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School Interventions for Children with ADHD
School Interventions for Children with ADHDBrandon K. Schultz, Ed.D., NCSP
Alvin V. Baird Attention & Learning Disabilities [email protected]
Brandon K. Schultz, Ed.D., NCSP
Alvin V. Baird Attention & Learning Disabilities [email protected]
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
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.