SCHOOL INTERVENTIONS FOR ADHD
David W. Kidder, Ph.D.
INTERVENTIONS RELATED TO HYPERACTIVITY
Do not attempt to reduce activity, but channel it into acceptable avenues.
Encourage directed movement in classrooms that is not disruptive. Invite active responses.
I. Have students stand or sit to indicate their response
2. Hold up cards to answer questions
3. Indicate answers with thumbs up or thumbs down
4. Use four comers of the room to indicate true, false, don't know, or no answer, and then have students listen to question and move to, point to, or face a comer of the room.
5. Have students act out the actions of the characters in a story being read aloud.
6. Use learning games such as Simon Says
7. Allow students to stand at their desks to work or participate in a class discussion.
8. Allow students to move around, sit on their legs, etc. in their desks as long as they are not disturbing others.
9. Take breaks for exercise.
10. Allow students to run errands for the teacher as rewards. .
II. Allow students to be the teacher helper handing out materials, papers, etc.
INTERVENTION RELATED TO ORGANIZATION
Students often have great difficulty with organization. One of the ways to help them with this is through the use of a notebook.
The next group of strategies deals with the student's inability to stay focused on a task or on the teacher and the lesson. Students with ADHD have difficulty sorting out relevant from irrelevant details. Let's do a little exercise to demonstrate how difficult this is.
INTERVENTIONS RELATED TO INCREASING FOCUS ON TASKS
1. The student's desk should be near the teacher (for prompting and redirection), away from other challenging students, and not touching others' desks. However, if the student is very auditorily distractible, he may benefit from being seated near the rear of the classroom. This eliminates the need for him to constantly look around to identify the sources of the distracting sounds. Experiment with seat location in the front of the classroom (near the board) and instructional area if the student is more visually distracted.
2. A small student to teacher ratio enables an increased amount of feedback during prime times of difficulty. Attempt to involve parent volunteers, paraprofessionals, student interns or practicum students from universities, or support staff in this capacity.
3. The student will respond better to situations that she finds stimulating and engaging. Varying the instructional medium and pace will help sustain her interest The student would probably find lessons that emphasize "hands-on" activities highly engaging. Keeping the time required for sustained attention on task balanced with more active learning will improve her performance. Changes in instructor's voice level and variation in word-pacing will also increase her attention during
4. Students using medication to treat attentional problems will have their optimal attention effects for methylphenidate 45 minutes to 2 1/2 hours after medication. Other medications differ, and it is best to check with the parents who can check with the physician about the time of maximum medication effects. If possible, it is best to schedule the most attention-demanding tasks for the student during this medication window.
5. Make sure the student establishes eye contact when receiving direction/instruction. This will improve understanding and follow-through on the task. Wait for a response before breaking contact with the student.
6. Combine verbal directions with illustrations or demonstrations of the desired task. The use of multiple modes of instruction increases the probability of successful learning of the task.
7. The student may tend to want to be "the first one done" on assignments. Set reasonable accuracy goals with the class and collect the entire group's work at once to reduce time pressures.
8. Visual posting: Limit visual distractions in the classroom which are not intrinsically related to the current academic subject, but use walls, boards, etc. for posting which pertain to the material being taught.
Children with ADHD have trouble completing their work. The simplest solution works the best, decrease their work load.
INTERVENTIONS RELATED TO WORK RATE:
Hyperactive children often do little or no independent work and must be continually reminded by the teacher to begin or return to task. They procrastinate on academic tasks. When actually on task, their work is usually done extremely rapidly with poor legibility, little attention to directions, and numerous careless errors. Sometimes they can slow down and produce high quality work, but only for limited periods of time and with extreme effort levels. In contrast the lethargic student with ADD works carefully, often meticulously, but the work rate is so slow the written tasks are rarely completed within time limits. This results in the student having to complete the work during recess, on breaks or at home.
Students with ADHD and ADD should be given reduced amounts of written work both in class and for homework. Long assignments are best divided into smaller portions and given one at a time to complete. This way they are not overwhelmed with the large quantity. This may be done for tests, dividing them up into sections. Worksheets can be cut into pieces. Homework should not take over 1 and 1/2 hours. Students with ADHD and ADD may take this long to complete an assignment which other students complete in 15 minutes. Listen to parents on this issue and ask how the child is doing.
INTERVENTIONS RELA'IED TO ACADEMIC LEARNING TASKS
HANDWRITING: One of the most difficult problems for ADHD students is handwriting. Hyperactive children write rapidly with little attention or care given to the quality and legibility of their work. Students with ADD without hyperactivity often have extremely neat handwriting, but they are extremely slow. Their work appears methodical and laborious. They may over stroke and rewrite, erase a lot.
Start with the correct grip. Start with large letters on grid paper. Have models of letters on the desk. For older children and for times when it is not necessary to practice handwriting, allow alternatives such as keyboard, typing, taping and transcription, and oral responses.
SPELLING: Spelling skills are often impaired with ADHD/ADD students since they are unable to display the necessary focusing and concentration to lock the forms of the work into long-term storage. Students with this problem can study the words overnight, appear to have total command of them, and then forget them before the test the next day.
Use manual alphabet, involve them in movement, involve them in touching, hear-see-say at the same time, emphasize phonics, use a word bank, personal dictionary, tape record drills.
Problems with mathematics facts, reading, oral instructions, memory, and auditory processing are also found in students with ADHD/ADD.
INTERVENTIONS FOR BEHAVIOR MANAGEMENT
Children with ADHD like and need more immediate, frequent, consistent, and tangible feedback. The obvious solution: Let's give it to them.
One of the most important interventions in this regard is to insure that students receive a high rate of positive verbal feedback throughout the day. The teacher or aide gives every child at least 10 "big deal" stickers and accompanying verbal feedback per day for positive behaviors (e.g., good attitude, paying attention, working cooperatively, etc). Positive statements should outnumber negatives by a 2 to 1 margin. One way to structure this is to playa tape with a tone that goes off on the average of every 10 minutes. When the tone goes off it is the teacher's or aide's responsibility to comment on the behavior of everyone. "I see Michael sitting nicely." "I see that Jennifer is looking at me." "Big Deal" stickers can be traded in for an activity or reward. A similar approach is to "catch the child being good". The teacher surprises a child who has usually been having difficulty and praises him for engaging in an appropriate behavior.
POSITIVE ATTITUDE BAROMETER: This activity is designed to help teachers assess the rate at which they make positive comments and then to improve positive attending:
1. Wear something with pockets. Place 20 chips in the right pocket. During a 1 hour time period, each time a positive comment is made to a student, move a chip to the left hand pocket.
2. Repeat the exercise. 'This time the goal is to move all 20 chips from the right to the left hand pocket.
3. Repeat the exercise. This time only move a chip after making a positive comment to the student with ADHD. (Obviously, moving all 20 in 1 hour might be overdoing it a bit and may even appear contrived to this student. Praise needs to be valid.)
MOBILE MOTIVATION: Place mobiles over each worktable. When the children at a particular table display good behavior, they earn an object to place on their mobile. The tables compete to see who will be first to complete their mobile.
GROUP REWARDS: Students are divided into groups by tables for specific activities or for the whole day. The group as a whole is rewarded for goal attainment and for self-control. A chart can be placed on the wall with group names which the students can choose. Each group can obtain a reward at the end of the period or day depending upon their performance. The teacher shows progress toward the reward on the chart. The group reward encourages peer support and pressure. It encourages working as a team, and team spirit. Everyone can win, so there is competition only with themselves. Some students tend to serve as a barrier to a group getting its reward. This is balanced by regrouping every so often. I personally do not believe that students should be graded based upon the group's performance.
Greenberg, Lawrence M. and Kindschi, Carol L. (1996) Test of Variables of Attention Clinical Guide. St. Paul, Minn: TOV A Research Foundation.
Fiore, Thomas A, Becker, Elizabeth A, and Nero, Rebecca C. Education of Children with Attention Deficit Disorder: Research Synthesis on Education interventions for students with attention deficit disorder. Research Triangle Park, North Carolina: ADD Intervention Center, Center for Research in Education, Research Triangle Institute.
Fowler, Mary. (1992) CHAD.D. Educators Manual: An In-Depth Look at Attention Deficit Disorders from an Educational Perspective. Fairfax, Virginia: Ch.A.AD.
Taylor, John F. (1992) Answers to AD.D. - The School Success Toolkit. Sa1em, Oregon: Sun Media.
Walker, Ronald A. Educating Students with ADHD/ADD: A Guidance Manual for Implementation of the Louisiana ADD Law. Baton Rouge: The Louisiana Department of Education, Office of Academic Programs.