Disabilities, Modalities, and Activity Adaptations Assignment Paper

Faland Jeanty
Professor Sara Tosado
LEI 3703
11/23/2014
Disabilities, Modalities, and Activity Adaptations Assignment Paper

Disabilities, Modalities, and Activity Adaptations Assignment Paper

ADHD also known as attention deficit/ hyperactivity disorder is a cognitive impairment that
is commonly developed in the childhood stage. The symptoms often begins in childhood and
continues throughout adulthood. Although unknown to scientist the causes of ADHD, studies has
suggest that a combination of factors has contributed to the development of ADHD. Genetic,
brain injuries, environmental, and nutrition are believed to be the factors of this disorder.
According to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders (DSM-5),
Children must have at least six symptoms from either (or both) the inattention group of criteria
and the hyperactivity and impulsivity criteria, while older adolescents and adults (over age 17
years) must present with five. (American Psychiatric Assosciation, 2013). ADHD is divided into
three subtypes: predominantly hyperactive-impulsive, predominantly inattentive, and combined
hyperactive-impulsive and inattentive. In the hyperactive-impulsive type the child may often
show at least six symptoms such as fidgeting, talking nonstop, have trouble doing quiet tasks,
touching and getting into everything, constantly running/jumping/climbing place to place,
interrupting conversations or speaking out of turn, etc. In the inattentive type, children are less
likely to act out. In contrast, they usually can sit quietly but are not able to focus and pay
attention to what they are doing or what is being said. Consequently, parents and teachers often
overlook these symptoms and may not notice that the child has ADHD. The most common type
of ADHD is the combined hyperactive-impulsive and inattentive type, which is simply six or
more of each of the subtypes joined together. All things considered, a child with ADHD must
shows these symptoms and it should be more severe than normal for children of that age.
To begin with, the prevalence of this disorder for children in American is relatively high.
According to the DSM-V about 5% of children are diagnose with ADHD. An increase from 2003
through 2011 went from 7.8% to 11%. Studies has shown that boys (13.2%) were more likely to

Disabilities, Modalities, and Activity Adaptations Assignment Paper

be diagnosed with the disorder than girls (5.6%) and the average age of ADHD onset was about 7
years of age. (Centers for Disease Control and Prevention, 2014).
To continue, it is evident that having ADHD can impair most of life domains such as
emotional, cognitive, and social. They are usually at a greater risks for a longer negative outcome
like academic difficulties, social skills problems, employment attainment and much more. As a
result, all aspects of life is being impacted. As the child gets older, the way the disorder impacts
changes upon them and their families. If a child with ADHD has one or more comorbid disorder
it can be even more difficult to control all aspects of life.
Moving along, recent evidence suggest about half of all individuals who have ADHD suffer
from a secondary condition. In the emotional domain people with ADHD has also developed
depression and anxiety. These secondary conditions occurs because they are caused by the
frustration of dealing with the symptoms of ADHD. Another domain that may be effected from
ADHD is cognitive impairment like learning disabilities. Approximately 20 to 30 percent of
children with ADHD develop a learning disability which render them the inability to achieve
their appropriate intellectual level. Additionally unlike secondary conditions that can be resolve,
comorbid disorders which means a disease or other pathological process that occurs
simultaneously with another, usually does not go away on its own. It requires its own specific
treatment.
Next, dealing with an individual with ADHD can be challenging. It is important to
understand the needs and strength of the individual. With ADHD, everyone is different so what
might work for one, may not work for another person. Depending on the type of ADHD a person
may possess, their needs and strengths varies. Since most of the time a child has the combined
type of ADHD it is essential to know their needs. Usually giving that child clear instructions,

Disabilities, Modalities, and Activity Adaptations Assignment Paper

downtime, and refocus techniques can have a significant outcome. Knowing their strengths is
also vital. Often times their strengths are unnoticed because of their behavior problems. Athlete
ability, creativity, leadership, and spatial intelligence are found with people with ADHD. In
recreational therapy services, all of these strength could definitely be beneficial to them. In the
Annual in Therapeutic Recreation journal article a study was done to see if there was significant
differences between 20 college students with Attention Deficit Disorder (ADD) and 20 peers
without ADD on: (a) sensation seeking; (b) associated behavioral factors; and (c) high risk
sensation laden recreational participation and interests. According to the study, it is suggested
that professionals should be promoting activities with higher "positive" sensation seeking
qualities than may be presently offered. Although the need for structure and schedules was
previously believed to be essential for individuals with ADD, offering a more flexible and
creative environment may be more important (Cramond, 1994). (Malkin, 2002). Therefore in
therapeutic recreation, these types of intervention should be considered when developing and
implementing programs.
Moreover, in recreational therapy there are different types of modalities that are provided for
individuals with ADHD. Common therapeutic recreation modalities for ADHD would be leisure
education, values clarification, self-esteem programs, social skill programs, community
reintegration, arts and crafts and much more. Leisure education focuses on the issues related to
leisure awareness, leisure resources, social skills, and activity skills. Generally, the goal of
leisure education services is to help clients understand the importance of leisure and learn ways
to participate successfully in leisure. (Terry Robertson, Terry long, 2008, p. 68). In the values
clarification modality the client goals are to identify their values, examine their personal
behaviors, choices and actions. Three progressive categories of clarification process are choosing

Disabilities, Modalities, and Activity Adaptations Assignment Paper

freely what values are important, cherishing those chosen values, and acting on those choices.
The next important modality for ADHD would be self-esteem programs. In self-esteem
interventions the purpose is to provide the opportunity for success, thus enhancing self-esteem.
In ADHD social skill programs are vital because communication, problem solving, relationships
skills are established. Community reintegration also known as community reentry is to assist
individuals to adjustment to home and community. Arts and crafts modality is used to help
clients with self-expression, leisure skill development, self-efficacy, and personal achievements.
By the same token, individuals with ADHD usually have complication with social
interactions. This is because their hyperactivity, impulsivity, and inattention behavior makes it
difficult to socialize. As a result negative outcomes cause emotional pain and suffering.
Likewise, they usually have problems communicating their issues and building relationships,
therefore intervention for fostering those skills are essential. Social skill is any skill that
facilitates interaction and communication with others. Interpersonal skills also known as people
or communication skills are skills that a person uses to interact with others. They include
persuasion and active listening. This modality would be important for someone with ADHD
because it can help alleviate much of the conflict and blame. With this modality, it will help the
individual learn strategies to become as proficient as possible.
When assessing a client with ADHD it is important to note their behaviors and attitudes.
Assessment is the process of determining current level of functioning. Observing how the client
interacts with peers in different settings can help to develop a plan. With an ADHD client, it may
be that they have trouble listening and staying focus. So assessing behaviors, performing
interviews, and observing would be appropriate to create a social skill intervention. Next step
would be planning. Usually every client have their own individualized program plan or IPP. The

Disabilities, Modalities, and Activity Adaptations Assignment Paper

IPP is a statement of the clients strength, limitations, goals, and objectives. In planning, the goal
would be to successfully have the client participate with their peers in activities, share, and build
teamwork. After planning, implementation would be the next step. The facilitation techniques
that would be necessary when implementing social skills intervention is briefing, leading, and
debriefing. In detail, briefing involves informing the client of what is about to happen, behavioral
expectations, and established goals related to the activity. Leading ensures that the event taking
place is related to the targeted goals. Debriefing is processing and reviewing skillful questioning
of a client to enhance understanding, learning, or insight. All three stages can ensure accurate
implementation. The final step of the APIE process of social skills intervention would be
evaluation. Evaluation is the process of determining the effectiveness of the clients goals. In a
client evaluation, summative evaluation which is documenting the outcomes of a specific
treatment is important based on the social skill modality, because at the end of the program or
activity the therapist can evaluate what worked or didnt work for the client. Depending on the
client and program the therapist can decide if formative evaluation is necessary.
Furthermore, there are many specific activities that could be done to fulfill the overall
purpose of the social skill modality. Games and activities like: What is it? Musical chairs,
Outdoor group exercise, Getting to Know You, and Bingo are all games that is intended to
promote social skills. What is it? Is a game that promotes socialization in a group. The objective
is to get everyone to communicate with each other so they can figure out the items that are in the
box. (Sharon Lewis, Keyhealthcare 2009). This game stimulates sharing of ideas among the
group. Musical chairs is another great social skill activity because the client is interacting with
the people around them. The advantage of the game is movement, since often times the client
have trouble staying still for long periods of time. Outdoor group exercise like hiking and biking

Disabilities, Modalities, and Activity Adaptations Assignment Paper

with a group will keep the high energize child moving and participating with peers which will
make them feel included. Getting to Know You (Kathy Brigham, 2003) is another socialization
game that helps client with ADHD interact with peers. The game of Bingo could also be a great
activity because it increase socialization skills that can also build relationships.
To continue, Getting to Know You, would be an appropriate game to implement as a warm up
to a therapeutic recreation program. The overall purpose is to have a group of individuals learn
something that they didnt know before about each other. The game doesnt require much just
paper and pen, but can be modified depending on the client population. The objective is to
encourage social interactions. With individuals with ADHD, especially children it is very
difficult to interact with others because of how they are negatively perceived. There are no rules
so the game can easily be modified. The first step would be to have everyone write a statement
about themselves for example, I know how to crochet, I am the oldest of 12 siblings, etc.
Once they are done, number each statement and put them in a basket. Next, have the participant
pick a number and the therapist read the statement. Each member in the group has to guess if the
statement about the person who selected the number is true or false. This is also a good social
game because participants find things that they have in common with each other, thus creating
potential friendships. Social interaction is so important with people with ADHD because they
often dont do well with socializing. Without social interaction skills, they are likely to fail in
relationships, jobs, school, and any other major life aspects. It is imperative to gain those skills
necessary to have a successful social lifestyle.
Following the activity analysis form, the analysis of each functional domain is straightforward.
In the physical aspect it required little to no movement at all. The body position was to sit, no
body parts, movement, or coordination was required. In the social aspects, cooperation within the

Disabilities, Modalities, and Activity Adaptations Assignment Paper

group was necessary but no goal was established. In the cognitive aspects, no rules were
required. The instructions was simple and no strategy or scoring was calculated. Memorization
was not crucial, however guessing if the statement was true or false was expected. The degree of
verbalization of thought process was greatly desired in order to participate in the activity. There
was no reading, writing, math, spelling, colors, numbers, shapes or body parts required in the
activity. In the affective aspects joy was the only emotion expected. Finally, in the administrative
aspect no special expertise, time limit, or facility was necessary. The only equipment needed was
paper and pen and at least a minimum of 4 people. The game was in its simplest form so every
client population could participate and benefit from it.
Depending on the type of group of ADHD children that the TR is implementing the activity
on, some adaptations may or may not be necessary. For the hyperactive-impulsive ADHD group,
the therapist can have the child walk to pick a number off the board/basket instead of telling the
child to verbalize a number. The therapist can also draw a line in the middle separating the true
side from the false side. While reading the statement, the child gets to move to either side to
guess which one is true about his partner. Doing this modification will relieve the child
hyperactivity and impulsivity while still being engage in the activity. For the inattentive type, the
only adaptations necessary is to play the game for a short period of time and to make sure
everyone is participating. Also making sure that the steps to the game are broken down to the
simplest form can help the clients participate. At the end, gathering a summative evaluation will
determine if the adaptations applied met the clients needs. For instance, did letting the
hyperactive-impulsive child move about help them participate through the game and make sure
the instructions clear enough to help the inattentive child feel like they understood?

Disabilities, Modalities, and Activity Adaptations Assignment Paper

Moving along, individuals that has social impairments like substance abuse users can also
benefit from the social skill modality. Substance abuse is the over dulgence or dependence of an
addictive substance like alcohol and drugs. Just about anything can contribute to the cause of
substance abuse like influences in early childhood, genetic factors, peers, etc. Substance abuse
users come to have several issues like behavioral, cognitive, and psychological problems.
Symptoms of a substance abuse are typically recognizable at first by friends and family. The
signs involves aggressiveness, irritability, forgetfulness, depression, denial of alcohol and drug
abuse and much more. At this point, treatment and interventions should be considered. In
substance abuse, everyones needs are different. So customizing to everyone unique problems or
situations are important. For example in adolescents, their brain are still maturing and they are at
the psychosocial stage of development. They need treatment that focuses on social, physical,
mental, and emotional growth. Integrating family and friends are key because they are highly
influential. For women who are substance abuse user, they are physiologically different from
men and they have a greater chances of having health related issues. Nonetheless, all have
common needs which is to learn how to be socially, physically, mentally and emotionally
functional. With that being said, substance abuse users also have many strengths. Their strength
are usually hidden because the abuse of substance has taken over all of life domains. The use of
alcohol or drugs alters their functional abilities, so assessment of their need and strength are
necessary for effective treatment.
When making adaptations for the substance abuse user in the Getting to Know You activity,
consider the needs and strengths of the individual. The effect of substance abuse normally leads
the abuser to having social problems. The client would be required to be sober so that all aspects
of the activity can be involved. In the physical aspect, no body parts, coordination, strength are

Disabilities, Modalities, and Activity Adaptations Assignment Paper

required. Social interaction is the main idea, so an intragroup cooperation and a degree of
communication is needed. In the cognitive aspects, the rules and instructions are simple to
follow. The degree of verbalization of thought process and concentration is required. The skills
of writing is included but can be modified if the client cannot write. In the affective aspects of
the activity the client should feel some type of joy but no frustration, anger, or fear. While
learning new things about others, this should open pathway to communication and socialization
with other people. Finally if more adaptations are needed, make the appropriate evaluation of the
needs of the client. With this activity, whether it be dealing with individuals with ADHD or
substance abuse users, the success of promoting social skills are met through their goals.

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Disabilities, Modalities, and Activity Adaptations Assignment Paper

References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental
Disorders. Arlington, VA: American Psychiatric Association.
Centers for Disease Control and Prevention. (2014, September 29). Attention-Deficit /
Hyperactivity Disorder (ADHD). Retrieved from Centers for Disease Control and Prevention:
http://www.cdc.gov/ncbddd/adhd/data.html
Malkin, E. R. (2002). Sensation-seeking in college students with attention deficit disorder:
implications for recreational therapy interventions. Annual in Therapeutic Recreation, 33.
Terry Robertson, Terry long. (2008). Places, Models, and Modalities of Practice. In E. C.
Richard Williams, Foundations of Therapeutic Recreation (p. 68). Champaign: Human Kinetics.

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