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July 16, 2008 © Harlacher, 2008 1

Managing ADHD in the Classroom:Classwide Interventions

Jason Harlacher, MS, NCSPWashoe County School District

University of OregonSchool Psychology Doctoral Program

July 16, 2008 © Harlacher, 2008 2

Agenda

� Discuss universal classroom support for students with ADHD

� Classwide interventions

� Questions/discussion

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Rationale

� 3 to 5% diagnosed

� Individualized interventions = taxing, a lot to ask, a lot of time/energy, poor fidelity

� Classwide interventions = target student with ADHD, but benefit all students

� High social validity

� Evidence-based

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Effective Support

� Understanding need for external incentive/feedback

� Behavior expectations proactively taught

� Instruction matches skill level

See Carbone, 2001; Darch et al., 1998; Pfiffner et al, 2005;

Salend et al, 2003.

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Effective Support

� Preferential seating

See Carbone, 2001; Darch et al., 1998; Pfiffner et al, 2005;

Salend et al, 2003.

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Effective Support

� Preferential seating

� One-step directions

� Brief transitions

� Minimizing distractions

� Use of praise (4:1)

See Carbone, 2001; Darch et al., 1998; Pfiffner et al, 2005;

Salend et al, 2003.

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Effective Support

� Specific Behavior Praise Statements (SBPS)

� Example: “Sally, I like the way you’re sitting at your desk and working quietly.” or “Jimmy, I’m glad you raised your hand and waited.”

� Non-example: “Good job!”

� 1 SBPS/10 minutes = 47% on-task

� 1 SBPS/2 minutes = 89% on-task

Sutherland et al (2000); Reinke et al (1997); William Jenson, U of Utah

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Academic Interventions

� ClassWide Peer Tutoring (CWPT)

� Computer-Assisted-Instruction (CAI)

� Choice-Making

� Instructional Modification

� Academic: target the academic deficits

� Behavioral: target behavioral symptoms

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ClassWide Peer Tutoring

� Students are paired together and provide instruction, assistance, and feedback to each other work together on an academic activity

+ frequent & immediate feedback- setup time· social function

Greenwood et al., 1997

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Computer-Assisted-Instruction

� Computer-based programs that serve as supplements to traditional instruction

+ natural extension of instruction, “extra practice”

- curriculum and program mismatch?

· practice in a very visual format

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Choice-Making

� Student makes a choice between teacher-selected assignments

� Selects work from a teacher-developed menu

+ student autonomy, easy to implement

- use with caution

· defiance, low to no work completion

Powell & Nelson, 1996

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Instructional Modification

� Modify the content and/or delivery of instruction

� Break assignment into smaller parts; give more frequent, smaller deadlines

� “Triangle, Circle”

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1

Dots strategy

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Instructional Modification

� Modify the content and/or delivery of instruction

+ flexible/adaptive

- decreases amount of work

· good for non-compliance

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Behavioral Interventions

� Contingency Management

� Token Economy and Response-Cost

� Peer-Monitoring

� Therapy Balls

� Self-Monitoring

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Contingency Management

Antecedent Behavior Consequence

before after

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Contingency Management

� Token Economy

� Providing tokens (points, chips) contingent on appropriate behavior

� Response Cost

� Removal of tokens after inappropriate behavior

+ effective, external incentive

- tough to manage consistently

· for any situation

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Token Economy guidelines

� Develop 3 positively stated rules

� Provide examples and non-examples

� Practice the expected behaviors

� Emphasize social reinforcement over token

� Make praise explicit and clear

� Make plan to fade use, progress monitor

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Response-Cost guidelines

� Allow for “Cash-in” before starting.

� Keep students out of negative points.

� Have contingency plan if students refuse to give up tokens

� Practice when students lose tokens

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Token Economy and Response Cost example

“ADHD Classroom Kit”

� Earn happy faces for appropriate behavior

� When inappropriate behavior occurs, receive warning sign

� More happy than sad faces, team wins “Rewards Target Game (RTG)” � “Act like your favorite animal”; Freeze dancing, charades

� Used during a “work burst”, 2 to 6 times/day

Anhalt et al, 1998

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Peer-Monitoring

� Students are taught to provide reinforcement to others for appropriate classroom and social behaviors

+ provides positive peer attention

- Lead to hyper-vigilance of negative beh?

· social deficits

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Therapy Balls

� Using “gym balls” as seats

+ socially valid

- may not be practical, pricey

· fidgety/hyperactivity

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Self-Monitoring

� Teams evaluate themselves on a designated behavior while the teacher does as well

� Ratings are then compared

� Teams earns points for matching behavior ratings, then for increasing appropriate behavior

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How to use self-management

� 1. Initially teacher controls contingencies and manipulation of target behavior

� 2. Introduce self-management technique to facilitate transfer of teacher-controlled contingencies to student-controlled contingencies

� 3. Fade use of self-management over time as target behavior becomes maintained naturally

Teacher-maintained…(self-management)…Student-maintained

1

0

1

1

1

0

1

5

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Salend et al, 1992

� Inappropriate verbalizations (talk outs)

� Example and non-examples of behavior

� Each team rated selves with a form

� Teacher rated teams

� 0 to 5 talk outs = 5 = Excellent

� 6 to 10 = 4 = Very good

� 11 to 15 = …

Salend et al (1992)

+ maintenance- blame· impulsivity

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Ideal Plan

� Identify a specific behavior and time period

� Talking out during independent math time (30 minutes at 10am).

� Evaluate universal support

1/minuteRatio of positive to negative statements/use of SBPS

Yes Minimized distractions?

~2 minutesBrief Transitions?

Adjust to give one at a time

One-step directions? Complete worksheet, check answer

with peer, correct, turn in, get out

reading book

YesInstructional match?

-assignment: complete add & sub pxs; regroup__

-level: ________CBM: on-grade level__

Last rowPreferential seating?

Yes No

Yes No

Yes No

Behavior expectations taught?

-Be there, be ready (check board for supplies needed)

-Be safe (stay in seat, raise hand)

-Be responsible (turn in work)

Student

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Ideal Plan

� Identify a specific behavior and time period

� Evaluate extent of “universal” support

� Judge function of behavior

� CWPT = social function; still completing same assignment

� 15 minutes

� Implement & evaluate

� Way to measure? July 16, 2008 © Harlacher, 2008 38

Conclusions

� Various academic and behavioral interventions to use at various points

� Evidence-based

� Low-risk, anonymity

� No “one size fits all” intervention

� Consider function of behavior

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Questions

� Comments? Feedback on the interventions?

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One more idea

� The “Office”

� Providing an “office” for the student to work free of distractions

� Set a time limit

+ still academically engaged

- can be viewed as punishment

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Resources for CAI

� www.soliloquylearning.com

� www.readwritethink.org

� www.sra4kids.com

� Headsprout

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References

� Anhalt et al. (1998). The ADHD classroom kit: A whole-classroom approach for managing disruptive behavior. Psychology in the Schools. 35, 67-79.

� Barkley, R. (2005), Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment (3rd Ed.) Guilford: NY

� Carbone. (2001). Arranging the classroom with an eye (and ear) to students with ADHD. TEACHING Exceptional Children. 34, 72-81.

� Darch, et al. (1998). Instructional classroom management: A proactive model for managing student behavior. Beyond Behavior, 9, 18-27.

� Greenwood et al. (1997). Together we can! Classwide peer tutoring to improve basic academic skills. Longmont, CO: Sopris West.

� Harlacher et al (2006). Classwide interventions for students with ADHD. Teaching Exceptional Children, 39, 6-12.

� Powell & Nelson (1996). Effects of choosing academic assignments on a student with ADHD. Journal of Applied Behavior Analysis, 30, 181-183.

� Salend et al (1992). Group evaluation: A collaborative peer-mediated behavior management system. Exceptional Children, 59, 203-209.

� Sutherland, K.,Wehby, J., & Copeland, S. (2000). Effect on varying rates of behavior-specific praise on the on-task behavior of students with EBD. Journal of Emotional and Behavioral Disorders, 8, 2-8. Walker, H., Zeller, R.,

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Ratio of positive to negative statements/use of SBPS

Minimized distractions?

Brief Transitions?

One-step directions?

Instructional match?

-assignment_________________

: -level:_________________________

Preferential seating?

Yes No

Yes No

Yes No

Behavior expectations taught?

Student