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School- and classroom-based interventions to support children and adolescents with ADHD: Innovative
and promising approaches
Gary Stoner, Ph.D.Email: [email protected]
University of Rhode IslandPresentation for the Coventry Public Schools
March 12, 2009
ADHD in School Contexts: Reasons for Concern
• School success is both critical and potentially elusive for students with ADHD
• Increasing numbers of children who are “difficult-to-teach” and “difficult-to-manage”
• Reactive support model (i.e., wait to fail) remains prevalent mode of practice in special education and school psychology
CHALLENGES TO INTERVENTION IN PUBLIC SCHOOLS
• Lack of knowledge about effective supports for students with ADHD
• Challenges in designing/implementing individual modifications
• Lack of knowledge or experience with behavioral techniques
• Support of administration/policies for intervention
• Class size• “Fairness” to other students?
CHALLENGES TO INTERVENTION AT SECONDARY LEVEL
• Multiple teachers/staff• Resistance of faculty• Defiance of student• Student reaction to peer pressure• Competing demands for student
time
TARGETS FOR TREATMENT
• Behavior Control• Staying on-task; Paying attention• Following classroom rules• Anger control
• Academic Performance• Class Participation• Homework Completion• Organizational Skills
• Note-taking• Studying for exams• Long-term projects
• Appropriate Social Behavior• Social Problem Solving
Some guiding principles for intervention with ADHD• Apply the group primary, secondary,
tertiary prevention/intervention model (RTI), but with individual students
• Combine proactive and reactive management strategies (e.g., teach rules and daily report)
• Intervention in place at point of performance of target behaviors
• Intervene early in the course of problems
Some guiding principles for intervention with
ADHD(cont.)
• Use multiple intervention agents• Link assessment data to
intervention• Individualize interventions• Again…deliver interventions at the
“point of performance”
Academic Systems Behavioral Systems
1-5% 1-5%
5-10% 5-10%
80-90% 80-90%
Intensive, Individual Interventions•Individual Students•Assessment-based•High Intensity
Intensive, Individual Interventions•Individual Students•Assessment-based•Intense, durable procedures
Targeted Group Interventions•Some students (at-risk)•High efficiency•Rapid response
Targeted Group Interventions•Some students (at-risk)•High efficiency•Rapid response
Universal Interventions•All students•Preventive, proactive
Universal Interventions•All settings, all students•Preventive, proactive
Designing School-Wide Systems for Student Success (see www.pbis.org)
Primary and Secondary Prevention Strategies: Preschool
• Home/school/community based support for:– Language development/early literacy/cognitive
development• (Read Together/Talk Together)
– Social development/socialization• The Incredible Years programs (U. Washington, Carolyn
Webster Stratton)• Oregon Resiliency Project: Strong Start Program, a
social and emotional development curriculum (Merrell, 2007; Brookes)
– School readiness
Elementary
• Academic– Skills for School Success (Curriculum Associates)– Basic Skills Instruction/Progress Monitoring
• Social/Emotional/Behavior– Positive Behavior Support; First Steps Program (Sopris
West)– Oregon Resiliency Project: Strong Start/Kids Programs, a
social and emotional development curriculum (Merrell, 2007; Brookes)
• Mental Health– Oregon Resiliency Project: Strong Kids (Online)
Middle
• Academic– Advanced Skills for School Success (Curriculum
Associates)– Assignment/Work Accommodations– Curriculum-based collaboration and Instructional
support (SPED)• Mental Health
– Oregon Resiliency Project: Strong Kids Program, a social and emotional development curriculum (Merrell, 2007; Brookes)
• Social/Emotional/Behavior– Positive Behavior Support; Teaching Self-Management
Strategies to Adolescents (Sopris West)
High School
• Academic– Advanced Skills for School Success– Assignment/Work Accommodations;– Curriculum-Based Collaboration and Instructional Support (SPED)
• Mental Health– Oregon Resiliency Project: Strong Teens Program, a social and
emotional development curriculum (Merrell, 2007; Brookes)• Social/Emotional/Behavior
– Positive Behavior Support– Teaching Self-Management Strategies to Adolescents (Sopris
West)• Dropout prevention
– Check and Connect Program, (Christenson, University of Minnesota)
Time/Grade/Age
Lo
Hi
The Effects of Computerized Reading Instruction on the Academic
Performance of Students Identified with ADHD
(School Psychology Review, 2005, 34, 246-254)Julie Clarfield and Gary Stoner
University of Massachusetts Amherst
Children with ADHD are at higher than average risk
for:• Behavioral and academic difficulties• Grade retention• Placement in special education
programs• School drop out• Lower high school GPA• Enrollment in college degree
programs
Children with ADHD and academics, continued:
• As many as 80% of students with ADHD exhibit academic difficulties, including lower than expected work completion rates
• Approximately 20-30% are identified with learning difficulties due to problems with acquisition of academic skills
• Recent studies show literacy/reading skill acquisition problems relative to matched peers as early as Kindergarten
• These risks and outcomes suggest need for effective educational interventions
Computers (CAI) are promising, as students
with ADHD perform better:• …when provided with immediate
(vs. delayed) feedback• …when stimulus conditions are
novel (vs. familiar)• …when provided with one-to-one
student-teacher ratio
Purpose of present study:
• evaluate the effectiveness of a recently developed computerized reading instruction program—Headsprout
• …with participants diagnosed with ADHD and experiencing reading problems
Research questions:
• Relative to teacher directed, small group instruction, what are the effects of the Headsprout reading program on students’ task engagement?
• Relative to teacher-directed, small group instruction, what are the effects of the Headsprout reading program on students’ oral reading fluency?
Participants:
• Tim. 6 yo, repeating Kindergarten. – inattentive subtype of ADHD; 2.5 mg of
methylphenidate once a day during the first 7 weeks; then an 18mg dose of Concerta once a day.
• Kevin. 7 yo, 1st grade student.– combined subtype of ADHD; receiving
Special Education services for math and writing
• Joe. 6 yo 1st grade student. – combined subtype of ADHD; 5mg of
methylphenidate once a day
Methods:
• Independent Variable: Headsprout reading program; 3 x week, 20-30 min. each
• http://www.headsprout.com• Dependent variables:
– Oral Reading Fluency– On- and off-task behavior
• Multiple Baseline Design, across participants
Features of Headsprout:
• internet-based reading program; no adult required
• explicit instruction in phonemic awareness and phonics
• introduces consistent letters and sounds, fluency building exercises and segmenting and blending strategies
• provides explicit instruction in building sight word vocabularies and recognizing and using punctuation cues
• student works sequentially through 40 animated lessons, each lasting approximately 20 minutes.
Headsprout features (cont.):
• highly interactive: students engage in over 180 active learner interactions per 20-minute lesson
• lessons are individualized and adapt to a child’s pace
• student success rate in each lesson is at least 90% • Completion of most Headsprout activities involve the
child moving a character to a desired destination• students keep track of own progress through the use
of a colorful progress map • positive feedback is provided after each correct
response, and the program rewards the student with brief (10-30 second) humorous movies in between activities
Figure 1. Percentage intervals of off task behavior as a function of typical reading instruction and computer assisted reading instruction.
Tim
0
10
20
30
40
50
60
% o
f In
terv
als
Off
Task
Kevin
0
10
20
30
40
50
60
% o
f In
terv
als
Off
Task
Joe
0
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20
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40
50
60
0 10 20 30 40 50
School Days
% o
f In
terv
als
Off
Task
Baseline CAI
Off-task data
• Tim. Off-task 24% BL vs. 3% CAI
• Kevin. Off task 49% BL vs.6% CAI
• Joe. Off task 26% BL vs. 4% CAI
Figure 2. Words read correctly per minute as a function of typical reading instruction and computer-assisted reading instruction.
Tim
0
5
10
15
20
25
30
35
40
45
Wo
rds C
orr
ect P
er
Min
ute
Kevin
0
5
10
15
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30
35
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45
Wo
rds C
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ect P
er
Min
ute
Joe
0
5
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0 10 20 30 40 50 60
School Days
Wo
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orre
ct
Pe
r M
inu
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Baseline CAI
Reading fluency data
• Tim. 6 WRC in baseline vs. 18 WRC during intervention; Weekly gain .55 before intervention to 1.65
• Kevin. 14 WRC in baseline vs. 33 WRC during intervention; Weekly gain .55 to 2.90
• Joe. 10 WRC in baseline vs. 24 WRC during intervention; Weekly gain .20 to .75
Discussion
• Positive effects of CAI on task engagement and academic performance, similar to Ota and DuPaul (2002)
• Different in that Ota and DuPaul study involved math, drill and practice, and upper elementary students
• High degree of social validity• URL: www.headsprout.com
Future work
• individual Headsprout effects (rather than additive)
• home based, parent guided intervention
• home/school combinations• group study with more effective
instructional comparison; control group?
Parent tutoring for students with
attention-deficit/hyperactivity disorder: effects on reading
performance at home and schoolChristine Hook and George J. DuPaul
School Psychology Review 1999, Vol.28, No. 1; pg. 60-75.
Procedures
• Four children: three 2nd Graders, one 3rd Grader
• Parent tutoring in reading, 10 minute sessions
• Material from current school stories/reading
• Preview, reading aloud, error correction, praise, review of story
• Mean Sessions per week, 3• Mean weeks, 6
Peers as intervention agents
• Plumer, P. J., & Stoner, G. (2005). The relative effects of Classwide Peer Tutoring and peer coaching on the positive social behaviors of children with Attention Deficit Hyperactivity Disorder. Journal of Attention Disorders, 9 (1), 1-11
Table I
Results
Percent of intervals
observed containing
positive social Participants
interactions Heidi Colin Samantha
Academic Activity
Mean and range
Baseline 3%(2-3%) 5%(2-8%) 10%(0-25%)
CWPT 87%(80-99%) 93%(87-97%) 98%(95-100%)
CWPT and Peer 94%(80-100%) 99%(97-100%) 100%(No range)
Coaching
Recess and Lunch
Mean and Range
Baseline 45%(42-48%) 45%(12-63%) 68%(42-95%)
CWPT 32%(3-75%) 46%(0-77%) 69%(15-100%)
CWPT and Peer 62%(27-93%) 75%(63-87%) 90%(77-98%)
Coaching
The Effects of Self-Management in General Education Classrooms on
the Organizational Skills of Adolescents With ADHD
SAMMI GUREASKO-MOORE, GEORGE J. DUPAUL, GEORGE P. WHITE
BEHAVIOR MODIFICATION, Vol. 30 No. 2,
March 2006, 159-183.
Information
• Three 12-year old, 7th Grade boys• Focus on classroom organization,
including:– Arrive on time for class– Prepared to begin class (oriented to T_– Has paper/notebook– Has pen/pencil– Completes homework– Hands in homework on time
Procedure: Students provided
• Explanation and rationale for self-management
• A description of their current classroom functioning based on observation results
• An explanation of the importance of responsibility for one’s own behavior
• The specific responsibilities one must maintain to be considered prepared for class instruction
Monitoring
• Students established weekly goals• Initially, daily adult meeting and
monitoring and discussions• Daily meetings continued until student
met 100% of daily goals on 4 of 5 consecutive days
• Fading: every other day with monitor• Maintenance: One time per week
monitor
Support strategies for Middle and High School Students with
ADHD• Steve Evans and colleagues (James
Madison U., and now Miami of Ohio)
• Organization Checks• Social Problem Solving Skills• Homework Management Plan• EvansADHD.pdf
Some guiding principles for intervention with ADHD• Apply the group primary, secondary, tertiary
prevention/intervention model (RTI), but with individual students
• Combine proactive and reactive management strategies (e.g., teach rules and daily report)
• Intervention in place at point of performance of target behaviors
• Intervene as early as possible
Some guiding principles for intervention with
ADHD(cont.)
• Expand range of intervention agents beyond teachers, to:
• Peers• Computers• Self management• Parents
Effective support for students with ADHD: What
will it take?• Knowledge• Resources• General education--special education
collaboration• Communication• Effort • Persistence• Problem solving• REPEAT