Journal 2

European Journal of Medicine and Veterinary Sciences-Novus, 01(02), 0100010EJMVS

e-ISSN (2784-9724)

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Copyright © 2021 by Author/s and Licensed by EJMVS-NOVUS Publications Ltd., Italy. This is an open access article distributed under the Creative Commons Attribution

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Research article

Behavior Management of a Child with Attention Deficit Hyperactivity

Disorder (ADHD) in the classroom: A Case Study

Ugyen Dorji

Master of Education in inclusive Education, Royal University of Bhutan

A R T I C L E I N F O

Introduction According to Dukpa and Kamenopoulou (2018) Bhutan has signed several international legislations such as the

United Nations Convention on the Rights of the Child (1990), the Salamanca Statement (1994), and the

UNCRPD (2010) and engaged in the international movement towards the inclusion of students with disabilities.

Bhutan has also developed policies that will support an inclusive approach to education such as the National

Policy for Persons with Disabilities (Gross National Happiness Commission Secretariat (GNHCS), 2019) which

states that barriers to education shall be progressively removed and learning spaces will be accessible and safe.

Similarly, Bhutan Education Blueprint 2014-2024 emphasized on access to education as one of the key

recommendations to ensure equal opportunity for those children identified as having special educational needs

A B S T R A C T

The aim of this study was to find out how the behavior of a child with attention deficit

hyperactivity disorder (ADHD) has been managed in the classroom at Ability Bhutan Society

(ABS). The current study utilized qualitative method with single-case embedded design to

explore the behavior management of a child with ADHD in the classroom. Data was collected

through semi-structured interviews with four social workers and a mother of a child, direct

observation, participant observation, and document analysis. The qualitative data analysis was

guided by Braun and Clarke‟s framework for thematic analysis (2012). To manage the behavior of

a child with ADHD, the literature considers functional behavior assessment (FBA) and behavior

intervention plans (BIP) as an intensive interventions. After the data triangulation from different

sources of data, three main themes emerged: involvement of stakeholders, challenges, and

strategies to manage the behavior of a child with ADHD. The analysis revealed that use of daily

schedule, applied behavior analysis (ABA), and daily living skills as major strategies to be used

to manage the behavior of a child with ADHD in the classroom and at home as well. Moreover,

challenges like human resource, communication skills, behavior management, and the attitudes of

caregivers were also discovered in managing the behavior of a child with ADHD.

Recommendations on recruitment of more number of social workers were made to provide early

intervention services to children on one-on-one basis.

Keywords: Attention deficit hyperactivity disorder (ADHD), strategies, behavior, Management,

intervention plan, collaboration, challenges.

Received: 02.09.2021

Accepted: 27.10.2021

Final Version: 29.12.2021

*Corresponding Author:

Email: [email protected]

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(MoE, 2014). In 2017, The Ministry of Education in Bhutan has developed and endorsed with another policy

The Standards for Inclusive Education (MoE, 2017) which provides guidance and support for promoting

inclusion in the schools. The Bhutan Standards for Inclusive Education defines inclusive education as “the

process of valuing, accepting and supporting diversity in schools and ensuring that every child has an equal

opportunity to learn” (MoE, 2017, P. 7). The policy also outlines standards across three dimensions: Inclusive

Culture, Inclusive Policy and Inclusive Practice (MoE, 2017)

“Inclusive Education” is a relatively new endeavor in our education system and the Special Education Needs

(SEN) Program under Ministry of Education is progressively gearing towards 100% enrolment of children with

disabilities and providing quality inclusive education (MoE, 2017). In alignment with the rise in the global

prevalence rate of disability, a two-stage child disability study conducted by the Bhutan National Statistical

Bureau (2010–2011), estimates 21% of children aged 2 to 9 years have at least one disability, 19% with mild

disability and about 3% with a moderate or severe disability (National Statistics Bureau & UNICEF 2012). The

same study revealed cognition, behavior and communication as the most prevalent areas of disability. Since the

primary challenge children on the ADHD experience are in the above-mentioned areas Ministry of Education in

Bhutan have tried to enroll each and every child into the education system, many remain to be identified and

many still need further support even once enrolled in schools (MoE, 2017).

Literature Review The aim of the study was to develop an in-depth understanding of how behavior of a child with ADHD is

managed in the classroom and to know more about the case, the information gathered from the literature are

presented in the following sequence: definition of the case followed by symptoms and its causes, challenges and

some of the intervention strategies. According to Oke et al. (2019) one of the most common neuro

developmental problems affecting behavior of children all over the world is attention deficit hyperactivity

disorder (ADHD). “Attention deficit hyperactivity disorder (ADHD) is one of the most common neuro

developmental disorders with childhood onset and is characterized by pervasive and impairing symptoms of

inattention, hyperactivity and impulsivity that occur before the age of seven” (Lola et al., 2019, p. 1). American

Psychiatric Association (2013 as cited in Kortekaas, 2018) the current (5th) edition of the Diagnostic and

Statistical Manual of Mental Disorders (DSM) distinguishes between three presentations of ADHD,

representing the predominant symptom pattern: the predominantly inattentive presentation, the predominantly

hyperactive-impulsive presentation and the combined presentation. Appearances of the inattention component

of ADHD can include daydreaming, distractibility, and difficulty focusing on a single task, whereas the

hyperactivity component can be expressed as fidgeting, excessive talking, and restlessness (Biederman, 2005 as

cited in Ringer et al., 2019). Moreover, ADHD is associated with psychiatric and developmental disorders such

as Oppositional Defiant Disorder, Conduct Disorder, Anxiety Disorders, Depressive Disorders, and Speech and

Learning Disorders (Tong et al., 2016).Therefore, the behavioral disturbance of children with ADHD

significantly impairs their social, academic and occupational functioning.

Symptoms and Causes of ADHD

Borrill (2000) acknowledges the kind of symptoms professionals look for in diagnosing ADHD as “difficulty

following instructions or completing tasks, easily distracted and forgetful, often does not listen and is restless,

cannot sit still and talk too much, runs about and interrupts, blurts out answers and finds difficulty in waiting or

taking turns.” “It is still unclear what the direct and immediate causes of ADHD are, although scientific and

technological advances within the field of neurological imaging techniques and genetics promise to clarify this

issue in the near future” (Spellings et al., 2008, p. 2; Thapar et al., 2012). Having a rare copy number of

variants, some gene variants, extreme early adversity, pre and postnatal exposure to lead and low birth weight

or prematurity have been most consistently found as risk factors (Thapar et al., 2012). Moreover, there is a need

to consider the possibility of parents and siblings being affected and how this might impact on engagement with

families, influence interventions and require integration with adult services (Thapar et al., 2012). Similarly,

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most researchers‟ suspect that the cause of ADHD is genetic or biological influenced by multiple genes, non-

inherited factors and their interplay (Spellings et al., 2008; Thapar et al., 2011).However, none are yet known to

be definite causal of ADHD (Thapar et al., 2012).This means that any given risk factor will only be observed

during a proportion of cases and can even be found in those that are unaffected. According to Salend and

Rohena, (2003 as cited in Gehrling, 2006, p. 44) inattentiveness associated with ADHD can be affected by

biological factors, such as temperament and development, and environmental factors like infections, diseases,

birth trauma and lead poisoning. The manifestation and prevalence of ADHD are also associated with various

no inherited factors such as pre- and perinatal factors, environmental toxins, dietary factors, and psychosocial

adversity (Ringer et al 2019) but these factors have been conceptualized as nonspecific triggers of an

underlying predisposition to ADHD (Biederman, 2005 as cited in Ringer et al., 2019).

Methodology According to Ahmed et al. (2016) there are three main methods currently accepted for conducting research:

quantitative, qualitative and mixed methods. For this study, a qualitative methodology has been used as it

focuses on process, meanings and uses techniques such as in-depth interviews, focus groups and participant

observation (Sale et al., 2002 as cited in Ahmed et al., 2016, p. 33). Moreover, “the principal advantage of the

qualitative method is its ability to generate very rich and deep data” (Ahmed et al., 2016, p. 34).

Yin (2014) presents four basic types of designs for case studies: single-case holistic designs, single-case

embedded designs, multiple-case holistic designs and multiple-case embedded designs. In this study a single-

case embedded design is used because it contains more than one sub-unit of analysis and moreover it is used in

the field of qualitative methodology (Yin, 2014). Simons (2009 as cited in Rebolj, 2013) defines case study as

an in-depth exploration from multiple perspectives of the complexity and uniqueness of a particular project,

policy, institution, program or system in a real life. Similarly, Baxter and Jack (2008 as cited in Decristofaro,

2016) believe qualitative case study research to assist in investigation of phenomenon within its context using

different sources of data and ensures that the research question are not being explored through one perspective,

but rather a variety of perspectives to ensure multiple aspects of the research topic are experienced and

understood. Therefore, from this kind of approach, expectation to receive a rich information is high that can be

helpful to add to the existing literature on inclusion of students with ADHD in inclusive classrooms.

Data sources and data collection methods As McLaughlin (2020) states:

Data collection is the systematic approach to gather and measure information from variety of sources to get a

complete and accurate picture of an area of interest and it should be planned in advance to enable a person to

answer relevant questions, evaluate outcomes and make predictions about future probabilities and trends.

Ajayi (2017) further explains data collection as a process aimed for collecting and getting solution to the

problem at hand which is always specific to researchers‟ need. Bazeley (2004 as cited in Ahmed et al., 2016, p.

40) argues that data collected from multiple sources could complement each other to offer a more

comprehensive picture for the study. For this reason, Yin (2014, p. 107) adopts multiple data collection

techniques, such as interviews, observation, documentation, archival records and physical artifacts. In this

research, interviews, observations and documentation are used to collect both open and closed ended data as

required. Therefore, how each of the data sources will be used is explained as follows:

Interview: Ajayi (2017, p. 4) defines “interview as a technique that is primarily used to gain an

understanding of the underlying reasons and motivations for people‟s attitudes, preferences or behavior

and it can be undertaken on a personal one-to-one basis or in a group.” Similarly, an interview has been

defined by Sheppard (2004 as cited in Ahmed et al., 2016, p. 43) as a conversation with a purpose that

allows the researcher to gain insight into the interviewees‟ account of their experience, perceptions and

circumstances in relation to the specific research questions the interview is addressing. With this

information, data collection through interview for this study is done with one of the parents of a child

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(see Appendix A) and four social workers from the centre (see Appendix B). The participants‟ code

were used as SW1 (indicating social worker 1) – SW4 and a parent (mother). As per the participants‟

convenience, the semi-structured interview was carried out during break hours or after last session of

the day. As per Kabir (2018, p. 205) “the interviewer can not only record the statements the interviewee

speaks but can observe the body language, expressions and other reactions to the questions too which

will enable the interviewer to draw conclusion easily.” In this study also, to keep the proper records of

the information collected from the interviewee, researcher has used devices like recorder and mobile

phone so that it is easy for the recorder to trace the important points shared by participants. . Interviews

took approximately 17 minutes. All interviews were audio-recorded, transcribed verbatim (see

Appendix C), and before the analysis, transcripts were provided to the respective participant for

member checking (Creswell, 2014).

Observation: Ajayi (2017, p. 4) defines “observation as a technique for obtaining information,

measuring variables or gathering of data necessary for measuring the variable under investigation and

watching or noting of phenomena as they occur in nature with regards to cause and effect relation.”

Yin (2014) reveals types of observations as direct observation and participant observation. For this

study, both observation techniques were used in natural settings to make the participants comfortable.

Observations were done for the social workers teaching a lesson in the classroom mainly focusing on

the strategies and techniques used to help a child in the classroom (see Appendix D). Another

observation was focused on child‟s behavior and interaction in different settings: in the play field,

classroom, rest room, break time and playing with the peers (see Appendix E). Classroom lesson

observation was done six times a week and researcher was also involved in teaching a lesson. To

maintain the records of the observations made in different settings, observation tool was developed like:

observation form, event recording, checklist and rating scale (see Appendix F).

Documentation: Yin (2014, p. 107) explains “documents as useful even though they are not always

accurate and may not be lacking in bias but documents must be carefully used and should not be

accepted as literal recordings of events that have taken place.” Another source for data collection

methods for this research study was through documentation. Firstly, the bio-data of the child

maintained by the organization was referred to get the clear background information of the child and

also medical history of a child‟s diagnosis. Individualized Education Plan (IEP) of the child was used to

collect information on intervention strategies planned as per the diagnosis; strengths and weaknesses

(see Appendix G).

Validity: As a novice researcher, to ensure enough detail is provided so that readers assess the

validity of this case study research, triangulation of data sources technique was followed to

collect data from different sources and explore it from multiple perspectives. Knafl and

Breitmayer (1989 as cited in Baxter & Jack, 2015) also support the collection and comparison

of this data enhances data quality based on the principles of idea convergence and the

confirmation of findings. Integrating a process of member checking was another technique to

assess the validity after collecting and analyzing the data. In this technique, the data

interpretations were shared with the participants and the participants had the opportunity to

discuss and clarify the interpretation and also contribute new or additional perspectives on the

issue under the study.

Reliability: As Yin (2014, p. 48) assures: Objective behind of reliability is to be sure that if later

researchers follows the same procedures as described by an earlier researcher and conducts the same

case study over again, the later investigator should arrive at the same findings and conclusion.

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Therefore, to document the research procedures and make the readers believe in reliability of the

research, all the documents and procedures followed in the case were maintained through database and

use of case study protocol.

Ethical considerations: The main intent of the research was to find out the behavior manage of a

student with ADHD in the classroom. For that the ethical guidelines for Educational Research, adopted

by Paro College of Education (PCE) was followed to ensure that the study does not breach any of the

research ethics (see Appendix H). According to Widdowson (2011, p. 32) “research participants need to

be free to make the decision as to whether to participate or not in the research from a position of

informed consent”. “It is critical for a qualitative case study researcher to follow all ethical review

procedures regarding research participants and researchers are required to minimize risks and to inform

participants about risks that maybe involved” (Hancock & Algozzine, 2006 as cited in Decristofaro,

2016, p. 33). Prior to the interview, research participants were provided with letters of informed consent

(see Appendix I) in which they will be required to read and sign if they agree to participate in the

interview and observation sessions and provide documents required. The consent letter provides an

overview of the study, addresses ethical implications, and specify expectations of participation (see

Appendix J). Widdowson (2011, p. 32) shares “about confidentiality as an issue in case studies, as large

amounts of detail about the client's life may be published, thus compromising the client's anonymity.”

Therefore, informants were provided with information regarding the nature of confidentiality in an

effort to ensure their comfort and willingness to partake in the data collection process. Moreover,

informants were invited to read and comment on the finished case study, provide opportunity to remove

certain information and obtain consent for the case to be published.

Data analysis

According to Yin (2014) there are five analytic techniques to analyze the data, such as: pattern matching,

explanation building, time-series analysis, logic models and cross-case synthesis. In this case study research

pattern matching and thematic analysis tool were used because pattern matching compares an empirically based

pattern-that is, one based on the findings from our case study- with a predicted one made before we collected

our data (Yin, 2014) and Labra et al. (2020) explains thematic analysis as flexible, which offers rigorous

approach to subjective experience that is highly applicable to research in social work as a means of promoting

social justice and combating inequalities. Similarly, Braun and Clarke (2012) define thematic analysis as a

method for systematically identifying, organizing, and offering insight into, patterns of meaning across a

dataset. Thematic analysis involves six phases (Labra et al., 2020): familiarization with collected data;

generating initial codes; searching for themes; reviewing themes; defining and naming themes; presenting and

discussing results. In this case study research all the steps were followed to analyze the data. The textual data

were read and re-read (transcripts and responses to interviews) and listened to the recorded audios on daily

basis and maintained notes. Color codes were used for different interpretation about the data content from

different sources of data collected because as per Braun and Clarke (2012) codes can provide a pithy summary

of a portion of data, or describe the content of the data. The thematic analysis identified the common themes

and subthemes, and the two other friends performed an interceder reliability check for five full transcripts,

which were coded independently. Involved in reviewing the coded data to identify areas of similarity and

overlap between codes and identified codes that seem to share some unifying feature together. After that themes

generated and name for each coherent and meaningful pattern of structures.

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Results and Interpretations

Involvement of stakeholders: Under the theme involvement of stakeholders the two subthemes

emerged: Involvement of parents, and involvement of overseas experts. Each of the subthemes are

explained as follows:

Involvement of parents: All participants were asked to share how they engaged parents in managing

the behavior of a child with ADHD. Most of them shared having a good collaboration with parents in

terms of helping a child manage behavior. For example, Social Worker 1 (SW1) explained, “we inform

them how their children do in the centre, for instance your child shows this behavior, and your child

don‟t know this one, need to use devices”. Similarly, another social worker reported, “first time as soon

as the child comes to the centre we used to ask to the parents‟ consent and ask what type of behaviors a

child exhibits” (SW2).

Further it was also evident that they share intervention strategies to parents when SW4 reported “what

we teach in the class we used to share with the parents after the class hour and inform them to follow

similar activity at home”. Furthermore, the mother agreed that it was an advantage of bringing the child

at the centre for early intervention when she said “she is hyper at home but after bringing here in ABS

there is little difference”. Interestingly, there was also discussion about proper diet to be provided to the

child when one of the social worker reported, “we used to inform parents to minimize the sugar intake

and not to give junk foods especially noodles and juice” (SW3). This discussion suggests the need for

involvement of parents to support the needs of the child with ADHD.

Involvement of overseas experts: The centre do not provide intervention services on Friday, rather

they attend online training involving overseas experts from Australian Catholic University (ACU) as

professional development program. It was evident that they shared challenges and problems with the

experts and learn certain strategies to apply with children at the centre when one of the Social Worker

(SW1) explained, “we share all our doubts and problem about the children and they give us ideas how

to manage them in the centre”. Similarly, another Social Worker reported, “we get support from ACU

and long term volunteer Moira in terms of strategies to deal with children and we do apply with our

children” (SW3).

Further it is known that the parents of children with disabilities were also trained as a mother said “first

I have asked the strategies we have used are right or wrong and then they said to use picture

communication cues”. Therefore, it was obvious that there is involvement of overseas experts and

receives techniques to manage the behavior of a child with ADHD both for social workers as well as

parents.

Challenges

Under this theme the following subthemes emerged: Behavior management, communication skills, attitudes of

the caregivers, and lack of resources. Each of the subthemes is explained as follows:

Behavior management: Behavior management from this finding was one of the challenges faced by

children with ADHD in the centre and it was explicitly explained by one of the Social Worker, “If we

allocate a place for them, they will not listen because they like open space and movement free to move

up down….” (SW2). Further, the social workers expressed their helplessness when the strategies did

not work. For example, another Social Worker explained, “we feel hopeless sometimes when we are not

able to control their behavior even after applying various strategies” (SW4). Additionally, the mother of

the child also felt the same where she has to keep things in order as per the child‟s like, “she used to get

angry during play when her toys get distorted and she used to stay moody and cannot do other

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activities”. Furthermore, the researcher also observed the child having some behavior management

issues especially during group activity in the classroom.

Communication Skills: Communication skill was another challenge when managing a child with

ADHD in the classroom. As observed, a child with ADHD lacks communication skills especially in

terms of eye-contact and verbal speech. For example, one of the Social Worker reported that there was

“no eye contact that‟s why cannot teach what we wanted to teach…” (SW3). Similarly, the mother of

the child also reported that “she don‟t have eye contact and speech”. In observing the child it was

evident that the child was not giving any eye-contact and not speaking when teacher communicates

during activity time in the class. However, the child held teachers or mother‟s hand to communicate and

ask something as indicated by the mother when she said “when she needs water she used to drag me and

pushes my hand to bring”. The centre has a volunteer speech pathologist that provides therapy services

once a week to the child and it is yet to see the results of the speech therapy with the child in terms of

speech development.

Positive attitudes of the caregivers: To support children with disabilities, the caregivers should have

positive attitudes which include passion and patience. For instance, during personal communication

with parents of children with disabilities at the centre, one of the parents agreed that, “If we want to

teach a child with a disability, one should have a passion” (Father, personal communication, 10th

August, 2021). Similarly, the social workers expressed working at a slower pace and repeatedly as a

social worker said, “teaching repeatedly and slowly to make them understand and spare them extra

time, extra guide” (SW2). Moreover, to support children with disabilities one should have patience to

manage children and show interest in supporting them which was stressed by SW3, “we need interest

and have patience”. Furthermore, such attitudes were also adopted by the mother of the child when she

said, “I have repeated the activity and now she had become used to it with the routine”. Therefore, it

was observed that all the participants agreed exhibiting positive attitudes in managing and supporting

the behaviors of children in the classroom as well as at home.

Lack of Human Resources: Lack of human resources was one of the key challenges in the centre.

Most of the children coming to the centre were severe and they need one-on-one support but due to lack

of social workers and volunteers they were not able to provide services as required. It was evident that

the social worker had a tough time managing children with diverse disabilities in the classroom.

Though they have one volunteer in each room to support them they face problem when there are more

number of children in the classroom.

It is noteworthy that they were relieved with few students from Paro College of Education for school

professional experience at the centre and this was acknowledged by one of the Social Worker, “we

would like to thank friends who have come from Paro College and helped us in teaching children which

made our work easier” (SW1). Therefore, resources are human or material has to be in place to support

a child with ADHD in managing their behavior.

However, in terms of assistive devices and other materials, the centre did not have much of an issue.

The parents in order to engage children at home, the resources required were modified and improvised

with the knowledge provided by the centre. For example one of the Social Worker reported that the

parents were informed how to, “use resources which are available at home like child‟s toys, plates,

cloths, picture books….”(SW1). Interestingly, mother of a child used „Google‟ for information on how

to manage her child‟s behavior at home when she mentioned, “initially I got from Google”.

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Strategies

Under this theme the subthemes emerged are: Daily Schedule, Applied Behavior Analysis, and Daily Living

Skills. Each of the subthemes was explained as follows:

Daily Schedule: It was generally felt that using of schedules daily for children with ADHD helped the

participant‟s structure activities during the school sessions and at home. Further, having daily schedules

prevented the child from exhibiting maladaptive behaviors as one of the Social Worker explained that,

“If they are engaged through activities from morning till evening then they will not display unexpected

behaviors….” (SW1). In a similar way, to engage children through daily schedule, task should be on

continuous process as informed by Social Worker when it was reported that, “We need to prepare

continuous task otherwise….” (SW4). It is worth noting here that the mother tried using daily schedules

at home with her daughter though it was not structured like in the centre when she said, “I made routine

for her starting from morning and set activities based on routine”. Therefore, scheduling is one of the

strategies to manage the behavior of a child with ADHD both at centre and at home.

Applied Behavior Analysis (ABA): Observations has been made on participants using applied

behavior analysis (ABA) strategies such as modeling, turn taking, rewards, reinforcements, task

analysis, time-out, and direct instructions at the centre to manage the behavior of children with

disabilities. It was evident that to calm sensory issues and manage the behavior of a child with ADHD

in the classroom, the social workers used weighted jacket. For example, SW1 shared, “We use weighted

jacket which helps in controlling movement”. Further, it was highlighted that strategies such as

modeling, task analysis and reinforcement were used to ensure that the child complete the given task

when one of the social worker reported that, “we use modeling, positive and negative rewards, „first and

then‟ and tokens” (SW3). In addition, it was strongly felt that a child with ADHD requires clear and

short instructions for each activity completion followed by time out session which highlighted by one of

the social worker who asserted, “we use direct instruction with short sentences and time out session”

(SW4). Initially the mother either consoled or ignored the child‟s behavioral issues and tantrums but

later she also started to adopt some of the ABA strategy in making the child to complete the task and

collect the materials from the floor to learn in order to about modeling and self-management. Therefore,

it was evident through observation and the interview that the social workers and parents used ABA

strategies to manage the behavior of a child with ADHD.

Daily Living Skills (DLS): Daily living skills were another strategy that the centre emphasized as an

independent skills training for the children in the centre. It included basic living skills like brushing

teeth, washing hands, arranging their toys, and feeding themselves. Similarly, the parents were

instructed to continue these skills and practice at home. A social worker shared that, “during free time

take them for walk, make them to collect their toys and put back in the container, make them to arrange

their plates, fold their cloths and put in the cupboard….” (SW1). It was evident that the social workers

potty trained the children and also from the interview the social worker emphasized it when she said,

“we train them to go for toilet independently” (SW4). Further, the mother of a child also reported about

implementing such skills at home and that her child was persistent and never giving up. For instance the

mother said, “I gave her new slipper this morning and she was trying to adjust her legs until it fits her

full legs inside it”. Therefore, it was confirmed that daily living skills (DLS) was one of the strategy

applied by participants to manage the behavior of a child with ADHD.

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Conclusion There are several policies and guidelines to support children with disabilities within Bhutan which includes:

national policy for person with disabilities (2019), standards for inclusive education (2017), and guidelines on

assessment, examination, promotion and transition for students with disabilities (2018). In addition, it was

estimated about 21% of children aged 2 to 9 years have at least one disability in Bhutan (2012). Therefore, the

context of the research study was selected from one of the civil society organization (CSO) which provides

early intervention services to children with disabilities. Information on use of functional behavior analysis

(FBA) and planning of the behavior intervention plan (BIP) was also emerged from the literature review as

main intervention strategies to manage the behavior of children with ADHD. Behavior Management of a child

with Attention Deficit Hyperactivity Disorder (ADHD) in the classroom was the main research topic and

intervention strategies were also discussed from different literature but three main strategies worked well to

manage the behavior of a child with ADHD: applying applied behavior analysis (ABA) techniques, following

daily schedules and teaching daily living skills (DLS). Each child with ADHD comes with their own skills and

behavior across a wide continuum of impairments. Intervention strategies must be individualized based on the

function of particular behavior, age level of the child and the structural constraints of the classroom. Moreover,

daily schedules has been focused more to manage the behavior of a child with ADHD. Involvement of

stakeholders was one of the theme emerged after data triangulation and it was discussed as one of the important

indicator to use while managing and supporting children with ADHD. Similarly, this aligns with one of the

subthemes „attitudes of caregivers‟ towards children with disabilities. When there are strong collaborations

among different individuals and agencies, appropriate services to children with disabilities at the right time can

be provided. However, centre lacks human resources especially the social workers and if they can solve this

problem, then other challenges like behavior management and communication skills of children with disabilities

can be managed well. Hence, the interventions and modifications that are essential for the academic

achievement of one child with ADHD may be entirely different for another. Consequently, the social workers

need to pick and choose appropriate strategies in order to meet the individual needs of their children.

In summary, this research study concluded with the evident that the familiarity of these techniques has been

shown to be beneficial in the management of children with ADHD in the classroom and improvements were

realized in inattention behavior and hyperactivity. Similarly, the results showed an impressive decrease in

inappropriate classroom behaviors of a child with ADHD. Therefore, children with ADHD require service

providers best efforts and instruction to manage their behavior in the classroom.

References 1. Ability Bhutan Society. (2018). Handbook for families and caregivers of children with and without

disabilities. Kuensel Corporation Ltd.

2. Ability Bhutan Society. (2020). ABS Annual Report 2020. Rainbow Prints

3. Adams, D., Harris, A., & Jones, M. S. (2016). Teacher-Parent collaboration for an Inclusive classroom”

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Appendices

Appendix A: Interview Questions for mother of a child

1. How is your child doing at home?

2. What are some of the inattention behaviors your child display at home?

3. How do you overcome those behaviors at home?

4. Would you like to share with me some of the strategies you follow to manage his/her

inattention behavior at home?

5. How did you get these strategies?

6. How do you collaborate with school in terms of managing inattention behavior of your child?

7. Can you share some strategies that you received from the school?

8. What role did you play during IEP development of your child in terms of behavior management?

9. Can you explain the changes in the behavior of your child after applying various strategies?

10. Is there any strategies that best work for your child to manage his/her inattention behavior at

home? Why do you think so?

11. Can you share some of the strengths of your child?

12. How did you use their strengths to manage their inattention behavior at home?

13. Would you like to share any other information besides what we have discussed?

Appendix B: Interview Questions for Social Workers

1. Please tell me about your professional background.

2. How long have you been teaching a child with ADHD?

3. What are your experiences of teaching a child with ADHD?

4. Would you like to tell me some of the challenges you faced when dealing a child with ADHD?

5. What are some of the behavior issues a child with ADHD display in the classroom?

6. Can you share some inattention behavior of a child with ADHD in your class?

7. How do you overcome those inattention behaviors?

8. What strategies do you follow to manage inattention behavior?

9. In what way do these strategies work in managing the inattention behavior of a child?

10. How do you collaborate with parents on some strategies that they can follow at home?

11. Can you share how you integrate the strategies followed at home with strategies you follow in

the school?

12. Would you like to share with me some strategies that are reflected in child‟s IEP?

13. Can you tell me which strategies work best for a child with ADHD to manage his/her

inattention behavior in the class?

14. Please share some strengths of a child with ADHD in your class?

15. How did you use their strengths to overcome inattention behavior of a child in the class?

16. Would you like to share any other information besides what we have discussed?

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Appendix C: Interview Transcription

Appendix D: Direct Observation Form

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Appendix E: Child Observation Journal

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Appendix F: Behavior Observation Check list

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Appendix G: Child‟s IEP Form

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Appendix H: Research Ethics

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Appendix I: Consent Form

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Appendix J: Participants Information Form

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