories. Fewer than six symptoms of inattention are present, although inattention may still be present to some degree. 2. Predominantly inattentive The majority of symptoms (six or more) are in the inattention category and fewer than six symptoms of hyperactivity-impulsivity are present, although hyperactivity-impulsivity may still be present to some degree. Children with this subtype are less likely to act out or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing. Therefore, the child may be overlooked, and parents and teachers may not notice that he or she has ADHD. 3. Combined hyperactive-impulsive and inattentive

 Six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present. Most children have the combined type of ADHD. Treatments can relieve many of the disorder's symptoms, but there is no cure. With treatment, most people with ADHD can be successful in school and lead productive lives. Researchers are developing more effective treatments and interventions, and using new tools such as brain imaging, to better understand ADHD and to find more effective ways to treat and prevent it.

Symptoms
ADHD used to be known as attention deficit disorder, or ADD. In 1994, it was renamed ADHD and broken down into three subtypes, each with its own pattern of behaviors: 1. An inattentive type, With signs that include: * Inability to pay attention to details or a tendency to make careless errors in schoolwork or other activities * Difficulty with sustained attention in tasks or play activities * Apparent listening problems * Difficulty following instructions * Problems with organization * Avoidance or dislike of tasks that require mental effort * Tendency to lose things like toys, notebooks, or homework * Distractibility * Forgetfulness in daily activities 2. A hyperactive-impulsive type, With signs that include: * fidgeting or squirming * Difficulty remaining seated * Excessive running or climbing * Difficulty playing quietly * Always seeming to be "on the go" * Excessive talking * blurting out answers before hearing the full question * Difficulty waiting for a turn or in line * Problems with interrupting or intruding 3. A combined type, Which involves a combination of the other two types and is the most common Although it can be challenging to raise kids with ADHD, it's important to remember they aren't "bad," "acting out," or being difficult on purpose. And they have difficulty controlling their behavior without medication or behavioral therapy.

Causes
Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD. Genes

Inherited from our parents, genes are the "blueprints" for who we are. Results from several international studies of twins show that ADHD often runs in families. Researchers are looking at several genes that may make people more likely to develop the disorder. Knowing the genes involved may one day help researchers prevent the disorder before symptoms develop. Learning about specific genes could also lead to better treatments. Children with ADHD who carry a particular version of a certain gene have thinner brain tissue in the areas of the brain associated with attention. This NIMH research showed that the difference was not permanent, however, and as children with this gene grew up, the brain developed to a normal level of thickness. Their ADHD symptoms also improved. Environmental factors Studies suggest a potential link between cigarette smoking and alcohol use during pregnancy and ADHD in children. In addition, preschoolers who are exposed to high levels of lead, which can sometimes be found in plumbing fixtures or paint in old buildings, may have a higher risk of developing ADHD. Brain injuries Children who have suffered a brain injury may show some behaviors similar to those of ADHD. However, only a small percentage of children with ADHD have suffered a traumatic brain injury. Sugar The idea that refined sugar causes ADHD or makes symptoms worse is popular, but more research discounts this theory than supports it. In one study, researchers gave children foods containing either sugar or a sugar substitute every other day. The children who received sugar showed no different behavior or learning capabilities than those who received the sugar substitute. Another study in which children were given higher than average amounts of sugar or sugar substitutes showed similar results. In another study, children who were considered sugar-sensitive by their mothers were given the sugar substitute aspartame, also known as Nutrasweet. Although all the children got aspartame, half their mothers were told their children were given sugar, and the other half were told their children were given aspartame. The mothers who thought their children had gotten sugar rated them as more hyperactive than the other children and were more critical of their behavior, compared to mothers who thought their children received aspartame. Food additives Recent British research indicates a possible link between consumption of certain food additives like artificial colors or preservatives, and an increase in activity.11 Research is under way to confirm the findings and to learn more about how food additives may affect hyperactivity.

Diagnosis
Because there's no test that can determine the presence of ADHD, a diagnosis depends on a complete evaluation. Many children and adolescents diagnosed with ADHD are evaluated and treated by primary care doctors including pediatricians and family practitioners, but your child may also be referred to one of several different specialists (psychiatrists, psychologists, neurologists) especially when the diagnosis is in doubt, or if there are other concerns, such as Tourette syndrome, a learning disability, anxiety, or depression. To be considered for a diagnosis of ADHD: A child must display behaviors from one of the three subtypes before age 7

These behaviors must be more severe than in other kids the same age The behaviors must last for at least 6 months The behaviors must occur in and negatively affect at least two areas of a child's life (such as school, home, day-care settings, or friendships)

Treatment
ADHD can't be cured, but it can be successfully managed. Your child's doctor will work with you to develop an individualized, long-term plan. The goal is to help a child learn to control his or her own behavior and to help families create an atmosphere in which this is most likely to happen. In most cases, ADHD is best treated with a combination of medication and behavior therapy. Any good treatment plan will require close follow-up and monitoring, and your doctor may make adjustments along the way. Because it's important for parents to actively participate in their child's treatment plan, parent education is also considered an important part of ADHD management. Medications Several different types of medications may be used to treat ADHD: Stimulants Are the best-known treatments they've been used for more than 50 years in the treatment of ADHD. Some require several doses per day, each lasting about 4 hours; some last up to 12 hours. Possible side effects include decreased appetite, stomachache, irritability, and insomnia. There's currently no evidence of long-term side effects. Non-stimulants Approve for treating ADHD in 2003. These appear to have fewer side effects than stimulants and can last up to 24 hours. Antidepressants Are sometimes a treatment option; however, in 2004 the U.S. Food and Drug Administration (FDA) issued a warning that these drugs may lead to a rare increased risk of suicide in children and teens. If an antidepressant is recommended for your child, be sure to discuss these risks with your doctor. Medications can affect kids differently, and a child may respond well to one but not another. When determining the correct treatment, the doctor might try various medications in various doses, especially if your child is being treated for ADHD along with another disorder.

Trade Name Adderall Adderall XR Concerta Daytrana Desoxyn Dexedrine Dextrostat Focalin

Generic Name amphetamine amphetamine (extended release) methylphenidate (long acting) methylphenidate patch methamphetamine hydrochloride dextroamphetamine dextroamphetamine dexmethylphenidate

Approved Age 3 and older 6 and older 6 and older 6 and older 6 and older 3 and older 3 and older 6 and older

dexmethylphenidate (extended release) Focalin XR methylphenidate (extended release) Metadate ER methylphenidate (extended release) Metadate CD methylphenidate (oral solution and chewable tablets) Methylin methylphenidate Ritalin methylphenidate (extended release) Ritalin SR methylphenidate (long acting) Ritalin LA atomoxetine Strattera lisdexamfetamine dimesylate Vyvanse Behavioral Therapy

6 and older 6 and older 6 and older 6 and older 6 and older 6 and older 6 and older 6 and older 6 and older

Research has shown that medications used to help curb impulsive behavior and attention difficulties are more effective when combined with behavioral therapy. Behavioral therapy attempts to change behavior patterns by: Reorganizing a child's home and school environment Giving clear directions and commands Setting up a system of consistent rewards for appropriate behaviors and negative consequences for inappropriate ones Here are examples of behavioral strategies that may help a child with ADHD: Create a routine Try to follow the same schedule every day, from wake-up time to bedtime. Post the schedule in a prominent place, so your child can see what's expected throughout the day and when it's time for homework, play, and chores. Get organized Put schoolbags, clothing, and toys in the same place every day so your child will be less likely to lose them. Avoid distractions Turn off the TV, radio, and computer games, especially when your child is doing homework. Limit choices Offer a choice between two things (this outfit, meal, toy, etc., or that one) so that your child isn't overwhelmed and overstimulated. Change your interactions with your child Instead of long-winded explanations and cajoling, use clear, brief directions to remind your child of responsibilities. Use goals and rewards Use a chart to list goals and track positive behaviors, then reward your child's efforts. Be sure the goals are realistic (think baby steps rather than overnight success). Discipline effectively

Instead of yelling or spanking, use timeouts or removal of privileges as consequences for inappropriate behavior. Younger kids may simply need to be distracted or ignored until they display better behavior. Help your child discover a talent All kids need to experience success to feel good about themselves. Finding out what your child does well whether its sports, art, or music can boost social skills and self-esteem.

Alternative Treatments
Currently, the only ADHD therapies that have been proven effective in scientific studies are medications and behavioral therapy. But your doctor may recommend additional treatments and interventions depending on your child's symptoms and needs. Some kids with ADHD, for example, may also need special educational interventions such as tutoring, occupational therapy, etc. Every child's needs are different. A number of other alternative therapies are promoted and tried by parents including: megavitamins, body treatments, diet manipulation, allergy treatment, chiropractic treatment, attention training, visual training, and traditional one-on-one "talking" psychotherapy. However, scientific research has not found them to be effective, and most have not been studied carefully, if at all. Parents should always be wary of any therapy that promises an ADHD "cure." If you're interested in trying something new, speak with your doctor first. Parent Training Parenting a child with ADHD often brings special challenges. Kids with ADHD may not respond well to typical parenting practices. Also, because ADHD tends to run in families, parents may also have some problems with organization and consistency themselves and need active coaching to help learn these skills. Experts recommend parent education and support groups to help family members accept the diagnosis and to teach them how to help kids organize their environment, develop problem-solving skills, and cope with frustrations. Training can also teach parents to respond appropriately to a child's most trying behaviors with calm disciplining techniques. Individual or family counseling can also be helpful. ADHD in the Classroom As your child's most important advocate, you should become familiar with your child's medical, legal, and educational rights. Kids with ADHD are eligible for special services or accommodations at school under the Individuals with Disabilities in Education Act (IDEA) and an anti-discrimination law known as Section 504. Keep in touch with teachers and school officials to monitor your child's progress. In addition to using routines and a clear system of rewards, here are some other tips to share with teachers for classroom success: Reduce seating distractions Lessening distractions might be as simple as seating your child near the teacher instead of near the window. Use a homework folder for parent-teacher communications The teacher can include assignments and progress notes, and you can check to make sure all work is completed on time.

 Break down assignments Keep instructions clear and brief, breaking down larger tasks into smaller, more manageable pieces. Give positive reinforcement Always be on the lookout for positive behaviors. Ask the teacher to offer praise when your child stays seated, doesn't call out, or waits his or her turn instead of criticizing when he or she doesn't. Teach good study skills Underlining, note taking, and reading out loud can help your child stay focused and retain information. Supervise Check that your child goes and comes from school with the correct books and materials. Sometimes kids are paired with a buddy to can help them stay on track. Be sensitive to self-esteem issues Ask the teacher to provide feedback to your child in private, and avoid asking your child to perform a task in public that might be too difficult. Involve the school counselor or psychologist He or she can help design behavioral programs to address specific problems in the classroom.

Helping Your Child

You're a stronger advocate for your child when you foster good partnerships with everyone involved in your child's treatment that includes teachers, doctors, therapists, and even other family members. Take advantage of all the support and education that's available, and you'll help your child navigate toward success.

ROLE OF NURSE IN CARE OF HEALTHY/ILL SCHOOLER

The National Association of School Nurses identifies 7 core roles that the school nurse fulfills to foster child and adolescent health and educational success. The roles are overarching and are applicable to school nurses at all levels of practice, in all geographic settings, and with all clients.

1. The school nurse provides direct care to students The school nurse provides care for injuries and acute illness for all students and long-term management of students with special health care needs. Responsibilities include assessment and treatment within the scope of professional nursing practice, communication with parents, referral to physicians, and provision or supervision of prescribed nursing care. An individualized health care plan is developed for students with chronic conditions, and when appropriate, an emergency plan is developed to manage potential emergent events in the school setting (eg, diabetes, asthma). Ideally, this health plan is aligned with the management plan directed by the childs pediatrician and regularly updated through close communication. The school nurse is responsible for management of this plan and communication about the plan to all appropriate school personnel. The school nurse has a unique role in provision of school health services for children with special health needs, including

children with chronic illnesses and disabilities of various degrees of severity. Children with special health needs are included in the regular school classroom setting as authorized by federal and state laws. As a leader of the school health team, the school nurse must assess the students health status, identify health problems that may create a barrier to educational progress, and develop a health care plan for management of the problems in the school setting. The school nurse ensures that the students individualized health care plan is part of the individualized education plan (IEP), when appropriate, and that both plans are developed and implemented with full team participation, which includes the student, family, and pediatrician. 2. The school nurse provides leadership for the provision of health services As the health care expert within the school, the school nurse assesses the overall system of care and develops a plan for ensuring that health needs are met. Responsibilities include development of plans for responding to emergencies and disasters and confidential communication and documentation of student health information. 3. The school nurse provides screening and referral for health conditions Health screenings can decrease the negative effects of health problems on education by identifying students with potential underlying medical problems early and referring them for treatment as appropriate. Early identification, referral to the medical home, and use of appropriate community resources promote optimal outcomes. Screening includes but is not limited to vision, hearing, and BMI assessments (as determined by local policy). 4. The school nurse promotes a healthy school environment. The school nurse provides for the physical and emotional safety of the school community by monitoring immunizations, ensuring appropriate exclusion for infectious illnesses, and reporting communicable diseases as required by law. In addition, the school nurse provides for the safety of the environment by participating in environmental safety monitoring (playgrounds, indoor air quality, and potential hazards). The school nurse also participates in implementation of a plan for prevention and management of school violence, bullying, disasters, and terrorism events. The school nurse may also coordinate with school counselors in developing suicide prevention plans. In addition, if a school determines that drug testing is a part of its program, school nurses should be included in school district and community planning, implementation, and ongoing evaluation of this testing program. 5. The school nurse promotes health The school nurse provides health education by providing health information to individual students and groups of students through health education, science, and other classes. The school nurse assists on health education curriculum development teams and may also provide programs for staff, families, and the community. Health education topics may include nutrition, exercise, smoking prevention and cessation, oral health, prevention of sexually transmitted infections and other infectious diseases, substance use and abuse, immunizations, adolescent pregnancy prevention, parenting, and others. School nurses also promote health in local school health councils. 6. The school nurse serves in a leadership role for health policies and programs As a health care expert within the school system, the school nurse is a leader in the development and evaluation of school health policies. These policies include health promotion and protection, chronic disease management, coordinated school health programs, school wellness policies, crisis/disaster management, emergency medical condition management, mental health

protection and intervention, acute illness management, and infectious disease prevention and management. 7. The school nurse is a liaison between school personnel, family, health care professionals, and the community. The school nurse participates as the health expert on the IEP17 and 50418 teams. IEP teams identify the special education needs of students; 504 teams plan for reasonable accommodations for students special needs that impact their educational programs. As the case manager for students with health problems, the school nurse ensures that there is adequate communication and collaboration among the family, physicians, and providers of community resources. This is a crucial interface for the pediatrician and the school nurse to ensure consistent, coordinated care. The school nurse also works with community organizations and primary care physicians to make the community a healthy place for all children and families.

SCHOOL NURSE ACTIVITIES

Assessment of health complaints, medication administration, and care for students with special health care needs; A system for managing emergencies and urgent situations Mandated health screening programs, verification of immunizations, and infectious disease reporting; and Identification and management of students chronic health care needs that affect educational achievement. The AAP recognizes the need for appropriate management of student health conditions in its policy statement, Guidelines for Administration of Medication in School. It also recognizes the need for policies for emergency medical situations that can occur in school and the school nurses role in developing and implementing these policies. The school nurse serves as an extension of traditional community health services, ensuring continuity, compliance, and professional supervision of care within the school setting.