Purpose
With the continued increase in the number of preschoolers with developmental delay and the challenges of caring for young children with attention deficit hyperactivity disorder (ADHD), this study was designed to address the difficulties encountered by providers and educators by implementing a visual cueing picture card strategy. The purpose of this strategy was to increase the attention span of three-year-old children with ADHD during daily routine activities. As some studies have shown that the visual cueing strategy has significant supportive effects on children with special needs and has been successfully applied in a variety of educational contexts to enhance attention and improve classroom management efficiency (Wu & Tsai, 2021; Chen et al., 2019; Chen & Ho, 2008; Tzen, 2005). Based on existing research, this study applied visual cue cards as an intervention to increase the focused attention of young children with ADHD and provide effective teaching strategies for field educators to improve teaching effectiveness and classroom management efficiency in an integrated education setting.
Methods
This study was a case study of a three-year-old boy with ADHD at three months of age based on purposive sampling; a single-subject cross-situational multibaseline design was used according to the research objectives and questions (Niew & Wu, 2019, pp. 79-81). The study was conducted in a Workplace Mutual Assistance Childcare Service Center with different time, place, and activity settings to investigate the change in focused attention (dependent) of young children with ADHD after an intervention with visual cue cards (independent variable). The study was divided into three periods: the baseline period, the intervention period, and the maintenance period. In addition to quantitative data collection, the researcher also utilized participant observation to collect qualitative data in order to present a complete picture of the study. In the study, a total of 14 weeks were spent on 8 interventions of the visual cueing chart, and the data were collected using the “Pre-school Special Educational Needs Children’s Behavioral Observation Record Sheet”, the “Inattentive Behavior Frequency Record Sheet”, and the mobile phone video recordings. The study cases’ attentional performances in the three time periods of meal cleansing, toilet cleaning, and tidying up were also recorded by means of the graphic method and the visual analysis method. The focus of the study was on inattentive behavior, which was mainly to observe whether the children were able to follow the teacher’s planned activities and achieve the expected goals in the situation. Therefore, the number of inattentive behaviors was used to assess the effectiveness of the visual cueing strategy in reducing inattentive behaviors.
Results
In this study, a systematic observation and intervention was conducted on Case F’s inattentive behavior. Through the use of visual cue cards, the case was observed for changes in attentiveness during the meal and cleaning segments, the toileting segment, and the packing and picking up and dropping off segments. During the meal and cleaning periods, F’s inattentive behavior decreased from an average of 3.67 times per day in the baseline period to an average of 2.1 times per day in the intervention period, and further decreased to an average of 1.5 times per day in the maintenance period; it can be seen that the trend of the data points was the same in the baseline period, and it was in line with the principle of stabilization before entering into the intervention period; the trend of inattentive behavior showed a decreasing trend after the beginning of the intervention period, which indicated that in this situation, the inattentive behavior of the cases in the intervention period decreased. At the beginning of the intervention period, the trend of inattentive behavior shows a decreasing trend, indicating that the number of inattentive behaviors in this situation has decreased significantly; after entering the maintenance period, the number of inattentive behaviors shows a slightly higher but moderate trend compared to the intervention period. During the toilet use period, F decreased from an average of 4 times per day in the baseline period to 2 times per day in the intervention period, and remained in this state in the maintenance period; the trend of the toilet use situation in the data points of the baseline period was flat, and the trend of the inattentive behavior showed a decreasing trend after the beginning of the intervention period, indicating a significant decrease in the number of inattentive behaviors in this situation; the number of inattentive behaviors showed a decreasing trend in the maintenance period compared to that of the intervention period. After the maintenance period, the number of inattentive behaviors continued to decrease compared to the intervention period. During the packing and picking up period, the number of inattentive behaviors decreased from an average of 3.5 per day in the baseline period to 2.5 per day in the intervention period, and further decreased to 2 per day in the maintenance period; the trend of packing and picking up was the same for all data points in the baseline period, and the stabilization principle was met before entering into the intervention period; the trend of inattentive behaviors showed a slight decrease after the beginning of the intervention period, which indicated a decrease in the number of inattentive behaviors. At the beginning of the intervention period, the trend of inattentive behavior showed a slight decrease, indicating that the number of inattentive behaviors in this context decreased, but not very significantly, and after entering the maintenance period, the number of inattentive behaviors showed a slight decrease compared to the intervention period. To summarize, the immediate effects of the visual cueing strategy on attentional learning effectiveness in the three contexts were, in descending order, toileting, meal cleaning, and picking up and dropping off. Secondly, semi-structured interviews with the three classroom teachers, the director, and the mother of the primary caregiver in the interview center revealed that Case F showed significant improvements in attention and self-care skills after the visual cueing strategy intervention.
Discussions and suggestions
The Impact of Visual Cue Strategy on enhancing F’s concentration and self-care skills during routine activities such as meals and cleaning, toileting, as well as packing and picking up periods with immediate, sustained effects and good social validity is in line with Niew, Wern-Ing’s (2008) principle of integrated education, whereby students with SEN enjoy equal access to educational resources and individualized support. Meanwhile, it also supports the viewpoints of Chang, Bey-Lih (2009), which proves that special education resources can effectively support ADHD students through the implementation of appropriate strategy in the daily general classroom environment. For the future, it is suggested that (1) continuous application and individualized adjustments be made; (2) the scope of the study be expanded; and (3) regular tracking and evaluation be conducted in order to further enhance the effectiveness of the visual cueing strategy, to promote the practice of integrated education at the preschool level, and to support the holistic development of students with ADHD in an integrated learning environment.
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