Informed Consent Form Annexure A

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Annexure A

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Dear Parent

NORTH-WEST UNIVERSITY

YUNIBESITI YA BOKONE·BOPHIRIMA NOORDWES· UNIVERSITEIT

POTCHEFSTROOM CAMPUS

You are cordially requested to consider taking part in the following research project with your child:

Title: The Efficacy of Berard AIT for learners with attention difficulties (Ethics number: The purpose of the research is to investigate the Efficacy of Berard AIT for learners with attention difficulties

The researcher/therapist will explain to you whether your child is in the experimental or control group. However, please take note that the assessment and intervention for both groups will be exactly the same. Your and your child's participation is voluntary and you may withdraw your child's participation at any time.

The Berard Auditory Integration Training (AIT) is a three month intervention process. Although the duration of the active training period lasts only ten to twelve days, the improvements escalate for the following three months. In the first interview the assessment as well as the intervention procedures of the Berard AIT will be explained to you in detail. Where after you need to sign this consent form. After the assessment has been conducted the training will start on a Monday and run until the Friday. Your child will have the weekend off and the second week of training will start again on the following Monday and last till the Friday

Training Protocol

A listening profile will be completed before the training sessions start. The listening profile determines if there are any peaks of hypersensitivity which must be filtered during the training. This is to make the training a more comfortable experience for the learner. The training will start within two weeks after the Listening Profile has been completed. The training will consist of two listening sessions per day, every day for a week. This schedule will be interrupted by the weekend, and then the training during the second week will presume - again two listening sessions twice a day. Each listening session will last exactly 30 minutes for no more than ten days. The two sessions must be at least three hours apart to give the listening system a proper rest.

After the first five days of training another Listening Profile will be completed by each learner. As the Listening Profiles usually change because of the AIT training, new filters will be set according to a specified protocol to benefit the learner optimally.

This listening protocol will be repeated again three months after the training has been completed.

The training will be conducted at the school before school starts and again at the closing of the school day. This is to ensure that the parent and home influence are minimized and the children are in the same environment during the time between the two sessions.

Possible risks:

It is possible that your child may exhibit physical and/or behavior problems for a period of time during or following the auditory training.

There may be a number of reasons for the regressive behaviour. 1. Fatigue- this may appear as irritability and hyperactivity. 2. There can be emotional outbursts

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3. Anger may also occur - blocked anger which your child begins to express.

4. The learner may act more independent and assertive, which the parents can experience as challenging behaviour.

5. In order for the body to change it needs energy. Some children will sleep up to 14 hours.

6. They may sometimes eat more or be not so hungry for a while.

7. There may be a shift in perception as a new world is opening up - they see and hear things differently.

8. Hypo-sensitive smell may normalize.

9. Adverse effects are transitional and indicate that the system is changing.

Dr. Berard believes that these reactions may indicate that the auditory integration training is being effective and producing a change in the participant. Therefore, one should not be alarmed if reactions occur. At the same time, Dr. Berard's experience has shown the training to be effective even if the participant has no reactions.

Support to minimize negative responses

If your child experiences any of the above mentioned behaviour please contact me immediately. The following techniques will be conducted by me with your help and permission to minimize negative responses to the training:

1. Sensory input

• Sensory integration will be encouraged during the AIT training • Deep pressure and/or massage could be applied

• Joint compression where the joints are pushed together to make the body aware of proprioception.

• Wheelbarrow walks and wall presses has a very calming effect.

2. Structured music like Mozart and Gregorian chants can be played to the child.

3. The Bach flower, a homeopathic medicine can be used under supervision of the therapist. However, please be beware, Bach flower contains ethanol (alcohol) as a suspension.

4. It is preferable to cut down on extra mural activities during the training.

It is important that you take note of the. benefits of Berard AIT: Some of the benefits may include a decrease in hypersensitivity to sounds, an increase in auditory comprehension, improved attention and an increase in social behavior. Dr. Berard, who developed the auditory integration training method, asserts that people who have auditory peaks in their hearing based on the audio test, will likely benefit from the training. It is also possible that individuals may benefit if their audio tests do not show peaks or if reliable audio tests are unavailable from individuals unable to participate in audio testing.

Confidentiality: Data in this study will be kept confidential.

Contact: If you have any queries regarding this research you are welcome to contact Dr Nel at (o/h) 016 910 3095. This research is conducted by Mrs. Hannelie Kemp, a Master's student under the supervision of Dr. Mirna Nel at the Faculty of Education Sciences, Vaal Triangle Campus, North West University.

However, please note that any queries. regarding the Berard AIT and the training sessions must be addressed to Mrs Kemp herself. Contact numbers:

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This research has been ethically approved by the North West University ethical committee.

Consent:

1 have read and understand the nature of my participation in this research project and agree to participate.

Name Signature

Date

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Annexure B

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NEUR

@

Learning and Hearing Centre

Knysna Primary Long street Knysna 6570

April2007

Attention : The Principal

Hearing Aids Learning and Hypnotherapy Bio-and Trauma and and Assessment Listening Consultant and Kinesiology Neurofeedback Addiction Counsellor

Tel: +27 (0)44 382 1168 ·Fax: +27 (0)44 382 7663

neurostim@internext.co.za • www.neurostimulation.co.za

Learning and Hearing Centre Shop 10, Wood mill Lane Knysna,6570

South Africa

I would appreciate it if I could conduct a research study at your school. Berard AIT, an intervention where the person listens to music entails two half hour sessions twice a day for ten days.

Berard AIT has been hailed to have a positive affect on children with attention problems and ten children from your school have been chosen to participate in the study.

Kind regards

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Annexure

C

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Checklists:

"'7

Copeland Symptom Checklist

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COPELAND SYMPTOM CHECKLIST FOR ATTENTION DEFICIT DISORDERS

Attention Deficit Hyperactivity Disorder (ADHD) and Inattentive Attention Deficit Disorder (ADD)

This checklist was developed from the experience of many specialists in the field of Attention Deficit Disorders and

Hyperactivity. It was designed to help determine whether your child/student has ADHD or ADD, to what degree, and if so, in which area(s) difficulties are experienced. Please mark all statements. Thank you for your assistance in

completing this information.

Name of C h i l d : D a t e :

-Completed by: _______________________________________________________________ _

Directions: Place a tick by each item below, indicating the degree to which the behaviour is characteristic of your child/student.

Not Just a Pretty Very

Score at all little much much

INATTENTION/DISTRACTIBILITY t.:\);; .· ' . \::;:,~, ; '.' ''""

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I. Has a short attention span, especially for low-interest activities 2. Has trouble completing tasks

3. Daydreaming

4. Easily distracted

5. Nicknames such as "spacey", or "dreamer"

6. Forgetful

7. Starts many things- finishes few

21

IMPULSIVITY

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l. Easily excited

2. Becomes frustrated easily

3. Does not think before acting 4. Is disorganised

5. Does not plan well

6. Constantly moves from one activity to another

7. Dislikes group activities that require patience and taking turns

8. Requires much supervision

9. Constantly in trouble for doing things wrong or for forgetting to

do things

10. Interrupts and talks out of tum

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Score %

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ACTIVITY LEVEL PROBLEMS

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Over activity/Hyperactivity

I. Restlessness -either fidgets or is constantly on the go

2. Reduced need for sleep

3. Talks too much

4. Constantly running, jumping and climbing

5. Kicks covers off- moves around constantly while sleeping

6. Difficulty staying seated at meals, in class, etc. %

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I. Sluggish- low energy level

2. Daydreaming, spaciness

3. Inattention due to low energy level rather than being distractible

4. Poor leadership ability

5. Has trouble getting started %

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NON-COMPLIANCE _:;,'·"' ,.,~ '' ;;

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I. Repeatedly disobeys

2. Argues a lot

3. Ignores socially accepted standards of behaviour

4. Does not do what is asked of him/her

5. Deliberately annoys others %

15

ATTENTION-GETTING BEHAVIOUR

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I. Often needs to be the centre of attention

2. Always asks questions or interrupts

3. "Picks on" other children and adults

4. Acts like the "class clown"

5. Uses bad or rude language to attract attention

6. Engages in other negative behaviours to attract attention %

18

IMMATURITY

I. Acts like a younger child (year or two years younger)

2. Physical development is delayed

3. Would rather be around younger children and relates better with

them

4. Often acts emotionally immature %

12

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Score %

POOR ACHIEVEMENT

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I. Achievements do not equal apparent ability

2. Loses books, assignments, etc.

3. Has trouble understanding and/or remembering things people

say

4. Learning problems

5. Fails to complete assignments

6. Completes schoolwork too quickly (rushes through it)

7. Completes schoolwork too slowly

8. Handwriting is messy or sloppy

9. Has trouble remembering directions and instructions %

27

EMOTIONAL DIFFICULTIES ;~~~i· ··}~; ;t;::;· ·. ~; . ·.

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I. Unpredictable mood swings

2. Irritable easily by minor things

3. Insensitive to pain or danger

4. Hard to calm down once over-excited

5. Easily frustrated

6. Temper tantrums, angry outbursts ("pitches fits")

7. Poor self-esteem %

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POOR PEER RELATIONS

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I. Hits, bites or kicks other children

2. Has trouble following the rules of games and social interactions

3. Is rejected or avoided by peers

4. Does not like group activities. Prefers to be alone

5. Teases peers and siblings too much

6. Bullies or bosses other children %

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Score %

FAMILY INTERACTION PROBLEMS- PARENTS(S) ONLY

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I. Frequent family conflict

2. Social gatherings are unpleasant

3. Parents argue over discipline

4. Mother or father spends hours on homework with this child

leaving little time for others in the family

5. Meals are frequently unpleasant

6. Arguments occur between parents and child over responsibilities

and chores

7. Family stress results from the child's social and academic

problems

8. Parents feel: _- frustrated _ hopeless _- alone

_ angry _ guilty _- afraid for child

_ helpless _ disappointed _sad & depressed %

24

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Client's name Date of birth Rater's name

Relationship to client

ABERRANT BEHAVIOR CHECKLIST

Gender Today's date Parent I Teacher I Trainer I Supervisor I Other

M IF

Where was the client observed Home I School I Residential unit I Workshop I Other

If in school, type of class

Race

Ethnic group

Client's medical status

a) Deafness Yes

b) Blindness Yes

c) Epilepsy Yes

d) Cerebral palsy Yes e) Other

Developmentally handicapped I Multi-handicapped Severe Behaviour Handicapped I Other

Black Coloured Indian

No ? (Don't know)

Current medications (Please list any medication and dosage schedule)

I. 2. 3. 4. 5.

-White

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ABERRANT BEHAVIOR CHECKLIST INSTRUCTIONS

The ABC-Community rating scale is designed to be used with clients living in the community. Please note that the ter

client is used throughout to refer to the person being rated. This may be a child of school age, an adolescent, or an adul

Please rate this client's behaviour for the last four weeks. For each item, decide whether the behaviour is a problem an circle the appropriate number:

0 = not at all a problem

1 =the behaviour is a problem but slight in degree 2 =the problem is moderately serious

3 =the problem is severe in degree

When judging this client's behaviour, please keep the following points in mind:

a) Take relative .frequency into account for each behaviour specified. For example if the client averages more tempe

outbursts than most other clients you know or most others in his/her class, it is probably moderately serious (2) or severe (3), even if these occur only once or twice a month. Other behaviour, such as noncompliance, would probably have to occur more frequently to merit an extreme rating.

b) If you have access to this information, consider the experiences of other care providers with this client. If the clie

has problems with others but not with you, try to take the whole picture into account.

c) Try to consider whether a given behaviour interferes with his/her development,functioning, or relationships. For

example, body rocking or social withdrawal may not disrupt other children or adults, but it almost certainly hinder individual development or functioning.

Do not spend too much time on each item -your first reaction is usually the right one.

l. 2. 2. 4. 5. 6. 7. 8. 9. 10.

II.

12. 13. 14. 15. 16. 17. 18. 19. 20.

Excessively active at home, school, work or elsewhere Injures self on purpose

Listless, sluggish, inactive

Aggressive to other children or adults (verbally or physically

Seeks isolation from others

Meaningless, recurring body movements Boisterous (inappropriately noisy and rough) Screams inappropriately

Talks excessively Temper tantrums

Stereotyped behaviour; abnormal, repetitive movements

Preoccupied, stares into space Impulsive (acts without thinking) Irritable and whiny

Restless, unable to sit still

Withdrawn; prefers solitary activities Odd, bizarre in behaviour

Disobedient; difficult to control Yells at inappropriate times

Fixed facial expression; lacks emotional responsiveness 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 2 3 3 3 3 3 3 3 3 3

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21. Disturbs others 0 2 3

22. Repetitive speech 0 2 3

23. Does nothing but sit and watch others 0 2 3

24. Uncooperative 0 2 3

25. Depressed mood 0 2 3

26. Resists any form of physical contact 0 2 3

27. Moves or rolls head back and forth repetitively 0 2 3

28. Does not pay attention to instructions 0 2 3

29. Demands must be met immediately 0 2 3

30. Isolates himself/herself from other children or adults 0 2 3

31. Disrupts group activities 0 2 3

32. Sits or stands in one position for a long time 0 2 3

33. Talks to self loudly 0 2 3

34. Cries over minor annoyances and hurts 0 2 3

35. Repetitive hand, body or head movements 0 2 3

36. Mood changes quickly 0 2 3

37. Unresponsive to structured activities (does not

react) 0 2 3

38. Does not stay in seat (eg during lesson or training

periods, meals, etc.) 0 2 3

39. Will not sit still for any length of time 0 2 3

40. Is difficult to reach, contact or get through to 0 2 3

41. Cries and screams inappropriately 0 2 3

42. Prefers to be alone 0 2 3

43. Does not try to communicate by words or gestures 0 2 3

44. Easily distractible 0 2 3

45. Waves or shakes the extremities repeatedly 0 2 3

46. Repeats a word or phrase over and over 0 2 3

47. Stamps feet or bangs objects or slams doors 0 2 3

48. Constantly runs or jumps around the room 0 2 3

49. Rocks body back and forth repeatedly 0 2 3

50. Deliberately hurts himself/herself 0 2 3

51. Pays no attention when spoken to 0 2 3

52. Does physical violence to self 0 2 3

53. Inactive, never moves spontaneously 0 2 3

54. Tends to be excessively active 0 2 3

55. Responds negatively to affection 0 2 3

56. Deliberately ignores directions 0 2 3

57. Has temper outbursts or tantrums when he/she

does not get own way 0 2 3

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ABERRANT BEHAVIOUR CHECKLIST

SCORE SHEET

Client's Name:

Date: Assessment Phase:

Rater:

Subscale I Subscale II S ubscale III Subscale IV Subscale V

(Irritability) (Lethargy) (Stereotypy) (H yperacti vi ty) (Inappropriate

Speech)

2

3

6

1

9

4

5

11

7

22

8

12

17

13

33

10

16

27

15

46

14

20

35

18

19

23

45

21

25

26

49

24

29

30

28

34

32

31

36

37

38

41

40

39

47

42

44

50

43

48

52

53

51

57

55

54

58

56

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Annexure D

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Primitive Reflexes

Name:

Date:

Age:

Emerge

Develop

Integrate

TLR-legsup

TLR-head up

L

R

Palmar

L

R

Babinski

L

R

Walk

Plantar

L

R

Rooting

Sucking

ATNR

Lying down

Standing

L

R

L

R

Spinal Galant

L

R

STNR

Lift head

Look down

Crawl

Fear Paralysis

Walk

Child walk

Push/Wave

Moro

Fixation

Cover

Fall

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Annexure E

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!Annexure F

1

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Quantitative

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(22)

Neurofeedback Full Assessment

;:..;N~a=m=e;.:..: _ _ _ _ _ _ ___,.;:D;;.;:a::.::t~e:=---Fp 1 Fp2 Delta Theta Alpha

SMR

Beta 1 Beta 2 Beta 3 Delta Theta Alpha

SMR

Beta 1 Beta 2 Beta 3 Delta Theta Alpha

SMR

Beta 1 Beta 2 Beta 3 T/B ratio Delta Theta Alpha

SMR

Beta 1 Beta 2 Beta 3 01 02 Delta Theta Alpha

SMR

Beta 1 Beta 2 Beta 3

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Annexure G

Integrated

Auditory

&

Visual

Continuous Performance

Test

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Integrated Visual and Auditory

Continuous Performance Test

(IVA)

The IV A is a programme which is used to test and accumulate information in the diagnosis and quantification of the symptoms of ADIHD. The programme is designed to give detailed performance information and to make the most accurate diagnosis possible, so that the nature of a person's self

-control problems can be understood.

The test task requires the test taker to click the mouse when he sees and hears a "1". He must not click the mouse when he sees or hears a two. Thus, test takers must remember the following:

1. Click when you see a "1" 2. Click when you hear a "1" 3. Do not click when you see a "2" 4. Do not click when you hear a "2"

IVA is the first commercially available CPT (Continuous Performance Test) to combine using a counterbalanced design, both visual and auditory CPT of impulsivity and inattention.

The basis for statistical analysis used by the IVA is the same as that which is used for most IQ tests. By using this ford, IV A enables the professional to apply familiar interpretive guidelines, making it easier to

interpret the test results. ·

The following scales are used as measures:

1. Prudence scale - Impulsivity and response - e.g. errors occur when test taker clicks to a "2" (non-target) after a series of"1"(target) are presented.

2. Consistency scale -Reliability of response time. Ability to stay on task

3. Stamina scale- Reliability to identify problems related to sustaining attention and effort

over time e.g. differences in reaction time between the beginning and end of task. 4. Vigilance scale- Inattention, Errors occurs when test taker fails to click to a "1" after a series 5. Focus

scale6. Speed scale

-of "2"'s are presented.

Measures the unusual number of occurrences for slow reaction time. Reaction time of all correct responses throughout the test and it helps to identify attention-processing problems related to slow mental processing. 7. Hyperactivity- The scale is derived by recording off-task behaviours with the mouse e.g.

multiple clicks, spontaneous clicks during instructions, anticipatory clicks and trials when the mouse button is held down.

8. Balance scale- Determines whether test taker processes information quicker visually or auditory, or if equally able to use each of these types of sensory input. 9. Readiness scale - Provides a subtle measure of attention problems by measuring test

performance when demands to respond are less frequent. 10. Comprehension scale- a) Identify random response b) Reduce false positives 11. Persistence scale - May reflect lack of motivation, or mental or physical fatigue. 12. Sensory I Motor scale- Measures speed of reaction time.

Summary: These attributes and validity scales help the clinician to understand a person's best modality of learning, need for structure, maturation level, comprehension and possible learning, emotional and neurological problems.

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IVA+Plus Standard Scales Analysis Full Scale Response Control Quotient 92 Full Scale Attention Quotient 81 Auditory RCQ = 98 Visual RCQ = 88 Auditory AQ

=

84 Visual AQ

=

83 150 140 130 120 110 100 90 80 70 60 50 40

Auditory Response Validity Check Visual Response Validity Check

Valid Valid

Fine Motor

Hyperactivity None

I

Mild Mod Sev Ext

PERSONAL INFORMATION Last Name

Social Securi ty #

Date of Birth (MM-DD-YYYY)

Sex (M/F) F

Di agnosis 1 (ICD code)

Diagnosis 2 (ICD code)

Di agnosis 3 (ICD code) Test Version 2006.20 Group Code Date 10/31/2007 11:41AM Comment First Name Educational Level 03/21/1999 Age 8 years On medication (Y/N)U Medication A Medication B Medication C TEST INFORMATION ID Code Not e Examiner Code

Distributed by BrainTrain, 727 Twin Ridge Lane, Richmond VA 23235 Phone (804) 320-0105 http://www.braintrain.com FAX (804) 320-0242

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10/31/ 2007 11:41AM

Auditory RESPONSE CONTROL Visual

Raw Quotient Primary Scales Quotient Raw 92. 0% 106 Prudence 80 80.0%

66. 1% 84 Consistency 107 73.5%

97 .5% 106 Stamina 88 90.3%

Hyperactive Events: 21

I

Fine Motor Reg. Quot: 98

Auditory ATTENTION Visual

Raw Quotient Primary Scales Quotient Raw

91.1% 85 Vigilance 98 88.9%

70.5% 93 Focus 103 71.9%

840ms 88 Speed 66 752ms

Att ribute Raw Q <----+----+----0----+----+---->

Balance 89.5% 125

_I

Vis Dom No Bias Aud Com

A 88 .2% 92 A

Readiness -

I

v 98.1% 122 _v

High No Bi as Low

i Symptomatic Raw Q WNL Mild Mod Sev Ext

A 93.8% 88 A Comprehension -

I

v

95.7% 102

v

A 67 .8% 86 A Persistence -

I I

v

71.9% 89

v

A 328ms 102 A Sensory/Motor

-

I

v

292ms 97

v

Norms : IVA+Plus 2004.1 03-14-2001 for F age 8 - 8

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"0/31/2007 11:41AM

IVA+Plus SUSTAINED ATTENTION SCALES

These two additional scales are provided for use with the IVA+Plus Interpretive Flowchart for ADHD.

Sustained Auditory Attention Quotient Sustained Visual Attention Quotient

80

85

---