Childhood ADHD: A Primer for Home-School Intervention

Childhood ADHD: A Primer for Home-School Intervention

Childhood ADHD: A Primer for Home-School Intervention

Brandon K. Schultz, Ed.S., NCSPAlvin V. Baird Attention & Learning Disabilities CenterJames Madison Universityhttp://chp.cisat.jmu.edu/presentationsworkshops.html

Brandon K. Schultz, Ed.S., NCSPAlvin V. Baird Attention & Learning Disabilities CenterJames Madison Universityhttp://chp.cisat.jmu.edu/presentationsworkshops.html

Agenda Diagnosing ADHD ADHD and Schools Home-School Interventions

Behavior Report Cards Assignment Notebook Tracking Organizational Skills

Diagnosing ADHD

Definition & Prevalence(American Psychiatric Association, 2000)

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

“Combined” (inattention & hyperactivity) Types Thought to afflict 3-5% of the population, with

boys more commonly diagnosed than girls, at a ratio of about 4 or 5:1

There is no “gold standard” assessment (i.e., indisputable) for ADHD. Instead, the diagnosis is based entirely on behavioral symptoms…

Definition & Prevalence(American Psychiatric Association, 2000)

Inattention: 6 or More…(American Psychiatric Association, 2000)

Fails to give close attention to details

Has difficulty sustaining attention in tasks

Does not seem to listen when spoken to

Does not follow through on instruc-tions / fails to complete work

Has difficulties organizing tasks and activities

Avoids/dislikes tasks that require sustained mental effort

Loses things necessary for tasks

Distractible Forgetful in daily

activities

Hyperactivity: 6 or More…(American Psychiatric Association, 2000)

Fidgets with hands or feet / squirms

Leaves seat in class-room / other places

Runs about / climbs excessively

Has difficulty playing quietly

Often “on the go” or acts as if “driven by a motor”

Often talks excessively Blurts out answers

before question is asked Has difficulty waiting for

turn Interrupts or intrudes on

others (butts into conversations or games)

Diagnostic Concerns(American Psychiatric Association, 2000)

Behaviors (previous slides) must: Be present for 6+ months & be present before age

7 Cause significant impairment in social, academic,

or vocational functioning Not be caused by other disorders, such as

Pervasive Developmental Disorder or psychotic disorders

Not be better accounted for by another mental disorder, such as anxiety disorders

Must occur in two or more settings

ADHD and Schools

What Can Parents Expect?

1.6

1.7

1.8

1.9

2

2.1

2.2

1st 2nd 3rd 4th 5th 6thReport periods

GPA in Community Control Sample of Middle School Youth with ADHD

Special Education?(Forness & Kavale, 2001)

ADHD is not a label that is recognized by IDEA. Instead, other categories may apply in cases where educational performance is negatively impacted….

Learning Disabilities

(26%)

Learning Disabilities

(26%)

Emotional Disturbance

(43%)

Emotional Disturbance

(43%)

Other HealthImpairment

(40%)

Other HealthImpairment

(40%)

What is ‘Other Health Impaired’?

OHI includes health conditions that affect academic performance, including heart disease, asthma, etc.

ADHD was officially added to this list of medical conditions. Since that time, the OHI category has grown considerably

0

0.05

0.1

0.15

0.2

0.25

0.3

1989

1990

1991

1992

1993

1994

1995

1996

%age ofSchoolEnrollment

Special Education? About half of all students with

ADHD receiving SPED services can be served effectively in the regular classroom environment. 40% can be served through some combination of regular and special education classrooms. 10% will require a self-contained environment.

Reg. Ed.

Combined

Self-Contained

What is a ‘504 Plan’?

Section 504 of the Rehabilitation Act prevents discrimination based on disabling conditions

Students not meeting the requirements for SPED may be eligible for a 504 Plan Must “limit one or more major life activities,” including

learning

What Interventions Are Used? General & SPED teachers differ in their emphasis, but the

interventions are surprisingly similar…

Intervention General Education Special Education

Changing seats 1 5

Behavior modification 2 1

Time-Out 3 4

Shortened Assignments 4 7

One-to-one instruction 5 3

Special Consultation 6 2

Peer tutoring 7 9

Frequent breaks 8 8

Assignment format 9 6

Parents’ Role

Parents have the right to request an evaluation for SPED eligibility

If the student is found ineligible: Parents have the right to appeal the decision (due

process) Have child re-evaluated under Section 504 Parent advocacy groups

Home-School Interventions

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

Behavioral Interventions – general tips: Consequences should occur soon after behavior Consequences should be ‘salient’ Don’t give tangible reinforcers for intrinsically motivated

behavior (e.g., $ for playing baseball) Move from contrived reinforcers to natural reinforcers over

time (generalizability) Move from dense reinforcement schedules to thin

reinforcement schedules over time Do not over-rely on punishment!!! Punishment should fit the crime and be limited in scope

Behavior Report Cards(Challenging Horizons Program Treatment Manual, 2004)

Daily Behavior Report Card Determine behavioral goals Rate child during a “baseline” period 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 Treatment Manual, 2005)

Goal: The student will demonstrate improvement in the targeted behavioral and/or academic problem areas.

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

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

3The mentor/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 mentor and student in one-to-one meetings at school.

Monday

Behavior 1:Tuesday Wednesday

1 2 3 4 1 2 3 4 1 2 3 4

Behavior 2:

1 2 3 4 1 2 3 4 1 2 3 4

Behavior 3:

1 2 3 4 1 2 3 4 1 2 3 4

Daily Behavior Report Cards

1 = Needs Much Improvement, 2 = Some Difficulty, 3 = Good Job, 4 = Great Job!

Turns in work on time Turns in work on time

Produces high quality work

Brings materials necessary for Brings materials necessary for class/subject areaclass/subject area

BKS

BKS

BKS

BKS

BKS

BKS

Assignment Notebook Tracking(Challenging Horizons Treatment Manual, 2005) Goal: The student will write all assignments

accurately and legibly in the appropriate place in his/her assignment notebook without prompting and/or behavioral contingencies

1The student sets up a written system for documenting academic

assignments that they are responsible for.

2Mentor routinely checks (no less than 1 time per week) the

student's assignment tracking for accurateness and legibility.

3Successful tracking is reinforced (e.g., praise, special activities)

and errors are corrected with mentor coaching until the student is independent with this task.

Average Percentage of Assignment Notebook Criteria Met Per Day

40

50

60

70

80

90

100

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

Day

Per

cen

tag

e o

f C

rite

ria

Met

Organization Skills(Challenging Horizons Treatment Manual, 2005)

Goal: The student will be able to maintain organization of his/her school related personal belongings (binder, book bag, locker) without prompting and/or behavioral contingencies in place.

1The mentor 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.

2

The mentor and/or 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 corrected with mentor or 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

References

American Psychiatric Association. (2000). The Diagnostic and Statistical Manual and Mental Disorders, Fourth Edition – Text Revision (DSM-IV-TR). Washington, DC: APA.

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. (2004). Harrisonburg, VA: James Madison University.

Forness, S. R., & Kavale, K. A. (2001). ADHD and a return to the medical model of special education. Education and Treatment of Children, 24, 224-247.