Impulsivity, acting before thinking, is another aspect of behavior that some preterm children have difficulty with. Most of you would have heard of, or have experience with, attention deficit hyperactivity disorder (ADHD); impulsivity is a common difficulty experienced by children with attentional behavioral difficulties, including many preterm children.

When attempting to intervene or accommodate for a students’ difficulties in the classroom, whether it is memory, attention, or executive functions, it is important to consider the classroom culture as well as teaching style. Ideas that will benefit more students have a better chance of success.

Children who are impulsive often show:

• A lack of understanding of cause and effect, i.e. they can explain the rules but have difficulty internalizing them and putting them into practice
• Difficulty delaying gratification
• Have a poor ability to regulate their behavior
• Don’t inhibit behaviour, they “act without thinking”

Strategies for Impulsive Behavior at school

Under certain circumstances the teacher should consider allowing the student to think “out loud” when they are problem-solving. The teacher may gain valuable insight into their reasoning style and the process will slow them down before they respond and act impulsively. The teacher can help restructure inaccurate perceptions.

The technique of “Stop- Think – Talk – Do” is used in many cognitive behavioral therapy interventions for students with attentional and impulsivity problems. This technique teaches the student to “stop” before acting impulsively, “think” about the cause-and-effect relationships of their intended behavior, “say” or verbalise to themselves or others what they will do, and “do” the chosen behavior.

Encourage thoughtful responding and decrease impulsivity by waiting 10-15 seconds before taking answers and during whole group instruction. Asking for feedback and answers straight away, as well as responding to the first few students who raise their hands, can increase impulsive behavior, it may also discourage the student because they are not able to organize and verbalise their thoughts as efficiently as other students.

Help the student identify a “support network” of peers and adults that can help give them hints about when to slow down. Teaching and practicing some of the above techniques can be helpful.

Consequences and reinforcement should be used as soon as possible after a given behavior so the student can easily connect the reward or punishment with the behavior. He may benefit from a demonstration of more appropriate behavior. Consistent consequences need to be enforced when the child’s behavior is inappropriate.

It is important to pair verbal praise with a reward. This will facilitate “weaning” from a concrete reward structure to an internalized system. Encourage the student to also write or say self-affirmations. A simple nod, wink, smile, or touch on the shoulder can carry tremendous recognition power.

Students with attentional problems sometimes respond poorly to institution wide or classroom behavioral systems. Although the student will be responsible for maintaining the classroom rules an individualized program should be considered. The student will benefit from an individualized approach, where the target behaviors are specifically identified and rewards and consequences are given immediately.

Rewards and praise should be given on a regular basis and are likely to change the attentional problem the most effectively. The “point system” is often an effective one. To reiterate, delayed feedback or inconsistent, variable feedback is problematic, in that the student may have difficulty in correlating delay and gratification.

Students are the best source of identifying their own rewards.

Instead of confronting the student continually on behaviors that are inappropriate, point out the alternative choices that are available. This will make the expectations clearer to them and avoid the negativity inherent in what they would perceive as criticism.

Some students respond to a prearranged cueing system with the teacher. In this system, the teacher gives a visual signal (touching the ear) or verbal phrase (“remember, I’m looking for good listeners”) when a targeted inappropriate behavior occurs. The cue can remind the student to correct behavior without direct confrontation or loss of self-esteem. It can involve the classroom teacher or any support personnel available to the student.

It may be necessary to supervise children in potentially dangerous situations. Although he may be aware that his actions are wrong or dangerous, he may not be able to stop himself from following through.

Referral to Clinical Psychologists to assist with behavior management

Referral to Clinical Psychologist to assist with behavior management. (Online links to clinical and neuropsychologists will be available soon at preemiehelp.com)