School Interventions for Children with ADHD

School Interventions for Children with ADHDBrandon K. Schultz, Ed.D., NCSP

Alvin V. Baird Attention & Learning Disabilities Centerschultbk@jmu.edu

Brandon K. Schultz, Ed.D., NCSP

Alvin V. Baird Attention & Learning Disabilities Centerschultbk@jmu.edu

Agenda ADHD “Refresher” Behavioral Interventions

Daily Behavior Report Card Matching Game

Academic Interventions Organizational Skills

Study Skills Interventions Teaching Imagery Techniques

ADHD “Refresher”

Definition & Prevalence(APA, 2000)

Attention Deficit Hyperactivity Disorder (ADHD) is the current terminology Includes “Predominately Inattentive,”

“Predominately Hyperactive-Impulsive,” and “Combined” (inattention & hyperactivity) subtypes

Thought to afflict 3-5% of the population, with boys more commonly diagnosed than girls, at a ratio of about 4 or 5:1

Diagnosing ADHD(APA, 2000)

ADHD is diagnosed based entirely on observed behavioral symptoms

In schools, ADHD typically manifests as: Extreme disorganization Failure to complete or turn-in assignments Physical overactivity (e.g., frequently out of seat) Failure to follow directions Failure to attend to details Daydreaming/distractibility

BUT… the symptoms change over time

ADHD and Development(Adapted from Barkley, 2006)

Age

Preschool Elementary Age SecondaryIA

Hyp

Imp

Late Onset

Impa

irmen

t

Late onset is highly related to minority

status and exposure to deviant peers

CD: Early Onset

Comorbidity (Becker & McCloskey, 2002; Greene & Doyle, 1999; Lahey et al., 1998; McMahon & Kotler, 2006)

Early starters tend to engage in the most

persistent, serious, and aggressive behaviors

Early starters are twice as likely to meet

diagnostic criteria for antisocial personality as adults (antisocial family

history)

ADHD

Age of Onset

ODD

7(?) 10

What Causes ADHD?(Nigg, 2006)

The causes are unclear, but research strongly suggests a biological link

Some environmental toxins (e.g. lead) may be associated with ADHD, but only explain a small portion of cases

Brain imaging techniques have found significant differences in specific parts of the brain for ADHD and peers

EEG scans have been shown to differ between ADHD and peers

Behavioral Interventions

Overview of Behavior Management Behavior management is a common-sense

approach to behavior problems The ABCs of behavior management:

If we put our energy into A and C, B will fall into place

Anticipate Behavior Consequences

Behavioral Interventions & Schools(Bear, Cavalier, & Manning, 2005)

Research suggests that most teachers use very similar punishment techniques Punishment appears to be generally overused

What seems to separate successful teachers is their reinforcement techniques! Master teachers praise their students often and

provide clear and consistent incentives in their classrooms for good behavior and achievement

Classroom Reinforcement Systems For the ADHD student, tangible classroom

reward systems should: Be consistent, specific, and frequent Generally avoid “response cost” procedures,

when possible, especially with younger students Use “menus of reinforcement” Not be used as bribes to discontinue bad behavior Be slowly tapered over time – avoid “star inflation”

– replace with praise and privileges

Behavioral Interventions

Daily Behavior Report Card

Daily Behavior Report Cards(Challenging Horizons Program Treatment Manual, 2005)

Daily Behavior Report Cards are frequent reports of the child’s behavior that are communicated home

Generally there are several steps: Determine behavioral goals (dead-man rule) Develop report card with child Reinforcers at school AND at home Assess progress over time Phase out behaviors on report card upon

“mastery”

Daily Behavior Report Cards(Challenging Horizons Program Treatment Manual, 2005)

“Keys” to creating a DBRC

             

1The teacher and student identify desired behaviors (e.g., remaining on task in class) that the student needs to improve.

2The classroom teacher(s) documents ratings of the student's performance on the target behaviors on a regular basis (at least weekly).

3The teacher ratings are communicated in writing to the parents/guardians of the student (at least weekly).

4Behavioral contingencies are provided at home.  Progress is also discussed between the teacher and student in one-to-one meetings at school.

Daily Behavior Report Cards

Goal 1:

1 = I Want Bobby to Do

Better2 = Bobby Did an OK Job 3 = Bobby Did a Great Job!

Goal 2:

1 = I Want Bobby to Do

Better2 = Bobby Did an OK Job 3 = Bobby Did a Great Job!

Bobby will work well with others

Bobby will stay on task in class

BKS

BKS

Daily Behavior Report Cards(Evans & Youngstrom, 2006)Daily Report Card for English TeacherMonday’s Date _______________________ Student – PollyInstructions: Please circle either the “yes” or “no” corresponding to each of the three target behaviors and the day of the week. This report should be faxed to Polly’s mother at work every Friday before 5:00 pm.

Monday Tuesday Wednesday Thursday Friday

Polly spoke only at appropriate times in class in accordance with classroom rules.

YesNo

YesNo

YesNo

YesNo

YesNo

Polly completed and turned in all work due today. Yes

NoYesNo

YesNo

YesNo

YesNo

More than half of Polly’s contributions to classroom discussions were relevant and non-redundant.

YesNo

YesNo

YesNo

YesNo

YesNo

DRBC Outcomes(Evans & Youngstrom, 2006)

0

10

20

30

40

50

60

70

80

90

100

1/8

/2006

1/1

5/2

006

1/2

2/2

006

1/2

9/2

006

2/5

/2006

2/1

2/2

006

2/1

9/2

006

2/2

6/2

006

3/5

/2006

3/1

2/2

006

3/1

9/2

006

3/2

6/2

006

4/2

/2006

4/9

/2006

4/1

6/2

006

4/2

3/2

006

Mondays of Week

Perc

en

t o

f D

ays M

ark

ed

Yes

Followed classroom rules aboutspeakingTurned in all work completed

Quality contributions to class

Baseline DRC DRC w/increased criteria

DRC + Medication

DRC Alone

DRC + Medication

Matching Game(The Challenging Horizons Program Treatment Manual, 2005)

A modification to DBRCs is to invite students to rate their own behavior and then compare their ratings with the teacher

“Matches” result in reinforcement (e.g., stars) Example

Academic Interventions

Organizational Skills

Organizational Skills(The Challenging Horizons Program Treatment Manual, 2005)

The organizational skills intervention is designed to help students self-monitor their bookbags and school materials

Generally there are several steps: Identify areas that must stay organized Design a checklist that clearly targets these areas Periodically check student organization Reward success and overcorrect problems

Organization Skills(Challenging Horizons Treatment Manual, 2005)

“Keys” to improving organization

             

1The teacher helps the student identify areas that are important to

keep organized (e.g., locker, desk, bookbag) and teaches the student specific ways to stay organized.

2The teacher(s) monitor the students ability to maintain

organization through regularly scheduled inspections/checks (completed at least weekly) and document progress

3Student success is reinforced (e.g., praise, points) and problems

are overcorrected with teacher assistance. 

Average Percentage of Organizational Criteria Met Per Day

50

60

70

80

90

100

1 3 5 7 9 11 13 15 17 19 21 23 25Day

Pe

rce

nta

ge

of

Cri

teri

a M

et

Study Skills Interventions

Teaching Imagery Techniques

The Challenge Children with ADHD Face When Studying

Learning begins with attention – you must attend to the material and then process (elaborate) at deeper levels

To get beyond this hurdle, children with ADHD need explicit instruction in practical and efficient study strategies

Learning Example

cap

apple

sock

pie

hand Jacket

foot

hot dog ear

Mnemonics Successful memory

techniques are often based on forming mental images (imagery) to help remember associations

The more elaborate and bizarre, the better!

“zdanie”

Mnemonics For younger children

(elementary age) imagery works best when it is taught to them, but for older children (middle school and up) imagery works best when they create their own.

???

Mnemonics – Loci Method

Picturing items/actions in familiar locations Walking through your house:

Open the front door and in the foyer is a _____. Then I go in the living room and on the TV is a ______. On the chair is a ____ and on the couch is ______. Etc., etc.

(Don’t look at next slide!)

Learning Example Revisited

cap

apple

sock

pie

hand Jacket

foot

hot dog ear

chp@jmu.edu

We Are Making Progress!

References

American Psychiatric Association (2004). Diagnostic and statistical manual of mental disorders (4th Ed., Text revision). Washington, DC: Author.

Bear, G.G., Cavalier, A.R., & Manning, M.A. (2005). Developing self-discipline and preventing and correcting misbehavior. Boston, MA: Pearson Education, Inc.

Challenging Horizons Program Treatment Manual (Integrated Model). (2005). Harrisonburg, VA: James Madison University.

Noel, J. T. (2005). What causes ADHD? New York: Guilford Press.