“The more I think about child development usually imagine a locomotive crossing uncharted territory and may at any time, derailed and go to tread new paths, many of them dangerous and treacherous. The earlier observe and identify such ‘course corrections’, soon have the chance to restore order and replace the ‘locomotive’ in the right track. “(Gustavo Henrique Teixeira) 1
“My son is 14 years old and since child is very agitated, could not play for a long time with a single toy, losing interest quickly. At mealtimes remained more standing than sitting, getting up and leaving the table for any reason. Today, teen, can sit, but not to move arms and legs. At school, the teacher complains that besides not stop sitting, talk all the time and bother who is quiet. He was grounded several times and some suspensions due to fighting and disobedience. Your notebook is a ‘scrawl’ and hardly do their homework. His grades are low and have repeated the year because they can not concentrate on study. Your room and your belongings are always messy. The only activities that interest are related to football (you know all of the subject), video games and conversations on Orkut. ADHD was diagnosed when he was 8 years. Your IQ (IQ) is above average. Does drug therapy, occupational therapy and psychological 4 years 6 years ago. ”
“My son can not organize your tasks. What I do to help you? He was always very shy, a few friends, never gave me work, but only at the end of adolescence is that the problems appeared … With 17 years her shyness was turning isolation, remained in silence in the room. I thought I was studying for the exam, but his thoughts were elsewhere. I had no girlfriend, not go out with friends and other teenagers. I realized that something was wrong. I thought about conflicts of adolescence, but his behavior was changing. He talked to himself, sometimes screaming and breaking objects. It was the beginning of the hallucinations and delusions of persecution. His diagnosis is schizophrenia. I thought he was just a shy boy. I never thought that his way would turn into disease. What to do?”
(Mothers reports for occupational therapy assessments)
How to deal with people with behavioral disorders?
The aim of this chapter is to guide parents and teachers to deal with children and adolescents with behavioral disorders. Through experiences in the clinic of Occupational therapy (OT), with neuropsychiatric and emotional disorders detected in childhood and / or adolescence, it is observed significant impairment in daily activities of these carriers. Family, school and social relationships are affected due to behavioral symptoms such as agitation, lack of attention, concentration, motivation, depression, cognitive impairment and others. Living with these carriers it is difficult because they have a significant disruption in daily activities, practices, school and, consequently, interpersonal relations are intensified and become more complicated. One of the proposals of the TO is to make parents and teachers help their children / students to organize themselves properly, rehabilitating them and creating family life opportunities, learning and other social skills.
What is occupational therapy?
TO is the science that studies human activity and use as a therapeutic resource for preventing and treating physical and / or psychosocial difficulties that interfere in the development and independence of individuals with regard to the activities of daily living, work and leisure. It is the art and science of guiding the individual’s participation in selected activities to restore, strengthen and build capacity, facilitate learning those skills and functions essential for adaptation and productivity, reduce or correct pathologies and promote and maintain health2.
Human activity is related to daily activities (tasks of day to day) and these tasks are of fundamental importance in our life, its realization, its implementation process and the end result have different degrees and values3. When these activities are impaired due to a disorder, the damage can be devastating for the individual, the family and society. The TO use as a tool in their interventions the activities is the execution of a task or action by an indivíduo4.
The objectives of the TO is that activities are an instrument of communication and expression of individual therapy, in which there is the establishment of a relationship in which three elements are crucial: the therapist, the patient and atividades5.
The occupational therapy process should favor the individual: the integration of dissociated content, always valuing the healthy aspects; the pathological aspects become more structured; the creation of enablers insert social5.
The daily activities
The daily lives of individuals consists of many activities that are carried out in a particular context, including the home environment, school, work, hospital, club, supermarket and others. According to Heller daily life it can be understood as “concrete repetition place of lived experience. It is a space of transformation, because that is occurring social relationships. Man participates in daily life with all aspects of his individuality, his personality “6. This makes us think that our way of being in the world is what gives us the internal organizational base and consequently tools for social interaction. The activities that individuals develop throughout his life are considered areas of occupation of to7 domain practices. The main activities são8: Activities of Daily Living (ADLs) – also known as basic activities of daily living. Relative: personal hygiene and personal care, food and clothing; Practical Activities of Daily Living (AVP) – also known as instrumental activities of daily living (IADL). Relative: care for the other, with animals, proper use of the media (telephone, computer etc.), use of public and private transport, financial management, care and health maintenance, housework, shopping etc .; Educational activities – are the teaching and learning activities (school). Relating to: the daily homework and study; Recreation Activities and Recreation – are recreational and entertainment activities; Productive Activities and Labor – activities related to the profession and represent economic character and occupational role; Body activities – are the activities related to the care of the body (physical aspects) and sports; Musical and Artistic Activities – related to expressive activities; and Cultural and Religious Activities – are related to the traditions and beliefs of a people, a community or a family.
Habits are associated with everyday life, and unique to each person (individual) and are mechanisms to get used humans to make every day required, expected or desired, efficiently. For example, the morning routine care (do toilet, coffee, read, etc.) in various task sequence is linked to routines. The habit of deficit is the extinction or the disruption of the daily routine. In young children there is a lack of own initiation habits, but during his neurodevelopment will get used to routines and habits copied or established by their caregivers. When habits and routines are absent, children do not develop at the appropriate age. Children and adolescents with absence habits consequently present losses in other cotidiano9 activities.
“Lucas wakes up at 09:30 am and will play game. Take your milk in the living room couch and pajamas, after two hours approximately, eat cookies and try to do their homework with the TV. At 12 lunch, eating very little, brush your teeth and wear the school uniform. Go to school. Returns at 18.30. Take a bath and then turn on the game and make the meals on the sofa. Then, watch TV and ends up sleeping on the couch with the TV … ”
The habits and Lucas routine is what usually happens in the daily lives of many families. Luke’s habits we consider appropriate? What would change in your habits? Are healthy habits? It is important to have a proper routine? It makes a difference in the lives of children and adolescents?
How to organize the daily activities of children and adolescents with behavioral disorders? TO-8
Establishing rules and boundaries is a need for education of any individual and means care and affection for the other. Every child and / or adolescent needs a reference and an appropriate role model. The family atmosphere should be a facilitator and continent to emotional and educational needs of our children and adolescents. The school is the second and most important institution, after the family. It is at school that learning is continuous and social relationships occur. Parents should choose and know the school when possible. Whether educators have some preparation to receive their children and communicate school commitments and any implications that a behavior disorder brings. Communication should be clear and shared between parents, brothers, uncles, grandparents, teachers and other caregivers should use the same language. The school has to establish regular contact with family and health professionals responsible for treatment. This communication is key to a favorable prognosis.
parents for advice
There are no “ready-made recipes” for dealing with children and adolescents with behavioral disorders, but some strategies and management tips may help in living and relieve the stress of family, such as:
Promote a peaceful environment with little noise and without much movement of people through the house. busy environments with many stimuli can be harmful. Avoid tense discussions and controversial issues within the home. The chaotic family functioning can intensify some symptoms.
Keep a neat, clean and organized home collaborates in the organization of the carriers. Establish a daily routine where there is participation of all family members. Do not forget that the family is an important reference for proper behavior of your child.
Planning is a task difficult to perform for the carrier of behavioral disorders, assist him as often as necessary, establishing and creating strategies to facilitate everyday tasks, step by step, guiding them to execute them in the simplest way possible. Avoid pressing down on it during its execution. It is not appropriate to use phrases like “stop doing time”, “walk fast” etc.
Encourage participation in various tasks, asking you to do small favors, like giving a message, look for objects or buy something. It is important to feel useful.
Dialogue and seek to establish a good relationship with your child. Look in the eyes and be clear in what you have to say and learn to listen to it carefully. Rules and limits should be placed very clearly and firmly but without punishment. Repeat as often as necessary rules in an objective way. Praising the progress towards good performance, behavior and other positive aspects is fundamental to self-esteem.
Avoid calling attention carrier in front of others so that he would not be embarrassed. Some labels should be avoided, as lazy, stupid, crazy, nerd etc. Think before you act to avoid losing control. Scold, beat, threaten or punish frequently, will only cause a stressful environment.
positive reinforcement and rewards may be more helpful than punishment. You must have good sense at this time that this is not the only way to set boundaries. Other forms such as dialogue, affection and teach him to reflect on his actions is very important.
Keep firmness and constancy in their purposes and not change your mind constantly. Parents need to keep a firm dialogue and aim with your children, avoid a desacate the other.
The daily routine needs to be well-structured, constant and predictable. Holders of behavioral disorders usually have impairments in their executive functioning, particularly in planning, initiative to perform tasks, make decisions and solve problems as well as other cognitive aspects, such as keeping the attention, concentration and memory.
Activities of daily living
As for personal care: establish daily schedules to wake up, brush your teeth, bathing and other hygiene; guide about clothing – some patients have difficulty in choosing the clothes, where to find it, care and their hygiene; healthy diet, with set times, sit at the table, use cutlery properly contributes to the establishment of good eating habits. Make family meals is of paramount importance, considering it a moment against its members and enable emotional exchanges.
Tip: Invite your child or teenager to help them set the table for dinner and preparing food for your interest.
As for the practical activities: teach the bearer to take care of your belongings, such as clothes, toys, school supplies and other – ask how the daily routine housekeeping your room and organization of other spaces; when there is domestic animals, you can give the task of care for the carrier, it can help you get a sense of what is “care” and have responsibilities; establish schedules for the use of computer and video games. These are activities of today and of great interest of children and adolescents, and extend and collaborate to some cognitive aspects, but must be controlled, monitored and not excessive. Aggressive content does not contribute anything. Look for more appropriate and educational games and preferably attend these games. Thus, parents will have some knowledge of content and can approach and interact in a more pleasant way. Tasks outside the home, in the community, parks, trips to the supermarket with an adult or alone when there is no risk to favor the exercise of autonomy, initiative and independence.
Tip: ask the child or adolescent perform small tasks, such as the computer (lists of the groceries), to learn to do practical activities gradually.
The implementation of school work and study are, most often, difficult to manage in the homes of people with behavioral disorders. Some tips presented here can help: establish fixed and daily schedules for assignments and study; the physical space should be quiet and little incentive – to put the carrier seated properly and keep the desk tidy, with only the necessary materials to prevent leakage; read the instructions of the lessons for the child or adolescent with difficulty, to help you keep the attention and understanding of the statements – you may need to make a summary of the content or report in the form of a story to facilitate understanding and attention; encourage reading is essential for learning. If the carrier does not have the habit of reading, take some time and read or tell stories daily. An example is to tell or read stories to the carrier 10 minutes before he lieth. Choose topics of interest. Newspapers, magazines and comic books can also be used. Reading can become a habit and the act of storytelling is a way to do something shared, favoring interpersonal relationship; use visual aids, drawings, computers, schematics, games etc. colored pens and highlighters can help them highlight what is most important to study; help the carrier in the organization of the case, sharpened pencils, notebooks and books. A tip would be to reupholster with the carrier his notebooks and books with favorite themes, customize your belongings and school supplies can motivate you to take better care of what is yours.
Tip: those with difficulties in educational activities should explore other resources that can be found on the Internet, museums and games. Example: Create a game of questions and answers that have to do with the study content.
The activities contribute to
TO-1The recreational activities, leisure, body (sports), cultural, religious, musical and artistic are necessary for anyone. In children and / or adolescents with behavioral disorders, they should be encouraged and contribute to the development of some motor, cognitive, emotional and social.
Recreation and leisure – is in recreation and leisure time in the play happens. At the time of play we can think about developing some aspects: pleasure, discovery skills, interaction and understanding of a functioning and field of reality, creativity and expressão11. The recreation and leisure facilitate learning. Parents and teachers should make possible and enjoy these moments to work compromised areas. For example: using games working motor coordination, memory, reasoning, initiative, attention and creativity. Play, build toys and games are approaching strategies with the child and / or adolescent and improve social skills. At leisure is included: walks in parks, clubs, trips to the cinema, and other events.
TO-body wellness2Atividades – encouraging sports practices is fundamental for the development and a better motor control. Other objectives are the rules, limits, energy expenditure and in the case of team sports, holders have the opportunity to learn to have team spirit, and improve interpersonal relationships.
cultural activities – to encourage children and / or adolescents to know museums, science fairs, cultural and artistic centers. historical and cultural aspects of a city, state or country favor the learning process. The display of objects, clothing experiments, historical, scientific and artistic curiosities help in memorization, comprehension and understanding of a culture and better attachment content. These activities can serve strategies to facilitate the study.
religious activities – religious aspects in the lives of children and / or adolescents with behavioral disorders can contribute to the establishment of virtues, beliefs, values, respect for others and a sense of brotherhood. Usually, religious communities promote gathering of children and adolescents who can provide healthy interpersonal relationships.
musical and artistic activities – these activities can provide children and / or adolescents with behavioral disorders possibilities of expression and other forms of communication that can improve some behavioral symptoms. Painting, drawing and theater, for example, can have a pleasing effect and promote the development of skills that arouse interest and serve as an escape valve for the improvement of self-control.
productive and work TO-14Atividades – these activities are important in adolescence. The realization of courses aimed at working activities (technical courses, computer etc.) can be an exercise to carry out professional activities. A job in this phase allows the teenager learn to take responsibility, rules and limits. In such cases, the work must be paid in accordance with the labor laws for children under 18 years.
It is important to evaluate the activities that fall for each carrier with behavioral disorders. Parents and teachers can seek help from the health professional responsible for the child and / or adolescent. The desire, skills and interests of patients should be considered in the choice of activities. The activities should be supervised and should not overwhelm the wearer. Exaggerations and excesses are not suitable.
In the school of choice for people with behavioral disorders, should be taken into consideração12: the school must meet the expectations of parents; individual differences, valuing the human aspects of relations and avoiding competitiveness and only the quantitative results; the overall development of the student and not just focus on a particular type of performance – artistic, sporting, musical etc .; the possibility of communication between family, therapist, doctor when necessary. Communication should be available for the exchange of information to define most appropriate behavior for each situation; the environment should be pleasant, quiet, with classrooms with a small number of students for the child maintain attention and concentration; various teaching resources such as computers, books, art supplies, musical instruments, games etc. that facilitate learning; trained and skilled teachers that promote enjoyable lessons for motivation of children and / or adolescents in the classroom.
Advice for teachers
The pedagogical approach adopted by the school in the teaching-learning process must use a methodology that considers the student as a unique being, with its own characteristics, abilities and unique difficulties, and that may be the main character of the learning process, being always served on their individual needs. Every carrier must have different psycho-pedagogical care, considering their behavioral difficulties can directly affect your escolar12.TO-16 performance
The school must follow certain strategies to provide effective teaching to patients with behavioral disorders: search for information on people with different behavioral disorders; the routine must be constant, predictable, with clearly established rules and setting limits on presented behavioral problems; offer support and encouragement to the student, providing support and individualized assistance when needed; praise the student when presenting appropriate behavior; avoid punishment, but if required to do them briefly, calmly, preferably away from the others. Criticizing improper behavior, but never the student; avoid the use of criticism that depreciate the student; teach the use of an agenda to guide the student of their duties; encourage the development of habits of cooperation; ask for help the student to perform small tasks inside and outside the classroom; sure if the student understood all instructions and tasks requested; talk to the student about their difficulties. Include it whenever possible in discussions, presentations and tasks, giving HIM possibilities of adequate participation and valuing it; stimulate social habits such as “say good morning”, “goodbye”, “please”, “thank you” etc .; offer jobs that are close to the practice of student life; use a variety of teaching and visual aids (slides, frame- -negro, posters, computers etc.) that facilitate the child to store, maintain attention and encourage learning. Materials such as highlighters, colored pencils, symbols and reminders can help; assist in planning activities, study student, discriminating what is important and necessary; help in the organization of school supplies and your desk; recognize their strengths and the effort expended; always encourage the study and homework daily.
Talk to children and / or adolescents as often as needed with clarity about their difficulties and is willing to help them.
Help them perform daily activities, making deals and creating rules of coexistence among family members. Encourage the development of a daily routine, guiding them from simple activities to more complex. Do not do the activities for them, or treat them as if they were not able. Believe me, they can!
Create opportunities for them to resume or learn to develop certain skills.
Help them believe they have healthy aspects and not just criticize their bad behavior.
Stimulate interaction with others, aiming at the improvement of their personal relationships.
Make them feel loved, affection is essential to their self-esteem.
Talking to parents
Understand, accept and implement some actions require a lot of patience and dedication of parents and other family members with patients with behavioral disorders. Investing in treatment is very important for a good prognosis. Try to know about the disorder and all the possibilities of treatment. The role of the family is to provide an enabling environment and continent, affection, limits, protection and receptivity. But do not forget that you also need to meet their emotional and personal needs. Ask for help when needed, we can only help others when we are in physical and emotional conditions. For example, in air emergency case, the guidance that flight attendants give is: “to drop the oxygen masks, put you first, then the children and the elderly.” This means that if I do not keep my conscience able to act in a situation with this, I have no way to help those who need it most.
TO-12 TO-13Atenção teachers!
You also have a difficult task is to teach and educate. When faced with people with behavioral disorders, this task becomes much more difficult, and need “to account” of a classroom and students with their specificities. Divide your troubles and anxieties with their coordinators and require the school to help them in solving their problems. The school has a duty to guide and take care of your teachers and seek guidance and recycling. The teacher – student with behavioral disorders – parents – health professionals should be constant.