Introduction
Attention-Deficit/Hyperactivity Disorder (AD/HD) is a neurological condition that has come to greater attention of parents, educators and the general public in recent years. Throughout history, characteristics of the disorder - hyperactivity, inattention and impulsivity - have been observed in children. Only in recent decades has understanding, diagnosing, and providing supports for these students become common. Heightened awareness of the disorder has positive and negative implications for educators. On one hand, an abundance of educational research has provided updated ideas for teachers and a wealth of resource materials are becoming available. On the other hand, some parents and educators wonder if the AD/HD diagnosis is being overused to account for a number of other conditions that may result in similar behavioral patterns. Regardless of the controversy, teachers in Sevier County must address the day to day challenges of working with students who exhibit these characteristics.
Students with AD/HD typically have a great deal of difficulty achieving success academically and/or socially. Difficulty with organizing work and completing assignments often translates into school marks far lower than would be predicted by the AD/HD student's ability. The student with impulsive tendencies can have further difficulty establishing and maintaining positive relationships with peers and teachers. These interrelated difficulties can cause a spiral effect as the student grows older. Difficulty with organization can lead to lower marks. Academic frustration and peer relationship problems can contribute to a feeling of rejection, which in turn can lead to depression, and depression can impact on all areas of student functioning. When educators, parents and significant others work together with these students this destructive spiral may be counteracted.
This resource guide is intended to assist teachers in planning and providing supports for students displaying the characteristics associated with AD/HD. In some cases, a formal diagnosis has been made or assessment has been requested. In other cases, the student needs support to achieve success even though a diagnosis has not been made.
This guide includes the following sections:
Attention-Deficit Hyperactivity Disorder (AD/HD) is a neurological disorder requiring a clinical diagnosis based on criteria outlined in The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV). Students with AD/HD demonstrate significant impairment related to inattention and/or hyperactivity and impulsivity compared to average children of the same age. The prevalence of AD/HD is estimated to be 3 - 5 % of the school-aged population. Clinicians typically report that boys are referred for AD/HD assessment nine times more often than girls, while studies using a general population base indicate that the ratio of boys to girls with the disorder is closer to 3:1.
The following information should be collected by a multi-disciplinary team to assist in making an AD/HD diagnosis:
life history and background of family members, including medical and psychiatric history, developmental history of the student, including birth history, developmental milestones, records of classroom-based and individual assessments that may be included in the student's permanent record folder at school and medical history, current physical examination to rule out other health concerns, information about a student's learning abilities and academic skills, ratings of the student's behavior using standardized behavior rating scales to be completed by parents and teachers, and descriptions of the student's behavior in various settings over time provided by parents and teachers (objective observational data provided by the school could be very useful in this regard).
In addition, psycho-educational testing is helpful to determine the student's learning strengths and needs and to determine if learning disabilities are impacting on the student's school achievement.
Matthew, a grade
four student, has a hard time getting started on his journal every morning. He
loses his pencil and can't find his notebook, usually due to the mess in his
desk. As a result, he often wanders around the classroom to borrow things, and
in the process, forgets what he was supposed to do in the first place. He
rarely completes written assignments. His mother has recently mentioned to the
teacher that getting Matthew out of bed and ready for school in the morning is
getting harder and harder everyday. He complains that "none of the other
kids like him".
The following symptoms are listed in the DSM-IV and are used by qualified health professionals to diagnose AD/HD. Some of these symptoms must be displayed in a number of settings, persist over at least six months and must have been observed prior to age seven in order for the diagnosis to be made. The following information is not intended for diagnostic purposes; a referral for diagnosis should be made to a physician or registered psychologist with training in AD/HD and other childhood disorders. Under current IDEA criteria, a diagnosis of AD/HD that has an educational impact qualifies the child for service under Other Health Impaired. The following symptoms are paraphrased from the DSM-IV.
Inattention Symptoms
Often:
June sits staring
out the window. Ms Smith asks the class to get out math books. June reaches in her desk and pulls out a
teen magazine, flipping to the picture of the latest teen movie star. Later she
wonders why everyone else knows how to do the math questions. She looks over at
the way Samantha is doing her work and wonders how she'll ever know what to do.
Often:
Cameron, a grade
nine student, is the life of the class. He always has an interesting story to
tell, rarely related to the subject being studied. He gets along so well with
his peers that no matter where the teacher places him in the classroom, he
spends more time socializing than working on the assigned tasks. Teachers, as a
last resort, often ask him to sit in the hall so that others can do their work.
Cameron is fascinated with computers and cars and will spend endless hours
designing programs, working on his car or reading car or computer magazines. He
often misses class on test days, especially when an essay test is expected.
He's barely passing Language Arts and Social Studies, even though a psychological
assessment done when he was in Grade 3 indicates that he has high average
ability.
Impulsivity Symptoms
Often:
When caught
fighting on the playground for the third time this week, Suzie, a grade seven
student, explained that it "wasn't her fault". Karen had made a face
at her and the other kids were always calling her names. "You're always
picking on me!", she exclaimed to the principal when called into the
office. "Nobody ever listens to my side of the story!"
Antonio, a grade
10 student, is thinking of quitting school. He was in a car accident last week.
He expected the car ahead of him to turn left on the amber light and intended
to follow before the light turned red. That stupid woman, didn't she know how
to drive in the city? Anyway, he missed a few days of classes because of the
accident (how else was he going to get his car fixed?) and now was very close
to failing most of his courses. What was the use anyway? He'd never get good
enough marks to get into the mechanics course he was planning on, anyway. It
would be so great to sleep in everyday without his mother yelling that he'd be late
for school....
The DSM IV outlines three types of AD/HD:
1.AD/HD Combined Type
Six or more of the symptoms of inattention and six or more of the symptoms of hyperactivity-impulsivity have persisted for at least six months in a child's behavior. Most children and adolescents with AD/HD have the combined type.
2.AD/HD Predominantly Inattentive Type
Six or more of the symptoms of inattention, but fewer than six of the symptoms of hyperactivity impulsivity have persisted over at least six months in a child's behavior.
3.AD/HD Predominantly Hyperactive - Impulsive Type
Six or more of the symptoms of hyperactivity-impulsivity, but fewer than six of the symptoms of inattention have persisted for at least six months in a child's behavior.
Can other disorders accompany AD/HD ?
Students with AD/HD often have other problems as well. Twenty to twenty-five percent of these students also have learning disabilities. The incidence of oppositional defiant disorder and conduct disorder is higher in students with AD/HD than in the general population. Some students with AD/HD have accompanying emotional disorders such as depression or anxiety. A small percentage of students with AD/HD also have Tourette's Syndrome. In addition, students with AD/HD often have difficulty with motor skills and coordination. Teachers should keep in mind that many students with AD/HD do not have an additional disorder.
Are there other conditions that produce similar symptoms?
The symptoms associated with AD/HD can result from a number of conditions, some physical, some environmental, and some genetic. While it is possible for students with AD/HD to be affected by a number of other conditions, some children displaying these symptoms are doing so for reasons other than AD/HD.
Some circumstances that can result in students displaying patterns of behavior similar to AD/HD are:
Teachers should keep in mind that the presence of symptoms associated with AD/HD is not sufficient for diagnosis. Many young children display hyperactivity for a variety of reasons, many of them environmental. Lack of parental attention or supervision, diet, and numerous other reasons can lead to a misdiagnosis of AD/HD, when in fact the child simply needs some structure and guidance. Remember, taking a drug such as Ritalin does not automatically imply that the child has AD/HD, nor does having a diagnosis of AD/HD imply that the student will automatically qualify for special education services. The disability must also have an identifiable impact on the child’s learning. Assessment must consider all possible causative factors and the consistency of these symptoms over time and in a variety of settings. A broad range of possibilities should be explored to ensure that all students are appropriately assisted to achieve their potential.
Students with AD/HD display a persistent pattern of inattention and/or hyperactivity/impulsivity. These students often experience impairment of their ability to address social, academic and vocational expectations. In the classroom, teachers often see students with AD/HD struggling with their school work.
Students with AD/HD may demonstrate the following characteristics in the classroom:
Myth #1: All students with AD/HD display aggressive, acting out behaviors that eventually lead to trouble with the law.
Fact: Many children and youth with AD/HD are not aggressive, violent, or in trouble with the law. Some,
particularly those who are predominantly inattentive, tend to be withdrawn and reclusive. While students with AD/HD are at greater risk of behavioral problems, appropriate early intervention can reduce the risk.
Myth #2: Medication is the only intervention that works with these students.
Fact: A number of strategies including training for teachers and parents in management strategies are proven to be effective components of treatment for students with AD/HD. Many experts in the field believe that medication may be necessary to maximize the effectiveness of other strategies. In any case, medication alone should never be the sole intervention.
Myth #3: Medication used to treat AD/HD is addictive and will cause drug abuse.
Fact: Stimulant medication taken as directed has not shown to be addictive by scientific studies. Students who respond well to medication and are academically and socially successful may be less at risk for drug misuse and other emotional problems.
Myth #4: The AD/HD diagnosis is being overused.
Fact: Researchers estimate that 3 - 5% of the school aged population have AD/HD. Current medical statistics indicate that the number of children diagnosed in Canada is well within this figure.
Myth # 5: Only boys can be AD/HD.
Fact: Although boys are more likely to have AD/HD than girls, it is not a gender-specific disorder. Clinicians typically report that boys are referred for AD/HD assessment nine times more often than girls. Studies using a broader population base generally indicate that the ratio of boys to girls with the disorder is closer to 3:1.
Teaching students with diverse needs has become the norm in most classrooms in Sevier County. Decades ago, students who had difficulty achieving success in the school system simply quit and entered the work force. As the job market has become more competitive, high school graduation has become a minimum requirement. Over the years, educators have worked to keep pace with this change. Making adjustments to the delivery of educational programs is one way to ensure that more students are able to achieve their full potential. Effective teaching requires consideration of student differences. The challenge for teachers is to provide each student with learning activities that:
Identifying students who are not reaching their full potential is an ongoing process. As teachers observe students working in the classroom, the strengths and needs of individuals become apparent. Some students appear to understand the concepts presented, but for some reason, are unable to complete assignments or prepare for tests. Some have so much difficulty attending to instruction that teachers are unable to determine whether these students understand the concepts presented or not.
When the teacher notices that a student is struggling to meet the expected learning outcomes, a systematic process should be followed. Not only is the professional response, it is also the legally mandated one. Sevier County Schools expects teachers to make concerted efforts to provide appropriate and well-designed instruction for all students in the general education classroom whenever and wherever possible. In order to make certain that the needs of the student are met, certain steps must be taken. These steps might include:
In some cases, the instructional adjustments made by the teacher will effectively assist the student to achieve success in the classroom. In other cases, in spite of the teacher trying a number of different instructional strategies, the student continues to struggle. In these cases, other professionals might be able to assist in planning effective programs for students with AD/HD.
If the student continues to struggle after adjustments have been made and efforts documented through collections of the student’s work as well as anecdotal records kept by the teacher, the classroom teacher, in consultation with the parents, should seek the support of other school personnel. This may include other teachers, including those who have previously worked with the student, the Consulting Teacher (or special education supervisor if needed), and/or the Resource Teacher, the School Counselor, and/or the Principal or other administrator. The teacher may also be assisted by colleagues through a process of consultation and collaboration. This may take the form of classroom observations, additional assessment, adapted instructional strategies, implementation and evaluation of those strategies, or intervention by the school counselor. For many students, such collaborative planning and the resulting interventions will successfully address the student's needs. If this is not the case, the teacher can approach the school-based IEP team for further assistance.
When addressing a referral for a student who may have AD/HD, the school-based support team (S-Team) should :
The structure and process followed by school-based support teams vary from school to school and from system to system. Teachers should check with school administrators or school-based special education staff to find out more about the school-based support team in their schools.
The school-based support team carries out further assessments and develops and implements support strategies to assist the classroom teacher in meeting the student's needs. If additional assistance is still needed the school based team may decide to make a referral to district based services or community professionals and services.
School Psychology is a district or area based resource to help teachers and parents plan educational programs for students. Most schools have a school psychologist as a part-time member of their staff, working from the district or superintendent’s office. On some occasions the system may contract private psychologists to complete assessments of students' learning needs. The decision to contract privately may only be made through the Department of Special Education’s administration. This is not a school-based administrative decision, unless the school is intending to contract and pay for the service themselves.
School psychologists may coordinate the data collection required for diagnosis of AD/HD. They would probably use a norm-referenced behavioral rating scale to gather information from teachers and parents about the student's behavior in various settings over time. In some cases, especially if learning disabilities are suspected, a thorough psycho-educational assessment may be conducted. This would usually include assessing a student's cognitive abilities and school achievement to establish the student's educational strengths and needs. It is important to note that not every child suspected of being AD/HD requires a full psychological battery of tests. The special education teacher in consultation with the school psychologist and other support team members, need to make those decisions collectively. Classroom teachers should provide information about the student, but they are generally not qualified to make a determination about whether or not testing for a specific disability should be done. Under no circumstances, should a general education teacher ever recommend to a parent that a child be tested for a specific disability that requires a medical or psychological diagnosis. The act of recommending places the teacher and school in a precarious position and makes them liable for all costs incurred as a result of that recommendation.
Because the school psychologist is able to observe the student in the school setting, he/she can help teachers, parents and students in a number of ways. Based on information collected through formal and informal assessment techniques, the school psychologist can assist to:
Depending on the educational needs of the student and the availability of specialist staff at the school district level, the school-based team might refer a student to
The roles of these specialist staff vary from district to district. In-school administrators and/or members of the school-based team should be aware of how these district based personnel can support teachers and students at the school level.
If the information collected about a student indicates that he/she might have AD/HD or another medical condition that affects attention, impulsivity and/or activity level, parents may wish to make a referral to a physician or registered psychologist for a formal diagnosis to be made.
Because most students with AD/HD are unlikely to demonstrate symptoms of the disorder in a one-on-one clinical setting (like the doctor's or psychologist's office), data collected at the school must be used to assist in the diagnostic process. Providing objective observational data in a number of different settings over time can provide community professionals with valuable information that is impossible to collect during a visit to the clinic.
Community based professionals can assist families with medical and general management of the student with AD/HD. For example, counseling for the student and/or the family, parent support groups, and assistance with medical management may be services available in the community. When parents access community-based supports, educators and parents should work together so home and school support can be coordinated whenever possible.
Students with AD/HD may benefit from adjustments to several aspects of their lives. If parents and educators, along with other service providers, are able to work together to help these students, they are more likely to become independent adults. A combination of individual and family counseling, parent training and support groups, appropriately structured educational programs, and sometimes medication may be recommended.
On a case by case basis, effective management should include some of the following components:
The most fundamental element in effectively managing this disorder is increasing the understanding of AD/HD in teachers, parents, and the students with AD/HD themselves. Providing information to each of these groups about the nature of AD/HD and strategies that have proved useful is critical. Building empathy in teachers and parents will increase their ability to be effective and view the student's difficulty in the context of a disorder rather than purposeful misbehavior or lack of effort. Students need to be helped to develop a positive attitude about learning to deal with AD/HD rather than to lean on the label as an excuse for lack of effort and learned helplessness.
When educators have a thorough understanding of AD/HD management strategies, they can plan and provide day to day activities that successfully include the student with AD/HD. Many teacher professional development activities teach skills for managing and reinforcing appropriate behavior. Recently published books and videos about AD/HD can be valuable resources (see Appendix 1).
In addition to learning about managing the disorder, teachers of students with AD/HD may benefit from the experiences of others who have worked with students with AD/HD. Many communities around the province have local chapters of provincial and national support groups that may be able to provide parents and educators with information about locally available supports. See Appendix 1 for a listing of these organizations.
The student with AD/HD also need to develop an understanding about the disorder. Teachers may be part of the support system to assist students in self understanding and acceptance. A supportive relationship with a teacher has proven to be one of the most significant positive influences on students with AD/HD. Often, students who lack important social skills and/or have difficulty learning suffer from a loss of self-esteem. As students with AD/HD grow older, they may need help with issues of peer acceptance and walking the fine line between independence and belonging. On a case by case basis, some of the following may be planned to enhance a student's self esteem:
Students with AD/HD typically have underdeveloped self-management skills which affects their ability to plan and carry out tasks to completion. This deficit could result in students having difficulty with the following skills:
External structures such as those listed below can assist students to compensate for their limited self management skills:
Only by teaching and reinforcing the above noted strategies can educators increase their effective use. Staff and/or students (including the case manager, a teacher's assistant, the homeroom teacher, a study partner, or a child care worker) can assist the student with AD/HD to use these strategies to keep on track at school. The ultimate goal should be to help the student to develop self-monitoring strategies that will assist them to function effectively on their own. ( See Appendix 2).
For greatest effectiveness, teachers are encouraged to work with parents to support students with AD/HD. For example, a communication book signed by parents can be used to ensure that parents are aware of issues that arise in class and teachers are aware of issues that arise at home. Both should ensure that positive messages are included frequently, as parents and teachers can grow discouraged when negative comments dominate communication. An agenda for older students can be used to ensure clear communication about assignments, projects and upcoming tests. An extra set of text books at home can reduce the number of lost or misplaced books. For student with severe difficulties, daily or weekly progress reports to parents can assist teachers to involve parents in ongoing support. In some cases, teachers and parents may wish to establish a reward system in which points that are awarded for school behaviors are used to earn home-based reinforcers.
Students with AD/HD should receive school based support services if the disorder significantly affects their school performance. An estimated 25% of students with AD/HD also have learning disabilities. When students with AD/HD have academic difficulties, they may be supported through Learning Assistance programs or services for students with Severe Learning Disabilities. Students who need behavioral support in order to achieve success at school may be supported through programs for students with moderate or severe behavioral disorders. Specific examples of academic and behavioral support will follow in the Case Studies section of this book.
An intervention plan for some students with AD/HD may include pharmacological treatment. While the media has described much controversy about using medication to treat AD/HD, scientific research describes medication as one of the most effective treatments for the disorder. The use of medication should be supervised regularly by the prescribing physician. The doctor, parent, child and school staff should all contribute important information to establish a baseline of symptoms and assist in monitoring the effects of medication on behavior and academic performance. Medication alone should never be the sole intervention. While medication may assist the student to focus on learning, it will not compensate for skills and knowledge that have not been acquired.
The decision whether to use medication or not is one that should be made on a case by case basis by the family of the student with AD/HD and their physician. Student involvement in the decision is important. At times, parents may call upon teachers to provide information or opinions about medication. Teachers should not provide recommendations to parents regarding medications; they should direct these queries to a physician trained to deal with AD/HD and other childhood disorders. Teachers can provide observational data describing the student's behavior to assist in monitoring medication. Because medication must be administered regularly, the family may request that the school administer medication. Teachers should be aware of district policies and procedures related to the administration of medication, including confidentiality for the student. Accurate records should be kept of medication administration. Stimulant medications are often prescribed in the treatment of AD/HD. Many people question why stimulants would be used for students who already appear to be over stimulated. Some research shows certain areas of the brain of students with AD/HD which control circulation are not as active as those of other children. These medications stimulate the areas of the brain which control concentration which allows the child to stop and think before acting. Other medications or combinations of medications may be prescribed for students with AD/HD.
Establishing a classroom environment that is friendly to students with AD/HD as well as other diverse needs requires careful planning. Students with AD/HD may appear to be willfully avoiding work when they lack the skills needed to begin the assignment. Working with these students can be frustrating at times. Teachers are encouraged to keep a disability perspective: AD/HD is a disorder that affects students' abilities to begin and follow through on tasks. These students are not "out to get" the teacher, although it may feel that way to the teacher during a stressful day at school. Teachers need to be responsive to the educational strengths and needs of individual students to ensure that appropriate expectations are established. The strategies presented in this section may assist teachers to minimize their frustration and maximize the students' ability to learn. Such strategies may be needed to support students with AD/HD throughout the school years. These strategies can also be helpful to other students in the class.
Many students with AD/HD can benefit from classroom based adaptations and support throughout their school years. Teachers may wish to use a planning tool to record the support provided. The AD/HD Accommodation Plan, used in each of the following case studies, is an example of a planning tool teachers find helpful.
Students with AD/HD who are receiving special education services require an Individual Education Plan (IEP). The AD/HD Accommodation/Support Plan could be used as part of the IEP planning process.
Structure classroom activities that require active learning and a high response rate from students. When an instructional style that enables students to actively participate in learning is used, students are more likely to remain on task during instruction. On the other hand, when students are required to sit and listen for long periods of time, students with AD/HD may display more inattentive and/or disruptive behavior. The following strategies can be used to maximize student involvement in learning:
Teach students organization skills that will help them to complete assignments. Teachers confronted with students who can not seem to keep track of belongings and assignments may wish to try the following
organizational system. While elements of this system could be used with individual students who require support, it is more likely to be successful if the whole class uses it regularly. In some cases, whole schools have decided to use some of these strategies to provide consistency for students across subjects and grades.
Establish the use of one large binder for all subjects with pocket dividers for each subject and hole punched pencil case for writing tools. A smaller binder with two pocket dividers could be used for primary students. Ensure that each student also has an agenda inside the binder. At the end of each class or day, post homework and tests and ask students to record required homework in their agendas. A buddy system to check the completion of each agenda and the inclusion in backpacks of materials required to complete homework can help to ensure students take home what they need. Assignments posted on flip chart paper or in an assignment binder at the back of the classroom can become a permanent record which students can consult when they have missed classes or are having trouble understanding or remembering what to do. An agenda of daily activities posted on the board can be an added visual organizer. Encourage students to use a backpack to carry the binder. Ask them to take the backpack from school to home and back again everyday so that it becomes a daily routine. If no assigned work is to be completed, the homework could be to organize the binder and backpack. Secondary students who are required to move from class to class may opt to keep all materials in a large pack, rather than in a locker, to reduce the possibility of losing necessary materials. Provide students with a "day at a glance" that can be used as a checklist on their desk as assignments are completed. Post a list of required materials on the inside of student lockers to encourage them to maintain a supply of materials needed.
Use strategies to maximize positive interaction with students and minimize opportunities for disruptive behavior.
Move around the classroom.
Look around the classroom. Provide immediate, specific feedback on learning and behavioral progress whenever possible.
Establish eye contact with most students prior to giving instructions to the class.
Talk to individuals and groups of students to build rapport and to establish and expand understanding of the learning outcomes.
Comment on positive, rather than negative behavior, whenever possible. Make comments specific to expected behaviors (e.g. I see that your outline is almost compete - good work!).
When verbal reprimands are necessary, move comfortably close to the student and use a soft, firm voice to specifically describe the behavior that is required. Avoid publicly criticizing students.
Clearly communicate rules and behavioral expectations and establish classroom routines.
"I didn't know we were supposed to do that!" is a common cry heard by teachers everywhere. While it may seem that students are being purposely noncompliant, many students, especially those with AD/HD, have difficulty with short term memory which can affect their ability to carry out verbally presented directions. Students with AD/HD can be taught to monitor their own behavior. The challenge for a teacher is to provide structure while helping to develop in the child a sense of control in life.
The following strategies can provide external structures for students who have difficulty internally regulating their behavior:
Using teaching strategies that combine more than one modality can enhance the student's ability to remember and understand information and directions. The following are examples of multi-sensory strategies:
Establish a physical plan that maximizes productivity.
The following strategies may help teachers to establish productive work spaces for all students :
In some cases, students with AD/HD will require individualized support, in addition to some of the accommodations listed above, to achieve success in the classroom. Specialized personnel such as learning assistance teachers, resource teachers or behavioral consultants should be involved in program planning for these students. For some students this planning may include the development of an Individual Education Plan (IEP).
1.Identify and carefully describe Target Behaviors
Direct observation can serve as a key source of information about a student's behavior and performance in a given setting. Observations are non judgmental descriptions of what a child actually does, as well as events that occur just prior to (i.e., antecedents) and just after (i.e., consequences) that behavior. Clearly describe specific behaviors that must be increased or decreased in order for the student to achieve success. Prioritize these behaviors and make a plan to address a manageable number of them.
2.Measure the frequency of target behaviors
Classroom teachers will want to use efficient, time-saving data collection systems. The data collected should reflect what the child actually does, what is happening in the environment when the behavior occurs, the consequences of the behavior, as well as the frequency. Observe the student several times and in different situations and compare the behaviors you see in each situation before you draw any conclusions. This data can be used for planning interventions as well as for providing information to medical professionals that may lead to a diagnosis.
To optimize the accuracy of your data collection, consider the following:
Specialist teachers, trained classroom assistants or volunteers could take more detailed observational data.
3.Involve the student in setting goals to reduce or increase the target behaviors and establishing a system to monitor and reinforce the behavioral change.
A critical part of the plan should include teaching the student appropriate behaviors to replace those that are being reduced. Some inappropriate behaviors are well established and frequent practice and reinforcement of more productive responses may be necessary for positive change. These replacement behaviors must be relevant and effective for the student.
A response cost system could be established in which points or tokens are awarded for meeting the goals of the behavioral plan and withdrawn when goals of the plan are not met. Points or tokens could then be used to "buy" privileges (e.g. computer time, preferred activities) or tangibles (e.g. sports cards, stickers, pencils). In some cases, parents and teachers may wish to collaborate to establish home rewards (e.g. family pizza night, choice of video rental, time to play video games) to reinforce points earned at school.
Include some behaviors in which the student is certain to succeed when setting reinforcers so the student achieves a feeling of success.
In many cases, students with AD/HD will require adaptations to instructional strategies or assessment to ensure progress in school. Some students with AD/HD may require modifications to curricular outcomes in specific subject areas.
1.Adaptations
A student who is provided with accommodations or supports in order to achieve the learning outcomes of the Tennessee curriculum is considered to be receiving adaptations. Adaptations required by students with AD/HD could include, but are not limited to:
a.Adaptations to Lesson Presentation
giving a structured overview before the lesson
using visual aids, demonstrations, simulations and manipulatives to ensure that students understand concepts presented
using an overhead projector and keeping each overhead for later review by the student
color coding with chalk or pens to add emphasis
providing a copy of teacher or peer notes to allow student to focus on listening
providing "turn and talk" or activity breaks to assist the student's ability to focus on instruction
providing a written outline or frame for students to fill in
enabling the student to tape record material presented verbally
using computer assisted instruction
establishing routines that enable the student to check understanding with a peer
including a variety of activities for the student in each lesson
collaborative planning with the learning assistance teacher to pre-teach key vocabulary and concepts
b.Adaptations to Assignments, Projects and Tests
giving instructions visually and verbally,
pairing students to check work
breaking large assignments into smaller parts and providing feedback and reinforcement as each part is
completed,
providing additional time to complete assignments or tests,
encouraging the use of manipulatives to understand mathematical concepts,
providing checklists, outlines, advanced organizers, etc. to assist in assignment completion,
supplying reading materials at independent reading level,
requiring the completion of fewer examples in drill and practice activities while maintaining the conceptual
difficulty of the assignment,
providing audio tape to assist students to focus on the material to be read and to maximize understanding.
using computer assisted drill and practice or simulation activities,
enabling students to demonstrate understanding using a variety of media including oral presentations, audio
or video taped assignments, bulletin board displays, dramatizations, and demonstrations,
enabling students to word process, rather than write, assignments
giving frequent shorter quizzes rather than longer tests that require a great deal of memorization,
giving tests and exams orally or on audio tape,
enabling students to audio record test answers on tape,
using a calculator or tables of basic facts to enable students who have difficulty memorizing to work on
higher level concepts in math and science
c.Organizational Supports
d.Compensatory Skills
2.Modifications
In most cases, the needs of students with AD/HD will be addressed by adapting instruction, strategies and/or assessment techniques. In a very few cases, students with AD/HD are unable to achieve the learning outcomes of the provincial curriculum, regardless of how much support is provided. These students require modifications to the learning outcomes to address their needs.
The following case studies illustrate the planning process and subsequent accommodation plans for students who display some of the characteristics of AD/HD. In some cases, a formal diagnosis has been made; in others, the reason for the learning or behavioral difficulty may be less clear. Teachers are encouraged to use the ideas presented here as suggestions for working with students who have similar characteristics while keeping in mind that every student is an individual. Strategies that are effective with one student are not guaranteed to be effective with another. Focusing on the individual strengths and needs of each student is one way to ensure that the support provided addresses each student's educational needs.
Case #1: Melodie - Grade 1
Melodie, 6, moved into Metropolis Elementary from Los Angeles in January of her grade one year. Her mother, a homemaker who appeared somewhat exhausted from managing Melodie, met with Miss Fontaine, the Grade 1 teacher. She informed the teacher that Melodie had been on Ritalin since Kindergarten and would need some special attention. She and her husband, an engineer, were looking for any suggestions the school could provide in managing Melodie at home as well. Miss Fontaine indicated that she would review Melodie's file and asked Melodie's mother if she and her husband could come in to meet with her and the school based team next week to discuss Melodie's program.
During the first week, Miss Fontaine made the following observations:
Melodie is cheerful and friendly. She seems keenly interested in pleasing the teacher and her classmates.
Melodie appears to have a strong understanding of verbally presented information, knows her colors and can count to 100. Melodie's literacy skills are at the emergent stage - she cannot recall letter names and does not appear to have any sight vocabulary. Maintaining one to one correspondence with objects while counting is difficult for Melodie. Melodie completes 2 out of 20 questions when not medicated (she indicated that she forgot to take her pill on Thursday morning); she completes entire sheet of 20 questions when she has taken her medication During both individual and group instruction, Melodie frequently interrupts to ask unrelated questions and change topics. When interacting with peers, Melodie constantly changes topics and commonly leaves an activity or game while others continue to play.
Information from Melodie's file indicated that she had received a psychological assessment and had been identified as having AD/HD as well as learning disabilities. She had been placed on a wait list for a special class placement in Los Angeles.
Miss Fontaine brought Melodie's case forward to the school-based team meeting so that planning could take place immediately. Mr. and Mrs. Marshall were invited and were able to meet with the team on Thursday of the second week Melodie had been enrolled at the new school.
At the meeting, the team agreed that acquiring literacy skills and helping Melodie to focus on the topic at hand were the most important goals to begin with. The following plan was developed.
Name: Melodie Marshall
Grade: 1
Date: January 21, 1998
School: Metropolis Elementary
Completed by: Mr. Copps, LA/Res.
Review Date: March 1998
1. Indicate the student's areas of strength:
Academics:
Personal Skills
___ Reading decoding
___ Computers/ technology
___ Reading comprehension
___ Interacting with peers
___ Written expression
___ Memory
_X_ Mathematics - recall of basic facts Can count to 100
___ Leadership Skills
___ Mathematics - conceptual understanding
___ Interacting with adults
_X_ Rich oral vocabulary
___ Requests help when needed
_X_ Ability to understand complex concepts
___ Sense of humour
___ Spelling
_X_ Responds well to praise
___ Other, please specify _________________________
_X_ Demonstrates enthusiasm
Areas of Interest
___ Other, please specify _________________________
___ Computers / video games
Comments:
___ Television / movies
___ Sports (specify) _________________________
___ Visual arts
___ Music (specify) _________________________
___ Volunteer activities (specify)
_________________________
___ Other accomplishments
_________________________
2. Indicate areas of concern that are significantly affecting the student's ability to learn and interact with others at
school:
Academics:
Behaviour:
_X_ Memory
_X_ interacting with adults
___ Understanding and following instructions
___ motor activity detrimental to learning (describe)
_________________________
_X_ Reading decoding
_X_ interrupting, blurting out, inappropriate
verbalizations talks constantly, changes topics,
leaves activities
_X_ Reading comprehension
_X_ interacting with peers in class
___ Written expression
_X_ interacting with peers at lunch and recess breaks
___ Mathematics - recall of basic facts
___ complying with staff requests
_X_ Mathematics - conceptual understanding One to
one correspondence
___ transitions between activities or classes
___ Limited oral vocabulary
___ behaviour during loosely structured activities
(assemblies, field trips, etc.)
___ Ability to understand complex concepts
___ attendance
___ Spelling
___ Other, please specify
_________________________
___ Other, please specify
_________________________
Organization:
___ handing in assignments
___ keeping track of necessary materials
___ time management
___ completing tasks
___ getting started on assigned work
Comments:
Goals/Person Responsible
Strategies
Progress Observed
1. Improve literacy skills.
Mr. Copps, LA/Resource Teacher
(20 minutes daily small group)
· Pull-out small group literacy instruction focusing on reading high interest stories, and
· Building sight vocabulary through key words – Melodie will select a high interest word everyday, print it on a card, illustrate it and review her key words several times each day
____________________
____________________
____________________
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Miss Fontaine, Classroom Teacher
· Follow-up practise on key words,
· Pocket chart activities for class to focus on building sight vocabulary
____________________
____________________
____________________
2. Improve focus on topic.
(Miss Fontaine)
· Provide picture cue cards of topic being discussed in content area subjects and direct Melodie to restrict comments to the topic on the card
· Encourage use of privacy board to limit distracting stimuli during independent work
· Remind Melodie of expectations prior to loosely structured activities (circle time) and seat near teacher
· Pair with positive role model for pairs activities during math centers; provide structured activities to do with manipulatives
____________________
____________________
____________________
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Case Study #2: Danny - Grade 3
Ms. Davies, Danny's grade three teacher, called Danny's foster parents, Mr. and Mrs. Farmer, and asked them to come in for a meeting. She was finding that Danny was increasingly difficult to manage both on the playground and in class. At the meeting, Ms. Davies described her concerns about Danny's behavior in school, and the parents indicated that Danny had similar difficulties at previous schools.
Together they reviewed the areas of concern and decided that aggressive playground behavior and not following teacher directions in the classroom were the most pressing areas of concern. Ms. Davies and the Farmers agreed to implement a behavior program focusing on these two concerns. To encourage Danny's compliance to instructions, Ms. Davies would monitor her instructions to Danny and track whenever he complied or not. Each time Danny complied, Ms. Davies moved a poker chip from one pocket to another. For each incident of non-compliance a chip was moved back. If all chips were in the right pocket when the lunch bell rang, Danny was rewarded with 15 minutes of computer time during lunch hour. Behavior at recess and lunch was tracked using the school-home report below and good days were rewarded with home activities given by the Farmers. A good week earned a bonus reward of a larger activity on the weekend.
Recess/Lunch Program
Name: __________________________
Week of _________________________
Key: 1 = Excellent
2= Ok
3=Not Ok
Behavior M T W & F
1 Keeping my cool
2 No rough stuff
In addition, Ms. Davies and Danny's foster parents identified task completion as the most pressing academic concern. It was agreed that Ms. Davies and Ms. Mooer would provide additional support and adaptation to Danny's program in order to address this area.
Name: Danny Jackson
Grade: 3
Date: September 25, 1997
School: Coastview Elementary
Completed by: Ms. Mover, LAT
Review Date: November 25, 1997
1. Indicate the student's areas of strength:
Academics:
Personal Skills
_X_ Reading decoding
___ Computers/ technology
_X_ Reading comprehension
_X_ Interacting with peers
___ Written expression
___ Memory
___ Mathematics - recall of basic facts
___ Leadership Skills
___ Mathematics - conceptual understanding
___ Interacting with adults
___ Rich oral vocabulary
___ Requests help when needed
_X_ Ability to understand complex concepts
___ Sense of humor
_X_ Spelling
___ Responds well to praise
___ Other, please specify _________________________
___ Demonstrates enthusiasm
Areas of Interest
___ Other, please specify _________________________
_X_ Computers / video games
Comments: New student: may have other strengths
___ Television / movies
___ Sports (specify) _________________________
_X_ Visual arts loves to draw
___ Music (specify) _________________________
___ Volunteer activities (specify)
_________________________
___ Other accomplishments
_________________________
2. Indicate areas of concern that are significantly affecting the student's ability to learn and interact with
others at school:
Academics:
Behavior:
_X_ Memory
___ interacting with adults
_X_ Understanding and following instructions
_X_ motor activity detrimental to learning (describe) out of seat, disrupts peers__
___ Reading decoding
_X_ interrupting, blurting out, inappropriate verbalizations
___ Reading comprehension
___ interacting with peers in class
_X_ Written expression
___ interacting with peers at lunch and recess breaks
___ Mathematics - recall of basic facts
___ complying with staff requests
___ Mathematics - conceptual understanding
___ transitions between activities or classes
___ Limited oral vocabulary
___ behavior during loosely structured activities (assemblies, field trips, etc.)
___ Ability to understand complex concepts
___ attendance
___ Spelling
_X_ Other, please specify defensive when corrected
Organization:
_X_ handing in assignments
_X_ keeping track of necessary materials
___ time management
_X_ completing tasks
___ getting started on assigned work
Comments:
Strategies
Progress Observed
1. Reduce aggressive behavior during unstructured activities
· Teach expectations for school wide behavior develop 3 rules
· Set firm limits: "hands-off"
· Provide supervised recess, if necessary
· Teach and provide practice of alternate, non aggressive strategies across situations
· Reinforce alternative strategies at home and in the community ( by parents)
____________________
____________________
____________________
____________________
____________________
____________________
2. Increase rate of compliance to teacher requests
· Teach expectations for compliance and provide practice across situations with positive reinforcers (time on computer)
· Provide 3 step level of intervention:
- verbal reminder or signal
- in class time out
- alternative classroom time out
____________________
____________________
____________________
____________________
____________________
____________________
3. Improve legibility of written work.
Ms. Davies
· Provide graph paper for Danny to use for math calculations so that the numbers will line up
· Decrease the amount of written work necessary so that Danny can work on quality over quantity (when necessary, provide photocopies of notes)
· Give Danny opportunities to start word processing assignments, if possible
____________________
____________________
____________________
____________________
____________________
____________________
4. Increase the number of time Danny is prepared for class with pencil, eraser and notebook.
Ms. Davies
· Provide central location for supplies of pencils, pens, etc.(cutlery tray near teacher's desk). Encourage all students to return stray items to the tray throughout the day.
· Establish a routine of listing materials required on the board before each activity (ruler, specific books, etc.)
· Laminate a short list (something to write with, something to write on, check the blackboard) to remind Danny what he needs at the beginning of each class.
____________________
____________________
____________________
____________________
____________________
____________________
____________________
Case Study #3: Kuldeep - Grade 5
Kuldeep is an 11 year old boy in Grade 5 who lives with his mom, dad, and younger brother. Dad has a history of AD/HD, inattentive type. Both parents are very supportive of the school; Kuldeep's mom often volunteers at school functions. Kuldeep was referred for a psycho educational assessment during his grade 4 year because his teacher was concerned that he may not be progressing according to his ability.
In addition to assessing Kuldeep's achievement and ability, the school psychologist collected some information about Kuldeep's behavior using a norm-referenced behavior rating scale. The psycho educational assessment showed that Kuldeep was below grade level in his reading and written expression skills (at the 15th percentile for his age) while his overall ability was in the average range. Information from the assessment also indicated to the school psychologist that Kuldeep may have AD/HD, predominantly inattentive type and recommended that the family refer Kuldeep to a pediatrician or registered psychologist for further assessment. As a result, Kuldeep was recently diagnosed with AD/HD and is on a trial of medication.
Kuldeep's grade 5 teacher, Mr. Shaker, observed the following in class, prior to the trial of medication:
Kuldeep often appears unaware of what is happening in class. He becomes immobile, staring straight ahead and when as