Resources
Introduction
Attention deficit disorders are disorders characterized by serious and persistent
difficulties in attention span, impulse control, and hyperactivity. Attention
Deficit Disorder (ADD) is a chronic disorder that can begin in infancy and extend
through adulthood. It can have a significantly negative effect on an individual's
life at home, in school, or in the community. There are two types of attention
deficit disorders: undifferentiated Attention Deficit Disorder (ADD) and Attention
Deficit Hyperactivity Disorder (ADHD). In undifferentiated ADD, the primary and most
significant characteristic is inattentiveness but hyperactivity is not present.
These students still manifest problems with organization and distractibility, even
though they may seem quite and passive. These students also tend to be overlooked
more easily in the classroom, and may be at a higher risk for academic failure than
those with ADHD.
To be diagnosed as having ADHD a student must display, for six months or more,
at least eight of the following characteristics prior to the age of seven:
- fidgets, squirms, or is restless
- has difficulty remaining seated
- is easily distracted
- has difficulty waiting for his/her turn
- blurts out answers
- has difficulty following instructions
- has difficulty sustaining attention
- shifts from one uncompleted task to another
- has difficulty playing quietly
- talks excessively
- interrupts or is rude to others
- does not appear to listen
- often loses things necessary for tasks
- frequently engages in dangerous actions
After: "Diagnostic and Statistical Manual of Mental Disorders" (3rd ed.,
rev.) (American Psychiatric Association, 1987).
CHICAGO, Sept. 30 (AP) - The American
Academy of Pediatric Me4dcine has issued its first guidelines for treating
attention deficit hyperactivity disorder, suggesting that stimulant drugs
may be most effective but that behavioral techniques should also be used.
The guidelines appear in the October issue of the medical journal Pediatrics,
which will be released Monday.
As many as 3.8 million school-age children,
most of them boys, are believed to have attention deficit disorders. Symptoms
may include a short attention span, impulsive behavior and difficulty sitting
still. The guidelines, which fall in line with those issued in recent years
by the National Institute of Mental Health, were created in consultation
with child psychiatrists and psychologists. They suggest that the evidence
favoring medications like Ritalin is stronger than the evidence about behavioral
therapy.
Symptoms improve in at least 80 percent
of children on stimulants, and medication should be switched if it is not
working, the guidelines say. Critics say that many doctors and teachers
turn to drugs like Ritalin as an easy fix and that their long-term effects
are uncertain. The guidelines say any treatment should begin only after
a diagnosis is certain and doctors, parents and teachers have discussed
appropriate treatment goals. The guidelines say drugs should be used with
behavioral techniques, including time-outs for hitting. They call for rewarding
children when they complete tasks, like homework.
General Strategies
- Student monitoring, self management, discipline, and
encouragement can be a very important aspect for academic success.
Below are the two basic aspects of AD/HD facilitation.
- Self-monitoring techniques can be very
effective in the school setting. Self-monitoring of attention involves
cuing the student so that he/she can determine how well he/she is
attending to the task at hand. Cuing is often done by providing an
audio tone such as a random beep, timer, or the teacher can give the
cue. The student then notes whether he/she was on or off task on a
simple recording sheet. Self-monitoring techniques are more likely to
be effective when tied to rewards and accuracy checks.
- Behavior management techniques must
often be used in the learning environment. By examining a student's
specific problem behavior, understanding it's antecedents and
consequences, teachers can help students with AD/HD to develop
behaviors that lead to academic and social successes.
- Providing supervision and discipline:
- Monitor proper behavior frequently and immediately direct
student to the appropriate behavior.
- Enforce classroom rules consistently.
- Avoid ridicule and criticism. Remember, children with AD/HD
have difficulty staying in control.
- Providing Encouragement:
- Reward more than you punish.
- Immediately praise any and all good behavior and performance.
- Change rewards if they are not effective in motivating behavioral change.
- Find alternate ways to encourage the child.
- Teach the student to reward himself or herself. Encourage positive self-talk
(e.g., "You did very well remaining in your seat today. How do you feel about that?").
This encourages the student to think positively about himself or herself.
- Bring to
the student's attention science role models with
disabilities with a similar disability to that of the student. Point out that this
individual got ahead by a combination of effort and by asking for help when needed.
- Reduce the amount of materials present during work time by having the student
put away unnecessary items. Have a special place for tools, materials, and books.
- Reward more than you punish, especially with positive reinforcers.
- Always try to be patient with an AD/HD student.
- Seat students with AD/HD near the teacher's desk, but include them as part of the regular class seating.
- Place these students up front with their backs to the rest of the class to keep other students out of view.
- Surround students with AD/HD with good role models, preferable students whom the AD/HD student view as significant peers.
- Encourage peer tutoring and cooperative/collaborative learning.
- A class that has a low student-teacher ratio will be helpful to a student with
AD/HD.
- Avoid distracting stimuli. Try not to place students with AD/HD near air
conditioners, high traffic areas, heaters, doors, or windows.
- Avoid transitions, physical relocation, changes in schedule, and disruptions.
- Be creative! Produce a somewhat stimuli-reduced study area with a variety of
science activities. Let all students have access to this area.
- Encourage parents to set up appropriate study space at home, with set times and routines established for study, parental review of completed homework, and periodic notebook and/or book bag
organization.
- Educational, psychological, and/or neurological testing is recommended to determine learning style and cognitive ability and to rule out any learning disability (LD is common in about 30% of students with AD/HD).
- A private tutor and/or peer tutoring at school will be helpful to a student with AD/HD.
- Have a pre-established consequence for misbehavior, remain calm, state the infraction of the rule, and avoid debating or arguing with the student.
- Avoid publicly reminding students on medication to "take their medicine."
- Bring to the student's attention mathematics models with disabilities with a similar
disability to that of the student. Point out that this individual got ahead by a combination
of effort and by asking for help when needed.
- Ask previous teachers about interactive techniques that have previously been effective with
the student in the past.
- Expose students with behavioral disorders to other students who demonstrate the appropriate
behaviors.
- Direct instruction or target behaviors is often required to help students master them.
- Have preestablished consequences for misbehavior.
- Administer consequences immediately, then monitor proper behavior frequently.
- Determine whether the student is on medication, what the schedule is, and what the medication
effects may be on his or her in class demeanor with and without medication. Then adjust teaching
strategies accordingly.
- Use time-out sessions to cool off disruptive behavior and as a break if the student needs one
for a disability-related reason.
- In group activities, acknowledge the contributions of the student with a behavioraldisorder.
- Devise a contingency plan with the student in which inappropriate forms of response are
replaced by appropriate ones.
- Treat the student with the behavioral disorder as an individual who is deserving of respect
and consideration.
- When appropriate, seek input from the student about their strengths, weaknesses and goals.
- Enforce classroom rules consistently.
- Make sure the discipline fits the "crime," without harshness.
- Provide encouragement.
- Reward more than you punish, in order to build self-esteem.
- Praise immediately and all good behavior and performance.
- Change rewards if they are not effective for motivating behavioral change.
- Develop a schedule for applying positive reinforcement in all educational environments.
- Encourage others to be friendly with students who have emotional disorders.
- Monitor the student's self-esteem. Assist in modification, as needed.
- Present a sense of high degree of possessiveness in the classroom environment.
- Students need to understand that something which is difficult for one student may be easier
for another student.
- Encourage and reinforce childrenŐs estimates, even if the answers are irrelevant.
- Develop their mental calculation skills at an early age. Help them by using rapidly flash
pictures, numbers, or objects. Help them concentrate on remembering and recognizing what they
saw first, second, and etc.
- Encourage older students to use place value to find answers to larger computation problems
mentally.
- Have children act out problems. It stimulates the studentsŐ interests and capture their
attention when their peers are acting.
- It is helpful to encourage students to feel comfortable with incorrect answers and teach
them to understand that they can learn from errors, in another word, be positive. (You may start
with a page of solved problems that include correct answers. Work with students to locate
the wrong answers by talking about unreasonable answers). If this is introduced at a young
age, this approach takes the fear out of making mistakes, teaches students to view mistakes
as a learning process, and helps them develop self-confidence.
- Make sure you understand students thinking before commenting on the work or marking an answer
as wrong. Remember, given their thinking or what they saw, their answer may be correct.
- Provide copies that are clear and uncluttered.
- Seat Students close to the blackboard.
- Provide a verbal description of printed materials, especially directions and other key
points.
- Directly teach students how to use the textbook format.
- Provide tape recorded textbooks.
- Use colored highlighting pens to emphasize key information and get attentions.
- Have short intervals during class sessions so that students get to refresh themselves
while gaining back their attention.
Teacher Presentation
- Consult with special education personnel to determine specific strengths and
weaknesses of each student.
- Maintain eye contact during verbal instructions.
- Make directions clear and concise. Be consistent with all daily instructions.
- When you ask an AD/HD student a question, first say the student's
name and then pause for a few seconds as a signal for him/her to pay
attention.
- To help with changes between assignments, provide clear and
consistent transitions between activities or warn the AD/HD student a
few minutes before changing activities.
- Repeat instructions in a calm, positive manner, if needed.
- AD/HD students may need both verbal and visual directions. You can do this by providing the student with a model of what he/she should be doing.
- You can give an AD/HD student confidence by starting each assignment with a few questions or activities you know the student can successfully accomplish.
- Self-monitoring techniques can prove effective in the school setting. Self-monitoring of attention involves cueing the student so that he/she can determine how well he is attending to the task at hand. Cueing is often done by providing an audio tone
- Behavior management techniques must often be used in the school.
By examining a child's specific problem behavior, understanding it's
antecedents and consequences, educators can help students with AD/HD
develop behaviors that lead to academic and social successes.
- Develop an individualized education program. By identifying each student's individual strengths and special learning needs, you can design a plan for mobilizing those strengths to improve students academic and social performance.
- Gradually reduce the amount of assistance, but keep in mind that
these students will need more help for a longer period of time than the
student without a disability.
- Require a daily assignment notebook as necessary and make sure
each student correctly writes down all assignments. If a student is not
capable of this, the teacher should help him or her.
- Initial the notebook daily to signify completion of homework
assignments. (Parents should also sign.)
- Use the notebook for daily communication with parents.
- Systematically introduce new mathematics vocabulary.
- State a purpose for any independent reading.
- Give verbal descriptions of each part of a multistep process or algorithm.
- Encourage students to verbalize steps as they work problems.
- Highlight operation signs in practice activities involving a mix of operations.
- Provide a model problem and solution at the top of practice worksheets.
- Use interesting problem situations within a childŐs experience.
- Provide construction paper "masks" to blot out portions of a page at a time to help
students keep their place in a book.
- Cut a worksheet into segments and assign only one small section at a time.
- Prompt Cards:
- Using Prompt Cards (Hide-and-seek cards to aid students with attention and
short-term memory deficits in understanding math facts. Cards helped one apply his
visual strengths and comprehend facts without memory overload because small steps were
emphasized at a time.
- Prompt cards appear to help minimize distractions for student by reminding him of
the task at hand. The Visual cuing system of the prompt card seemed to keep him on task
and to motivate him to complete problems as accurately as possible.
Laboratory (active and passive)
- Gradually reduce the amount of assistance, but keep in mind that
these students will need more help for a longer period of time than the
student without a disability.
- Consider alternative activities/exercises that can be utilized
with less difficulty for the student, but has the same or similar
learning objectives.
- Require a daily assignment notebook as necessary and make sure
each student correctly writes down all assignments. If a student is not
capable of this, the teacher should help the student.
- Gradually reduce the amount of assistance, but keep in mind that
these students will need more help for a longer period of time than the
student without a disability.
- AD/HD students may need both verbal and visual directions. You
can do this by providing the student with a visual model and a verbal
description of what he/she should be doing.
- You can give an AD/HD student confidence by starting each lab
assignment with a few questions or activities you know the student can
successfully accomplish.
- To help with changes in assignments, provide clear and consistent
transitions between activities and notify the student with AD/HD a few
minutes before changing activities.
- Make sure all students comprehend the instructions before
beginning their tasks (the AD/HD student will probably need
assistance).
- Simplify complex directions. Avoid multiple commands.
- Repeat instructions in a calm, positive manner.
- Help the students feel comfortable with seeking assistance (most
children with AD/HD will not ask for help).
- Assign only one task at a time.
- Modify assignments as needed.
- Keep in mind that students with AD/HD are easily frustrated and
they need assurance of things that are common in science, say, when an
experiment does not turn out as expected. Stress, pressure, and
fatigue can break down their self-control and can lead to poor behavior.
Group Interaction and Discussion
- Help the students feel comfortable in seeking assistance (most
children with AD/HD will not ask for help, especially in a group
activity).
- Gradually integrate the AD/HD student into the interactive system
- Accelerated Learning :
- Teamed/paired for mathematics and children can be grouped according to skill level,
then they are more likely to work at similar pace and can receive more help and individual
tuition. Pupils can change groups when appropriate.
- At times, it is advisable to provide a time limit (when working in groups) for short
assignments in order to capture the studentsŐ attention.
Research
- Monitor the AD/HD students closely on field trips.
- Review and discuss with the student the steps involved in a
research activity. Think about which step(s) may be difficult for the
specific functional limitations of the student and jointly devise
accommodations for that student.
- Consider alternative activities/exercises that can be utilized with less
difficulty for the student, but has the same or similar learning objectives.
- Monitor the AD/HD students closely on field trips.
- Help the students feel comfortable with seeking assistance (most
children with ADD will not ask for help).
- Use appropriate laboratory and field strategies.
- Give extra time for certain tasks. Students with ADD may work
slowly.
Field Experiences (active and passive)
- Gradually reduce the amount of assistance, but keep in mind that
these students will need more help for a longer period of time than the
student without a disability.
- Require a daily assignment notebook as necessary and make sure
each student correctly writes down all assignments. If a student is not
capable of this, the teacher should help the student.
- Repeat instructions in a calm, positive manner.
- Gradually reduce the amount of assistance, but keep in mind that
these students will need more help for a longer period of time than the
student without a disability.
- AD/HD students may need both verbal and visual directions. You
can do this by providing the student with a visual model and a verbal
description of what he/she should be doing.
- You can give an AD/HD student confidence by starting each
assignment with a few questions or activities you know the student can
successfully accomplish.
- To help with changes in assignments, provide clear and consistent
transitions between activities and notify the student with AD/HD a few
minutes before changing activities.
- Repeat instructions in a calm, positive manner.
- Make sure all students comprehend the instructions before
beginning their tasks (the AD/HD student will probably need
assistance).
- Simplify complex directions. Avoid multiple commands.
- Help the students feel comfortable with seeking assistance (most
students with AD/HD will not ask for help).
- Assign only one task at a time.
- Keep in mind that students with AD/HD are easily frustrated and
they need assurance of things that are common in science, e.g., when
an experiment does not turn out as expected. Stress, pressure, and
fatigue can help reduce their self-control and can lead to poor behavior.
- Monitor the AD/HD students closely on field trips.
Testing
- Make sure you are testing knowledge and not attention span.
- Give extra time for certain tasks. Students with AD/HD may work
slowly.
- Keep in mind that students with AD/HD are easily frustrated.
Stress, pressure, and fatigue can break down their self-control and
lead to poor behavior.
- Use especially some of the general strategies related to stress,
i.e., management (see first part of General Strategies).
Last updated:
September 18, 2002
Web Master
Ed Keller