THE HOLISTIC THERAPY FOR EFFECTIVE SERVICES FOR CHILDREN WITH ADHD IN KINDERGARTENS

Uncontrolled behavior in children with special needs with ADHD is still a phenomenon because they have not received proper services. Parents and teachers need to find the right way to serve children with ADHD to optimize their potential from an early age. This study aims to determine the pattern of teacher services provided to ADHD children in kindergartens. The service pattern provided to ADHD children can help teachers provide stimulation in accordance with the children’s needs.This study was conducted in six kindergartens located in Sleman Regency, Yogyakarta City, and Bantul Regency. The qualitative narrative method was employed in this study. The data of this study were collected through observation of ADHD children in six kindergartens and interviews with teachers. The research subjects were six children, and the data analysis technique used was the qualitative descriptive. The research results are divided into two parts. The first part is regarding the service pattern provided by teachers for children with ADHD with combined presentation (inattention and hyperactivity-impulsivity), predominantly inattentive presentation (inattention) and predominantly hyperactive-impulsive presentation. Meanwhile, the second part describes how the teachers treat children with ADHD while they are among their peers and the implication of holistic therapy given to ADHD children. The types of games given to ADHD children are mostly to practice logic, focus, and patience for example, games requiring gross motor and fine motor skills.


Introduction
Children at early age development and growth are unique, especially for those with special needs. Many children with special needs in Kindergarten show less self-control behavior when interacting with others. Children with special needs are now starting to get more attention from parents, schools, and the community because they are different from children at their age in terms of behavior ( & Bateman, 2014). Support and services provided at early childhood for children with special needs can improve their abilities which then may lead them to have an active role in society. Parents have a vital role in fully accepting children with special needs as who they are and supporting their education (Thomson, 2010).
Early age children with special needs, specifically with ADHD, may face various problems in schools, family life, and social interactions (Hoza, 2007). As many as 80% of children with ADHD often have problematic relationships with peers in which they often experience rejection. Children with ADHD sometimes find it difficult to make friends and be partners in school activities (Goldstein & Kennemer, 2009). This problem is unavoidable since children with ADHD are inattentive. This often leads to an assumption that those children are unable to obey the rules in society. Their impulsive and hyperactive behaviors are hated by peers because they are not able to evaluate and control themselves as well as respond appropriately to social cues (Kloo & Kain, 2016). ADHD (Attention Deficit Hyperactivity Disorder) is a complex developmental disorder that affects ISSN: 00333077 4623 www.psychologyandeducation.net self-control resulted in inattention, impulsivity, and hyperactivity (Aram, Bazelet & Goldman, 2010). ADHD is a disorder that begins in childhood that affects academic development, social adaptability in a family, and social adaptability among peers (Garcia, Grau & Garces 2015; Cherkasova, et al., 2013). Children with attention deficit and hyperactivity disorder tend to move more than normal children do and cannot control themselves, and as a result, it is difficult for them to interact with other people. The clinical appearance of ADHD can be detected early, from the baby's age. They are very sensitive to sound and light and tend to cry and scream. It is difficult for them to stay quiet, and they have very little sleep because they wake up often. They often experience colic, difficulties to eat or drink both breast milk or bottle milk, unwillingness to be calmed or held, refusal to be loved, excessive saliva, and sometimes they continously ask for a drink, bang their heads, hit their heads, drop the head backward, and are often over-tempered (Judarwanto, 2006;Barkley, 2006). The main problem faced by children with ADHD is a neurological condition where the brain fails and is hampered to control their bodies, thus appearing to be inattentive and making uncontrolled quick movements (Kauffman & Hallahan, 2011). Attention or hyperkinetic disorders are psychiatric problems or children's behavior disorders that are mostly found both at school and home. Boys with ADHD are more common that girls. This disorder is commonly identified at the age of three (Garcia, Grau & Garces, 2015). Boys tend to show very real hyperactivity or impulsive ADHD, while girls are more likely to be negligent (Hallahan, Kauffman & Pullen, 2014). If ADHD is treated early, it easier for the children to adjust to the later stages of education. When the children start school, both teachers and peers may accept their conditions. Children with ADHD have a high risk of developing psychiatric disorders with symptoms of antisocial behavior, moods that always indicate anxiety, and drug use in early adulthood (Gordon & Hinshaw, 2015). Prolonged anxiety causes ADHD children to experience mood swings and difficulty to control themselves, and as a result, they become rebellious (Rinsky & Hinshaw, 2011). Parents and teachers have a very important role for early age children with ADHD as the children often ask for help from other people because they have growth problems. Children with special needs are entitled to get the same education as their peers in order to be able to socialize from an early age and increase their confidence ( However, the best technique to provide services for children with ADHD so that they can grow well and adjust themselves to their environment is in question.

Methodology
This research employed the narrative qualitative approach. The research subjects were six children from six kindergartens located in some areas in the Special Region of Yogyakarta, Indonesia. The study was conducted in Kindergartens A and E located in Sleman Regency area, in Kindergartens C and D located in the Yogyakarta City area, and in Kindergartens B and F in the Bantul Regency. The data were collected through observation and interviews. Observations were conducted when children with ADHD got involved in activities at school from the beginning to the end of each class. Interviews were conducted with the class teachers, shadow teachers, kindergarten headmasters, and the kid parents to get information about various activities provided to children with ADHD. The questions were related to learning activities, types of games, eating habits, prayers, and how the children have a rest. Various behaviors of children with special needs were used as data in qualitative research ( The instruments used in this study were interview and observation guidelines. The collected data were analyzed using the qualitative descriptive method. The data were in the form of interviews, observations about children's activities, ADHD type detection instruments, photos, and videos. Those data were collected and analyzed to get accurate information about ADHD children's activities and behaviors. Then, triangulation on data collected from observations and interviews with kindergarten headmasters, teachers, and parents was done.

Results and Discussion
This research was conducted to examine the pattern of services provided by teachers to children with ADHD. Based on the service patterns of the six ADHD children, information about teachers' treatment and games suitable for the children is collected. Several patterns of care for children with ADHD are tailored to the type of ADHD as listed in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) as listed in Table  2. Table 2. Description of the ADHD Type According to DSM -5 The types of ADHD listed in table 2 have several characteristics or criteria that can be used as a reference for services. The criteria for ADHD types of attention such as: a) Often fails to give close attention to details or makes careless mistake; b) often has difficulty sustaining attention in activity; c) often does not seem to listen when spoken to directly; d) often has difficulty organizing tasks and activity; e) often does not follow through on instructions and fails to finish schoolwork; f) often avoids, dislikes or is reluctant to engage in task; g) often loses things necessary for tasks or activities; h) often easily distracted by extraneous stimuli; i) often forgetful in daily activities.
Kriteria ADHD tipe hyperactivity and impulsivity such as: a) often fidgets with or taps hands or feet or squirms in seat; b) often leaves seat in situations when remaining seated is expected; c) often runs about or climbs in situations where it is inappropriate; d)

No
Tipe 1. Combined presentation (Inattention and hyperactivity-impulsivity) 2. Predominantly inattentive presentation (inattention) 3. Predominantly hyperactive-impulsive presentation ISSN: 00333077 4625 www.psychologyandeducation.net often unable to play; e) often talks excessively; f) often has difficulty waiting his or her turn; g) often interrupts or intrudes on others; h) often "on the go" or uncomfortable being still for extended time; i) often blurts out an answer before a question has been completed. Early childhood with special needs can be categorized in combined presentation type ADHD if they have at least 6 characteristics of all attentions and hyperactive-impulsive types, children with attention-type ADHD if they have at least 6 of the 9 attention characteristics and hyperactive-impulsive type ADHD if they have 6 characteristics of 9 hyperactive-impulsive (American Psychiatric Association, 2013). Based on the types and criteria for ADHD mentioned above, it can be concluded that the types found in children with special needs in Kindergarten 3 in the area studied are as in Table 3. Table 3. Data on the types of early childhood with ADHD in Sleman Regency, Yogyakarta City and Bantul Regency Name ADHD Type Js, As, Ak Combined presentation (Inattention and hyperactivity-impulsivity) Df Predominantly inattentive presentation (inattention) Jt, Gn Predominantly hyperactive-impulsive presentation Based on the type of ADHD in table 3 found in the field, it can be seen that the services and therapy provided to early childhood with special needs with ADHD in 6 Kindergartens studied in the Special Region of Yogyakarta include: 1. Literacy and behavioral therapy services. Based on the data shown in Table 1 Playing the piano keyboard can improve children's musical potential and his emotions to follow to the tune. When Jt feels disturbed by others, the shadow teacher will direct Jt to refocus on learning activities. Jt's shadow teacher asks him to read picture books when he throws a tantrum and then she hugs him to make him chill. The school provides a special instrument to assess Jt. 5. Cognitive and motor therapy services. The pattern of services provided to Df is similar to that of his peers even though Df has an inattention ADHD type. Only when Df shows aggressive behavior, the teacher will give special treatment by separating Df from his friends. The games given to Df are ballthrowing and fine motor activities such as coloring and writing. Df's ability in writing and coloring is good, but he is not able to complete the tasks given. Cognitive treatment is provided to children with ADHD to improve their thinking skills to be more systematic in doing things. His teacher will move closer to him when asking questions. This trains Df to be attentive to other people. 6. Cognitive and behavioral therapy services.
Special treatment for Gn who has hyperactivity-impulsive presentation ADHD type is shadow teacher assistance. During learning, Gn is always active, but it is greatly influenced by his mood from home. When Gn goes to school happily, he tends to be easily managed and always eager to work on assignments given by the teacher. As an ADHD child, Gn is a fast learner who is capable of quickly completing assignments. His teacher always gives extra activities to prevent him from disturbing his friends. The teacher gives a few games that he likes, and when his friends do not give him the toys that he likes, he will hug them. Gn is fluent in English, so the teacher asks him to speak in English to motivate him. Speech therapy using a foreign language can improve children's confidence and communication skills. 7. Cognitive therapy service. Due to his special needs, Ak is in a special class of an inclusive school. The service provided for him is in the form of stimulations who has Combined presentation (Inattention and hyperactivityimpulsivity) ADHD type. His teacher often trains Ak to respond to others by inviting him to two-way communication. The teacher often asks him to express his opinion or what he feels. Then, he is asked to do the assignment based on the teacher's instructions, but he is allowed to add anything to stimulate his creativity. Indoor and outdoor games provided to Ak are basically the same as what other children do. By doing so, Ak will be more patient and more controlled in interacting with others. Based on the results of the study with six research subjects, it can be concluded that there are various types of services provided to ADHD children. The service patterns are adjusted to the children's types of ADHD. Based on the description of the six ADHD children above, it can be seen that there are several patterns of services provided to early childhood with 3 types of ADHD. The results show that the appropriate services that can be given to early childhood with ADHD are holistic services that include cognitive, literacy, behavioral, and motor therapies. In addition, there are also speech and medical therapy services that are provided to children with certain types of ADHD in accordance with their needs. The findings of services for early childhood with ADHD are shown in Table 4.  Literacy therapy is carried out through speech therapy and games with numbers and letters. This is the appropriate treatment for the inattentive type of ADHD. Motor therapy is done by stimulating gross and fine motor skills to improve children's attention. This therapy is suitable for the hyperactive and impulsive types. Different therapies provided for six research subjects are based on the types of ADHD. Cognitive therapy is given to children with ADHD with cognitive-behavioral approaches. Through various cognitive skills and abilities, the children are trained to find elements and stimuli from their environment, to learn about roles and understand other people roles, to identify the culture, language, values, and morals of society, to make the connection between a characteristic and function, and to improve their knowledge of the environment especially the skills that might be possessed by children with ADHD (Mohammed, 2016). Cognitive stimulation given to early age children with ADHD will increase academic abilities that are highly needed in children's daily activities (Uzunboylu & Özcan, 2019 ). This service includes: 1) collaboration between a service user and a professional providing services in the form of intense interviews to plan a treatment based on the user needs; 2) assurances that assessment results of interviews can be formulated into broader and holistic multidisciplinary plans and interventions; 3) scaffolding of changes to assess the function of the service and identify whether the next steps are appropriate for the user; 4) an opportunity for a different expert to provide input on the services provided; 5) consideration of appropriate programs as a tool to activate the action and get the expected results (Adamou, et al., 2016). Children with ADHD prefer to spend time doing activities requiring less attention and less details (Alessandri, 1992). An early introduction of literacy for ADHD children can train them to be more patient in paying attention to something starting from paying attention to writing (Aramaic, Bazelet & Goldman, 2010). Literacy therapy can develop children's cognitive and language skills so they are better prepared for school. Children with ADHD knowledge and selfpresentation abilities are often troubled and have distinctive patterns, so there is a need to ask them express their emotions (Kloo & Kain, 2016). Emotion poured into drama activities, poetry and other creative works have a positive impact on children with ADHD self-control, thereby reducing unpredictable movements. Continuous behavioral therapy done until the children respond without help proved to be very effective in reducing symptoms in ADHD children (Amalia, 2018). According to some experts, behavioral and motor therapies are suitable for hyperactive and impulsive children (O'Neill, Rajendran & Helperin, 2012). Children with ADHD excessive energy often leads to harmful actions. Children with this type of ADHD should be provided with many opportunities to show their abilities so that they will be able to communicate with many people and to control themselves. Early intervention with various motor game activities can reduce delays in children's motor development (Vasserman, M., Bender, H.A., & MacAllister, W.S., 2014). The data of this study were collected from six research subjects consisting of five boys and one girl. This research proves that three out of four children with ADHD are males (Ragnarsdottir, B., Hannesdottir, D.K., Halldorsson, F. & Njardvik, U., 2018). Several efforts need to be made to prevent ADHD in children. Education for parents and prospective parents is proven to be very effective in preventing the possibility of children with ADHD (Daley et al, 2009). Monitoring the development of children from an early age can decrease the number of problems and delays in growth. Conclusion ADHD children who get treatment and therapy from an early age will be easier to adapt to the environment. Early treatment for children with ADHD is needed because the main cause of ADHD is brain damage. The most effective therapies given to children at an early age with ADHD are cognitive, behavioral, literacy, and motor therapies. The order of therapy effectiveness corresponds to the type of ADHD with inattention, hyperactivity, impulsivity symptoms.Therapy for children with ADHD aims to train them to respond to stimuli and control their behaviors so they can interact with other people. Children with ADHD are provided with Legos, puzzles, as well as gross motor and fine motor game activities. Delay in providing treatment for ADHD children can cause juvenile delinquency in adolescence. Because they are difficult to control, children with ADHD may later be prone to involve in drug and alcohol abuse and use. Services for children with ADHD are